Coagulation Modifiers Flashcards
What are the steps in the
Blood Vessel Injury Healing Process?
Blood coagulation/clotting process
- Local vasoconstriction to seal off small injury (makes surface area of injury smaller)
- Platelet aggregation forms a platelet plug
- Hageman factor is activated (clotting factor)
- Intrinsic pathway (inside the vessel) converts prothrombin to thrombin to seal system
- Extrinsic pathway (outside the vessel) clots the blood that has leaked out of the vascular system
Lifespan Considerations for Coagulation Modifiers
In Children
- Most common: Antihemophiliac agents for children with hemophilia
- Injury and safety precautions: no contact sports, soft toothbrushes, no flossing
- Teach what to do if bleeding begins: constant firm pressure, call provider
- Drugs are based on weight and age
- Low-molecular weight heparins preferred
- Monitor closely
Lifespan Considerations for Coagulation Modifiers
In Adults
- Injury prevention: soft bristled toothbrush, no flossing, electric razor, no contact sports
- What to do if bleeding begins: constant firm pressure, call provider
- Caution with other meds due to interactions
- Medic Alert bracelet
- Extreme caution in pregnancy and lactation; choose alternate feeding method
- Periodic blood tests (less testing with newer meds)
- Monitor for signs of bleeding
Lifespan Considerations for Coagulation Modifiers
In Older Adults
- Look closely for drug interactions
- Impaired liver and kidney function: run liver and kidney function tests
- Start low, go slow
- Safety and Injury Prevention: Fall prevention, electric razors, soft toothbrush, no flossing
- Careful monitoring with additions, deletions, or changes to medication regimen (including dose changes)
Antiplatelet Agents
Mechanism of Action
Alters the formation of the platelet plug
* Blocks the receptor site on the platelet membrane which prevents platelets from sticking together and clumping (aggregating)
Antiplatelet Agents
Indications
- CV diseases that are prone to clogged vessels
- Keep surgical grafts open/patent
- Prevent cerebrovascular occlusion (strokes and TIAs)
- Adjunct to thrombolytic therapy after MI and to prevent another MI
- Aspirin: Antiinflammatory, antipyretic, analgesic
Antiplatelet Agents
Drug Names
Aspirin
Clopidogrel
Ticagrelor
Antiplatelet Agents
Contraindications
Absolute:
* Allergy
Cautions:
* Bleeding disorder (higher risk of bleeding)
* Recent surgery
* Closed-head injury
Antiplatelet Agents
Adverse Effects
🩸 BLEEDING: major effect! Monitor for black stools, bruising, petechiae, epistaxis
🧠 CNS: Headache, dizziness, weakness
🤢 GI: Nausea
Antiplatelet Agents
Drug Interactions
- Another drug that affects blood clotting
- Herbal supplements
Antiplatelet Agents
Assessment
History:
* Allergy, pregnancy, lactation, bleeding disorders, recent surgery, closed head injury
Physical:
* vitals, skin, CNS, perfusion
Labs:
* CBC
* Clotting studies
Antiplatelet Agents
Nursing Diagnoses/Conclusions
- Injury Risk (r/t CNS and bleeding effects)
- Impaired comfort (r/t GI effects)
- Knowledge deficit
Antiplatelet Agents
Implementation/Patient Teaching
- Safety precautions: electric razors, soft toothbrush, no flossing, no contact sports
- Small, frequent meals for GI effects
- Increased precautions for bleeding during invasive procedures
- Mark the chart of any patient receiving this drug
- Ice and pressure can help stop bleeding
Anticoagulant Agents
Mechanism of Action
- Interferes with the normal cascade of events involved in the clotting process
Anticoagulant Agents
Indications
Prevent new clot formation
* Atrial fibrilation
* Bed Bound
* Certain surgical patients
Prevent existing clots from getting bigger
* Deep vein thrombosis (DVT)
* Pulmonary Embolism (PE)
* Myocardial Infarction (MI)
Genetic disorders
(missing part of the clotting cascade)
Anticoagulant Agents
Drug Names
Warfarin
Heparin
“-xaban”
Rivaroxaban
Apixaban
Dabigatran
Anticoagulant Agents
Contraindications
Absolute:
* Allergy
Relative:
* conditions that would be worsened if bleeding occurs (recent trauma, GI ulcers, spinal puncture)
Cautions:
* Renal & hepatic disorders
Anticoagulant Agents
Adverse Effects
🩸 Excessive bleeding
* priapism
* Increased menstrual flow
* Black tarry stools
* Epistaxis
Heparin-induced thrombocytopenia (HIT): “allergy” to heparin - can never have heparin again
Anticoagulant Agents
Drug Interactions
Any drug that affects bleeding
* NSAIDs/Salicylates
* Antiplatelets
* Thrombolytics
Herbal Supplements (can increase bleeding)
NUMBER of many drug interactions Check drug guide
Anticoagulant Agents
Assessment
History:
* Allergy, pregnancy, lactation
* Conditions that would be worsened if bleeding occurs
Physical:
* Vitals, heart sounds, lung sounds, skin, CNS, orientation, perfusion
Labs:
* CBC (Hgb, Hct)
* Clotting studies
* Renal and hepatic function tests
* guaiac test for blood in stool
Anticoagulant Agents
Nursing Diagnoses/Conclusions
- Injury risk (r/t bleeding)
- Altered tissue perfusion (r/t blood loss)
- Altered cardiac output (r/t blood loss)
- Disturbed body image (r/t skin changes… bruising)
- Knowledge deficit
Anticoagulant Agents
Implementation/Patient Teaching
- Check lab values during treatment
- Monitor for signs of blood loss (epistaxis, petechiae, neuro status for brain bleed)
- Establish safety precautions: electric razor, soft toothbrush, no contact sports
- Increase bleeding precautions during invasive procedures
- Mark chart of patient receiving this drug
- Maintain antidotes on standby:
Warfarin: Vitamin K
Heparin: Protamine sulfate - Monitor patient carefully when change in medication
- Ice, pressure for bleeding
- Wear medic alert bracelet
- Keep follow up appts.
- Teach patient to report bleeding to provider
