Coagulation Modifier Flashcards
How does the body heal a blood vessel injury (5 steps)?
1) local vasoconstriction (at the site of injury) seals off small injury - prevents blood loss.
2) Platelet aggregation forms a platelet plug
3) Hageman factor ( Factor 12 - a clotting factor that circulates in the blood) is activated and start a chain reaction called the intrinsic pathway.
4) Intrinsic pathway (inside the vessel) converts prothrombin to thrombin to seal system - helps close the vascular system.
5) Extrinsic pathway (outside the vessel) cloths the blood that has leaked out of the vascular system.
Why does blood pressure lower when there is an injury to a vessel?
Fluid is leaking out of the cardiovascular system which causes the pressure within the cardiovascular to drop. It is important that this is fixed as soon as possible to prevent dangerously low blood pressure which may lead to shock.
What is proper/adequate cardiovascular pressure called?
Homeostasis
What are some life stage considerations to remember when administering drugs affecting blood coagulation to children?
Often given for children suffering hemophilia.
We need to educate on Injury prevention and safety precautions
What to do if bleeding begins
Drugs should be based on weight and age
Low-molecular weight heparins are preferred.
Need to be monitored closely.
What are some life stage considerations to remember when administering drugs affecting blood coagulation to adults?
Injury prevention - electric razor, soft toothbrush, no contact sports.
What to do if bleeding occurs - Constant, firm pressure and call provider.
Caution with other meds due to possible interactions - includes herbal remedies, supplements and vitamins.
Wear a medic alert bracelet
Extreme caution in pregnancy (benefit vs risk). During lactation the drug can alter blood clotting in the infant so breastfeeding should be discouraged and another method of feeding improvise.
Periodic blood tests - less testing needed with newer meds
Educate patient on signs and symptoms of bleeding as it is not always obvious -easy bruising, spots on skin.
What are some life stage considerations to remember when administering drugs affecting blood coagulation to older adults?
Be mindful of drug-drug interactions - older adults are often taking other drugs.
Impaired liver and kidney functions (altered metabolism and excretion)
Blood testing - kidney and liver function
Start low, go slow
Safety - implement fall precautions
Careful monitoring with any additions, deletions, or changes to medication regimen including doses.
What are signs and symptoms of bleeding that many people may not be aware of?
Easy bruising when bumping into things
Tiny spots on skin petechia may also be signs of bleeding.
What are the suffix(es),names and potential outliers for Antiplatelet agents?
- Aspirin - for prevention.
“grel” in the name
- Clopidogrel
- Ticagrelor
How does Aspirin work?
Antiplatelet agent blocks the receptor site on the platelet membrane which prevents platelets sticking together and clumping.
Why would you give Ticagrelor to a patient?
We would give antiplatelet agents to patients with CV disease who are prone to clogged vessels (prevention).
To keep surgical grafts open/patent.
To prevent cerebrovascular occlusion (strokes and TIA’s)
As an adjunct thrombolytic therapy after MI and to prevent another MI.
Aspirin also given as an analgesic, anti inflammatory and antipyretic.
When should we be cautious of giving a patient Ticagrelor?
Cautions r/t to higher risk of bleedings.
Antiplatelet agents are all related to higher risk of bleeding. We should be careful with giving these medications to patients who have bleeding disorders, had recent surgery and closed-head injury (could have a brain bleed).
Ticagrelor is an antiplatelet agent
What are some adverse effects of antiplatelet agents?
Bleeding (Number 1 adverse effect) - manifests as bleedings when brushing their teeth, or easier bruising. Black stool may also indicate GI bleeding.
CNS: headache, dizziness and weakness
GI: nausea
Are there any drug-drug interactions to be mindful of when it comes to antiplatelet agents and if so what are they?
Any other drug that affects blood clotting.
If taken with a drug that prevents clotting there is and increased risk of bleeding.
If taken with a drug that induces clotting then there is a decreased effect of the antiplatelet agents because the drugs will be working against each other.
Herbal supplements (many may increase risk of bleeding)
What nursing assessment should we do prior to giving our patient Aspirin?
Aspirin is an antiplatelet agent and prior to prescribing we should assess for :
History: Allergy, pregnancy/lactation, bleeding disorders, recent surgery, closed head injury
Physical : Vitals (evidence of bleeding), skin (evidence of bleeding such as bruising)
CNS : Consciousness and orientation.
Perfusion : temperature and color of the skin.
Labs: CBC (to monitor platelet functions), clotting studies
What nursing diagnoses can be made prior to giving patients antiplatelet agents?
Injury risk r/t bleedings and central nervous system effect.
Impaired comfort r/t GI & CNS effect
Knowledge deficit r/t drug therapy
What implementations should we be prepared to make when administering Clopidogrel to a patient?
Clopidogrel is an antiplatelet agent and we should be prepared to
- Provide small, frequent meals if patient have GI upset.
- Safety measures (soft toothbrush, electric razor);
- comfort measures
- Provide increased precautions against bleeding during invasive procedures (stopping an order before a scheduled surgery), apply pressure dressings after blood draws and IV removal.
- Mark the chart of any patient receiving this drug
- Provide thorough patient teaching
What are the suffix(es),names and potential outliers for Anticoagulant agents?
