Chapter 43 and 37

Question 1

What causes a blood clot?

Answer 1

decreased circulation, platelet aggregation, blood coagulation

Question 2

Antiplatelets affect the arteries or veins?

Answer 2

arteries

Question 3

anticoagulants affect the arteries or veins

Answer 3

both

Question 4

What are the two types of anti platelet drugs?

Answer 4

NSAIDs (aspirin) and P2Y12 receptor blockers

Question 5

If a patient shows to ED with signs of myocardial infarction or CVA, what can we give them immediately?

Answer 5

4 81mg CHEWABLE aspirin (acetylsalicylic acid) tablets

Question 6

Antiplatelets suppress what?

Answer 6

platelet aggregation

Question 7

What is long term-low dose ASA therapy?

Answer 7

81 mg ENTERIC COATED tablet taken daily to prevent MI, stroke, DVT

Question 8

Why do we prescribe enteric coated tablets for daily aspirin use?

Answer 8

reduce risk to GI lining

Question 9

Side and adverse effects of aspirin?

Answer 9

stroke, increase bleeding, GI ulcers/bleeding, thrombocytopenia, tinnitus and hearing loss (could indicate overdose)

Question 10

What are the P2Y12 receptor blockers?

Answer 10

clopidogrel, prasugrel, ticlopidine, ticagrelor

Question 11

When taken with NSAIDS clopidogrel can cause?

Answer 11

greater effects of bleeding

Question 12

What herbs need to be avoided when taking anti platelet and anticoagulation medication

Answer 12

garlic, gensing, ginko, feverfew

Question 13

Contraindications of taking anti platelet meds?

Answer 13

surgery (stop 7 days before) , bleeding, signs of hearing loss

Question 14

What are the signs and symptoms of bleeding we can monitor in all medications?

Answer 14

bleeding gums, tarry stool (melena), coffee ground emesis, petechiae, increased bruising, pallor, fatigue, pink urine, decreased BP, increased HR, hematoma

Question 15

Can aspirin and clopidogrel be taken together?

Answer 15

yes

Question 16

Nursing interventions for anti platelet drugs?

Answer 16

monitor VS (indicators of bleeding), S&S of stroke (blood thinners can cause hemorrhagic stroke) stop taking 7 days before surgery, platelet count should be 150-400k and no less, electric razor and soft bristled toothbrush, herbs

Question 17

What do anticoagulants do?

Answer 17

prevent current clot from growing and new ones from forming

Question 18

Heparin and LWMH inhibit?

Answer 18

thrombin and factor Xa

Question 19

Which anticoagulant is a Vitamin K inhibitor?

Answer 19

warfarin

Question 20

What do we use anticoagulants for?

Answer 20

treatment for A-fib, MI, CVA, artificial heart valves, preventing DVT and PE

Question 21

Adverse Effects of anticoagulants?

Answer 21

increased bleeding, hemorrhage

Question 22

When do we administer heparin?

Answer 22

those on bed rest (prevent DVT), DVT from turning into PE and CVA, open heart surgery, DIC (disseminated intravascular coagulation)

Question 23

can you take anti platelet drugs with heparin?

Answer 23

NO

Question 24

Adverse effects of Heparin?

Answer 24

bleeding, hemorrhage (can mean overdose/toxicity), thrombocytopenia, hypersensitivities,

Question 25

What is the LMWH drug we discussed?

Answer 25

enoxaparin

Question 26

How is enoxaparin administered?

Answer 26

umbilicus subcutaneously in pre-filled syringe *remember we do not expel air-bubble, rub site, and we must rotate sites

Question 27

Do we monitor aPTT with enoxaparin? Why?

Answer 27

No ; decrease risk of bleeding and longer half life

Question 28

Patient teaching for heparin?

Answer 28

use electric razors, soft. bristled toothbrush, do not take anti platelets, teach back and return demonstration if self administering enoxaparin

Question 29

Heparin is contraindicated in?

Answer 29

those with bleeding disorders (hemophilia), thrombocytopenia, hemorrhagic strokes, peptic ulcers, eye/brain/ spinal surgery

Question 30

Heparin is what pregnancy category?

Answer 30

c

Question 31

If heparin is given via IV, what are the nursing considerations?

Answer 31

use IV pump, take vital signs/new weight/ verify aPTT/labs and dose with another nurse before administering, monitor q4-6h, continuous infusion, has its own line

Question 32

Heparin Labs?

Answer 32

aPTT and pTT (monitor time it takes to clot)

Question 33

when is aPTT therapeutic?

Answer 33

60-80 seconds (70 seconds @ risk of bleeding, if > hold administration and contact provider)

Question 34

when is PTT therapeutic?

