Ch 34/40

Question 1

dig tox with older adults

Answer 1

more susceptible. decreased kidney flow. teach family or caregiver how to take pulse cause pt may not be able to dot it themself.
apical pulse quality and rhythm and rate

Question 2

immune fab consideration

Answer 2

Levels must be monitored daily for first 3 days ish because of unstable dig levels

Question 3

lmwh

Answer 3

inactivate Xa factor, less able to inactivate thrombin.

aptt not necessary, but yes plt.

Question 4

bridge tx

Answer 4

pt needs long term anticoags, gets heparin, should also be placed on oral anticoag while on heparin until inr is therapeutic (ie warfarin)

Question 5

oral anticoag

Answer 5

block synth of vit k > affect clotting factors II, VII, Ix, X
bleeding occurs in 10% pts on these

Question 6

anticoag antagonists

Answer 6

choice: vit k.
antagonist of warfarin. tx warfarin od or uncontrollable bleeed.
1-10mg given at once, if fails, give ffp/plt/whole blood.
24-48 hrs for effectiveness. affects warfarin 1-2 wks.
give vit k/ffp/both depending on INR/clinical status of pt

Question 7

antiplt drugs

Answer 7

prevent thrombus in arteries by suppressing plt agg.
prophylactic for MI/STROKE of fam hx, repeat mi/cva, stroke in pts with TIAs.
long term decreased dose of asa is also eff inexpensive tx for dec plt agg

Question 8

thrombolytics

Answer 8

thromboembolism causes ischemia, tissue death distally.
naturally clots take 1-2 wks to dissolve.
thrombolytics increase fibrinolytic mechanism, destroy fibrin in clot, throm/blood clot dissolves if thrombolytic is given within 4 hrs of AMI or 3 hrs of ischemic CVA

Question 9

epogen CI/pt ed

Answer 9

ci: uncontrolled HTN (also a side effect) and hypersensitivity to mammalian cell derived prods/human albumin.
pt ed: teach pt to take iron supp at HS w/o food or phosphate binders. teach pt proper subq injection tech/safe disposal of used needles n syringes

Question 10

neupogen life thrt a/e and pt ed

Answer 10

a/e life thrt: ards w septics, thrombocytopenia, mi, splenic rupture
pt ed: teach pt to continue until postchemo nadir anc=10,000 mm/3. anc = total wbc (% neut+%bands)
pt must take med until advised to d/c by doc.
teach pt to wash hands often, avoid crowds, avoid the sick

Question 11

neumega class, s/e, a/e, ci

Answer 11

TGF
se: fluid retenion, headache, dizzy, fatigue, rash, febrile, neutropenia
not for: pre-existing cardiomyopathy, chf
a/e: pulm edema, papilledema, pleural effusion, atrial dysrhythmia, stroke

Question 12

lovenox class, ni

Answer 12

lmwh

rotate injection sites, use clean technique

Question 13

tpa class, l/t a/e, ci

Answer 13

thrombolytic
l/t: intracerebral hemorrhage
stroke
atrial/ventricular dysrhythmia
pulm edema
screen well for CI!! ci: internal bleeds, bleeding disordre, recent cva, surgery/trauma, bacterial endocarditis, severe hep dysfx, severe uncontrolled htn, brain tumor/head trauma.

Question 14

warfarin food interaction, ni, pt ed

Answer 14

food: decreae diet in vit k
ni: keep antidote (vit k/ffp) readily available
pt ed: teach pt significant diet restrictions: no large amts of dark leafy greens, broccoli, legumes, coffee/tea/cola/excess etoh, foods high in vit k

Question 15

plavix class, drug/lab interactions, ni

Answer 15

antiplatelet drug
drug: increased bleeding w/anticoags, nsaids
lab: increased bleeding
ni: assess CBCs
monitor s/s of bleeding, teac pt to report immediately if any hemoptysis, hematuria, dark brown stool