- Heparin
- Warfarin
- -”xaban”
- Rivaroxaban
- Apixaban
- Dabigatran
What does anticoagulants do?
They interfere with the normal cascade of events involved in the clotting process.
Why would you give a patient Heparin?
Heparin is an anticoagulant and we give these medications to:
Prevent new clot formation which may be associated with atrial fibrillation, being bed bound and for certain surgical patients.
Prevent existing clots from getting bigger or new clots from forming. For example clots from, Deep vein thrombosis, Pulmonary embolism, MI
Generic disorders - Can replace a missing part of the clotting cascade that helps to break down or prevent clots.
When would we avoid giving a patient Warfarin?
If the patient have a condition that would be worsened if bleeding occurs (f.ex. if a patient has a spinal puncture, recent trauma or GI ulcers)
Warfarin is an anticoagulant.
When should we be cautious of giving a patient anticoagulants?
If they have renal or hepatic disorders
What are some adverse reactions when giving a patient Heparin?
Heparin is an anticoagulant and with these drug we see side effects such as:
- excessive bleeding and heparin-induces thrombocytopenia (HIT) may occur.
- HIT = allergic reaction where patient have a rapid decline in platelet count after receiving an anticoagulant agent - Patient can never have Heparin again.
- Priapism - Painful and prolonged erection due to the blood being thinner.
- Increased menstrual blood flow from endometrial bleeding.
- Epistaxis (nose bleed)
- Black tarry stools if GI bleeding is occurring.
Are there any drug-drug interactions that we should be aware of with Dabigatran and if so what are they?
Yes. Dabigatran is an anticoagulant and these drugs may interact with any other drugs that affect bleedings such as NSAIDs/Salicylates, antiplatelets and thrombolytics - may increase bleeding.
Herbal supplements - may increase bleeding.
Number of documented interactions, especially Warfarin.
What would we assess for prior to giving anticoagulants to a patient?
- History - anything that will make them more likely to bleed.
- Allergy, pregnancy, and lactation
- Conditions that would be worsened if bleeding occurs
- Physical : Vitals, heart sounds, lung sounds, skin, CNS, perfusion
- Labs: clotting studies, renal and hepatic function tests, CBC (hemoglobin and hematocrit - of these are low they are more prone to bleeding), guaiac test for occult blood in stool.
What nursing diagnoses would we anticipate prior to giving patients Apixaban?
Apixaban is an anticoagulant and we would want to prepare for
* Injury risk r/t bleeding risk
* Altered tissue perfusion r/t blood loss
* Altered cardiac output r/t blood loss
* Disturbed body image r/t skin changes like bruising.
* Knowledge deficit
What implementations would we want to make when giving a patient anticoagulants?
- Check lab values
- Monitor for signs of blood loss - all bodily fluids checked for occult blood. f.ex in vomit & urine
- Establish safety precautions - no slip socks, lighting to bathroom, soft toothbrush, no flossing, electric razor only.
- Provide comfort measures : gently wrap arm, encourage long sleeve shirt.
- Increase bleeding precautions during invasive procedures : increased pressure against puncture sites.
- Mark chart of any patient receiving this drug
- Maintain antidotes on standby:
Warfarin: Vitamin K (when INR are over where it should be - over 3)
Heparin: protamine sulfate - Monitor patient carefully when change in medication
regimen occurs - Provide thorough patient teaching
How do we know that the patient has received a therapeutic level of Warfarin when looking at their labs?
INR 2-3
How do we know that the patient has received a therapeutic level of Heparin when looking at their labs?
therapeutic aPTT should be between 60-80
* anti-Xa
What are the suffix(es),names and potential outliers for Low-Molecular-Weight Heparins (LMWH) (special anticoagulant)?
“-parin” (remember ‘parin’ from hePARIN in low molecular weight heaparins)
- Dalteparin
- Enoxaparin
How does LMWHs work in the body?
*Inhibit thrombus and clot formation by blocking factors Xa and IIa
These drugs have a longer effect/longer half life, but less effect on thrombin which means that there is a reduced risk of bleeding and because it is not affecting PTT we do not need to monitor labs.
Used in high risk conditions such as joint replacement, long bone fracture or bed rest.
- Block angiogenesis, the process that allows cancer cells to develop new blood vessels
Why would we give Enoxaparin to a patient?
Enoxaparin is an Low-Molecular-Weight Heparins and they are indicated for specific uses in the
prevention of clots and emboli formation
after certain surgeries, fractions or bed rest.
What are the suffix(es),names and potential outliers for Thrombolytic Agents (aka Clot
Busters)?
“teplase”
* Alteplase
* Reteplase
* Tenecteplase
What does Thrombolytic agents do?
Activates plasminogen to plasmin, which in turn breaks down fibrin threads in a clot to dissolve it.
This drug works systemically and will break down clots anywhere in the body.
Why would we give Alteplase to patients?
Alteplase is an Thrombolytic agent and we would give these drugs to treat acute MI/Stroke, pulmonary emboli and ischemic stroke.
When should we be cautious with giving a patient Reteplase?
Reteplase is an Thrombolytic agent and we should exhibit caution with giving these drugs to patients who have conditions that could be worsened by dissolution of clots (surgery,trauma,GI bleed, childbirth or recent stroke) or with patients with liver disease (where clotting factor is made, so they may already be having a decrease in clotting factors)