Answer 34

100-140 seconds (100 seconds @ risk of bleeding, if >140 hold administration and contact provider)

Question 35

Platelet count on heparin should be?

Answer 35

> 100,000 (if not contact provider and hold)

Question 36

Nursing interventions for heparin?

Answer 36

monitor signs of bleeding, monitor labs

Question 37

Antidote for heparin?

Answer 37

protamine sulfate (monitor 5-15 mins after administration and 2-8 hours after)

Question 38

What is warfarin used for?

Answer 38

treating DVT, prevent thrombus formation with those in A-fib or have prosthetic heart valves, prevent MI, TIA, PE, and DVT

Question 39

Adverse effects of warfarin

Answer 39

hemorrhage, hepatitis

Question 40

Drug interactions with warfarin

Answer 40

highly protein bound (check other drugs in case we need to fix dosages), pregnancy category X (teratogenic)

Question 41

What are the labs we monitor with warfarin

Answer 41

PT and INR

Question 42

therapeutic range for INR?

Answer 42

2-3 (3-4.5 if they have mechanical heart valve or recurrent systemic embolism)

Question 43

therapeutic range for PT?

Answer 43

18-24 seconds

Question 44

Can aspirin/ other NSAIDs be taken with warfarin?

Answer 44

No; teach patient to take acetaminophen

Question 45

Nursing considerations with warfarin

Answer 45

medication reconciliation, monitor VS/labs/bleeding, keep on heparin/enoxaparin until INR therapeutic, vitamin K is antidote

Question 46

patient teaching with warfarin?

Answer 46

notify dentist, wear medic alert bracelet, do not smoke, stay consistent with intake of vitamin k foods, do not sit or stand for prolonged periods, avoid crossing legs

Question 47

How long does it take warfarin to work?

Answer 47

feel effects after 8-12 hours ; 3-5 days to work (why we administer fast acting heparin first) , can feel effects of warfarin up to 5 days after stopping

Question 48

What are thrombolytic drugs used for?

Answer 48

clot busters, clearing out central lines

Question 49

What are the thrombolytic drugs?

Answer 49

streptokinase, cathfloactivase (goes in central lines) alteplase, t-PA

Question 50

thrombolytic drugs need to be administered within how many hours of symptoms?

Answer 50

within 3 hours of symptoms of stroke or MI

Question 51

Adverse effects of thrombolytics?

Answer 51

bleeding, reperfusion arrhythmias

Question 52

Nursing considerations of thrombolytic drugs?

Answer 52

CONTINUOUS CARDIAC MONITORING, VS, CT scan needs to be done to determine hemorrhagic vs ischemic stroke, labs, make sure patients know signs of MI and CVA so they get to ED on time

Question 53

What does epoetin alfa do?

Answer 53

increase production of red blood cells

Question 54

How is warfarin administered?

Answer 54

PO

Question 55

Indications of erythropoietin alfa?

Answer 55

CKD, chemo, HIV/AIDs meds

Question 56

Darbapoetin is? What is it used for?

Answer 56

long acting erythropoietin; used in CKD and anemia caused by chemo

Question 57

Side and Adverse effects of epoetin alfa?

Answer 57

HTN, risk for thrombolytic events, DVT, headaches and body aches

Question 58

Contraindications of epoetin alfa?

Answer 58

HTN

Question 59

Nursing considerations of epoetin alfa?

Answer 59

increase iron, monitor BP, H&H (heme should be 10-11 and HCT: 33%), S&S of stroke and MI

Question 60

Why should clients taking epoetin alfa report headaches?

Answer 60

could indicate stroke

Question 61

How is epoetin alfa administered?

Answer 61

subcutaneously and IV

Question 62

What does Filgrastim do?

Answer 62

increase production of neutrophils

Question 63

What are indications of filgrastim?

Answer 63

those with cancer, leukcytopenia,

Question 64

side and adverse effects of filgrastim

Answer 64

bone pain (take acetaminophen), leukocytosis, splenomegaly, risk of splenic rupture (long term use)

Question 65

Nursing considerations of filgrastim

Answer 65

CBC (WBC -100,000 & ANC- 10,000 hold medication), bone pain

Question 66

What does oprelvekin do

Answer 66

increase platelet production

Question 67

Indications of oprelvekin

Answer 67

treat thrombocytopenia, decrease need for platelet transfusion

Question 68

Side and adverse effects of oprelvekin

Answer 68

fluid retention, arrhythmias, eye effects, allergic reactions, anaphylaxis , dyspnea on exertion, edema

Question 69

Nursing considerations for oprelvekin

Answer 69

monitor for A-fib, tachycardia , AV flutter, conjunctival infections, papilledema, labs

Question 70

We know oprelvekin is effective when platelet count reaches what level?

Answer 70

50,000