Hematologic System Flashcards
Medication Administration IV Iron (ferrous sulfate)
Give test dose of 25 mg to determine sensitivity. Have epinephrine available in case of hypersensitivity. Follow with prescribed dose one hour later
Medication Administration Oral iron (ferrous sulfate)
Liquid: dilute with compatible liquid and give with a straw
Spread oral doses evenly over waking hours to maximize productions of RBCs
Give on an empty stomach for best absorption
Client Education ferrous sulfate (Anti-anemic)
Take on an empty stomach. If GI effects are too much, take with food
Stool may become dark green or black - harmless
Increase exercise and fiber intake if constipation occurs
Suck on hard candy or chew gum to relieve metallic taste
Interactions ferrous sulfate (anti-enemic)
Antacids reduce absorption
Vitamin C increases absorption, but also increases GI effects
Absorption of tetracyclines, fluoroquinolones, bisphosphates and penicillamine, will decrease administered with iron supplements
Concurrent use with ACE inhibitors may increase the risk of anaphylactic reaction with iron dextran
Evaluation of Medication Effectiveness ferrous sulfate (anti-anemic)
Increased reticulocyte count is expected within 4 to 7 days after beginning iron therapy
Increase in hemoglobin of 2 g/dL is expected 1 month after beginning therapy
Fatigue and pallor (skin, mucous membranes) should subside, and the client reports increased energy level
Adverse Effects
Vitamin B12
Erythema
Hypertension
Hypokalemia
Interactions
Vitamin B12
Folic acid can mask the symptoms of B12 deficiency; clients must take adequate doses of cyanocobalamin
Chloramphenicol (Chlormycetin) decreases effectiveness
Alcohol, cimetidine (Tagament), colchicine (Colcrys), and aminosalicyclic acid (Paser) reduce the absorption of oral form
Ascorbic acid (vitamin C) alters the stability of oral forms
Therapeutic Use
Vitamin B9 folate
Megaloblastic (macrocytic) anemia Folate deficiency (alcoholism) Prevent neural tube defects in developing fetus
Adverse Effects
Vitamin B9 folate
Increased yellowing of urine
Masks B12 deficiency in high doses
Increased risk of developing colorectal or prostate cancer (long-term use)
Therapeutic Use
factor VIII and factor IX
Hemophilia A (factor VIII) Hemophilia B (factor IX)
Adverse Effects
factor VIII and factor IX
Allergic reaction
Creutzfeldt-Jakob disease (minimal risk, plasma-derived products only)
Adverse Effects Antidiuretic hormone (desmopressin)
Fluid retention, hyponatremia
Seizures, drowsiness, headache, nausea, and mild GI discomfort
Therapeutic Use
heparin, enoxaparin
Anticoagulation for evolving cerebrovascular accident, pulmonary embolism, massive deep-venous thrombosis
Adjunct therapy during angioplasty, open-heart surgery, hemodialysis, blood transfusion
Prophylaxis for postoperative venous thrombosis and pulmonary emboli
Acute myocardial infarction (with thrombolytic therapy)
Ischemic complications of unstable angina and some dysrhythmias
Disseminated intravascular coagulation
Adverse Effects
heparin, enoxaparin
Bleeding/hemorrhage
Thrombocytopenia (low platelet count)
Hypersensitivity reactions
Neurological injury (from hematoma formation during lumbar puncture, epidural anesthesia)
Nursing Interventions
heparin, enoxaparin
For heparin overdose, stop heparin and administer protamine, which binds to heparin to form a heparin-protamine complex that has no anticoagulant properties
Administer IV protamine no faster than 20mg/min or 50 mg in 10 minutes
Monitor vital signs, checking for hypotension and tachycardia
Monitor activated partial thromboembolism time (aPTT), making sure it is no higher than twice the baseline value
Monitor platelet count periodically throughout treatment, especially in the first month
Stop heparin for for platelet counts below 100,000/mm3 and administer a non-heparin anticoagulant, such as lepirudin
Administer a small test dose first
Monitor for itching and rash or hives
Monitor for spinal insertion site for signs of hematoma formation, such as bruising or swelling
Monitor sensation and movement of lower extremities
Herbal Interactions
heparin, enoxaparin
Ginger, ginko biloba, feverfew, and evening primrose oil increase bleeding risk
Therapeutic Use
Vitamin K antagonist - warfarin
Prevention of venous thrombosis, PE during atrial fibrillation
Prevention of thromboembolism in clients who have prosthetic heart valves
Prevention or recurrent MI and TIA
Adverse Effects
Vitamin K antagonist - warfarin
Hemorrhage Toxicity (overdose)
Medication Administration
Vitamin K antagonist - warfarin
Administer orally
Measure baseline vital signs and prothrombin time (PT), reported as an international normalized ratio (INR)
Monitor INR; recommend reduced dosage for an INR above 2 to 3, depending on condition being treated, and an increased dosage for an INR below that range
Monitor PT/INR daily initially and eventually every 2 to 4 weeks
Expect anticoagulant effects to take 8 to 12 hr, with the full therapeutic effects in 3 to 5 days
Nursing Interventions
Vitamin K antagonist - warfarin
For warfarin overdose, stop the drug an administer vitamin K parenterally, usually IV
Monitor vital signs, checking for hypotension and tachycardia
Check hematocrit and blood counts
Administer vitamin K to promote synthesis of of coagulation factors VII, IX, X, and prothrombin
Administer IV vitamin K slowly and in a diluted solution to prevent serious reactions
Administer small doses of vitamin K (2.5 mg by mouth, 0.5 to 1 mg IV) to prevent development resistance to warfarin
If vitamin K cannot control bleeding, administer fresh frozen plasma or whole blood
Client Education
Vitamin K antagonist - warfarin
Stop taking the drug for signs of hemorrhage
Report bruising, petechiae, hematoma, or black tarry stool immediately
Wear medical identification indicating warfarin use
Avoid excessive alcohol ingestion
Tell clients to record the dosage, route, and time of warfarin administration on a daily basis
Make sure clients watch for and report signs of bleeding (bruising, gums bleeding, abdominal pain, nosebleeds, coffee-ground emesis, tarry stools)
Tell them not to take over the counter NSAIDs, especially aspirin, or drugs containing salicylates
Advise them to use an electric razor for shaving and a soft tooth brush
Avoid foods that contain vitamin K
Interaction
Vitamin K antagonist - warfarin
Heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides, and parenteral cephalosporins increase anticoagulation
Phenobarbital, carbamazepine, phenytoin, oral contraceptives, and vitamin K decrease anticoagulation
Excessive intake of foods high in vitamin K, such as dark green leafy vegetables including cabbage, broccoli, and Brussel sprouts, mayonnaise, canola, and soybean oils decrease anticoagulation
Warfarin interacts with many other prescription and over-the-counter drugs, foods, and herbals, so clients should check with their primary care provider and pharmacist to make sure no other interactions apply
Medication Administration
aspirin
Make sure clients swallow enteric-coated or sustained release forms whole and do not crush or chew them
Discontinue 1 week before scheduled surgery
Monitor for initial and continued therapeutic effects
Client Education
aspirin
Take with food or milk to minimize GI upset
Avoid alcohol
Report GI irritation or signs of bleeding
Report changes in urine output, weight gain, or S&S fluid retention such as edema or bloating
Report ringing or buzzing in the ears, sweating, headache, and dizziness (stop taking aspirin for these symptoms)
Do not give aspirin to children under 18
