Hematologics: Antiplatelet, Anticoagulant, Antithrombotic

Question 1

Coagulation

Answer 1

Formation of an insoluble clot

Question 2

What disease processes need to be Tx c hematologic medications?

Answer 2

1. DVT
2. Hx of stroke/MI
3. Pulmonary Emboli

Question 3

Steps of coagulation

Answer 3

1. Local vasoconstriction
2. Formation of platelet aggregation
3. Formation of blood clot/4 subcategories
4. Clot retraction and dissolution

Question 4

Formation of blood clotting

Answer 4

1. Intrinsic
2. Extrinsic
3. Common pathway
4. Conversion of prothrombin to thrombin

Question 5

Intrinsic

Answer 5

Belonging naturally

Essential

Question 6

Extrinsic

Answer 6

Not part of the essential nature of someone or something

Coming or operating from outside

Question 7

Fibrinolysis

Answer 7

1. Clot removal
2. Initiated by release of tissue plasminogen activator (tPA)
3. Circulation restored

Question 8

Antiplatelet Medication

Answer 8

1. Interferes c platelet aggregation
2. Prolongs bleeding time
3. Platelet aggregation occurs p vasoconstriction
4. Platelet enzymes cause increased platelet activity
5. Affects ADP & TXA2

Question 9

Name 3 antiplatelet medications

Answer 9

1. Aspirin (ASA)
2. Ticlopidine (Ticlid)
3. Clopidogrel (Plavix)

Question 10

Therapeutic uses for antiplatelet medication

Answer 10

1. Prevent clot formation
2. Tx thrombosis- clot in particular area
3. Tx emboli- clot breaks off & travels

Question 11

Contraindications for antiplatelet medication

Answer 11

1. Underlying bleeding disorders
2. Severe liver impairment
3. Active bleeding
4. pregnancy
5. ASA

Question 12

Antiplatelet Rx Interaction

Answer 12

1. Anticoagulant= Increase risk of bleeding
2. Antigout medications
3. NSAID’s c clopidogrel= Iincrease antiplatelet

Question 13

Antiplatelet adverse effects

Answer 13

1. Bruising & petechiae
2. GI: N/V/D & pain
3. Headache/dizziness/weakness
4. ASA= Hearing changes

Question 14

RN implication/Teaching for antiplatelet

Answer 14

1. H&P
2. Monitor I&O (dehydration)
3. Watch for bleeding
4. D/C MED 7-10 DAYS PRIOR TO SURGERY, DENTAL WORK
5. Monitor for hearing loss/dizziness/LOC
6. Take c food to decrease stomach upset
7. Avoid activities c possible increase bleeding

Question 15

Anticoagulant medication

Answer 15

1. Prolongs bleeding time by interfering c clotting

2. Given when pt has a high risk of developing thrombosis

Question 16

Name 3 Anticoagulant medications:

Answer 16

1. Warfarin (Coumadin)
2. Heparin
3. Enoxaparin (Lovenox)

Question 17

Warfarin Action

Answer 17

Interferes c vitamin K

Reduces synthesis of vitamin K

Question 18

Heparin Action

Answer 18

Prevents conversion of prothrombin to thombin & conversion of firbrinogen to fibrin.

Question 19

Warfarin Specific points

Answer 19

1. Atrial fib
2. CHF
3. Valvular disease
4. Pulmonary embolus
5. DVT
6. Take 3-5 days for therapeutic dose
7. Long term Tx use oral
8. Eat balanced meal
9. Monitor c PT= 1.5-2 x baseline=Therapeutic range

Question 20

Heparin specific points

Answer 20

1. Quick onset
2. DIC
3. IV/Subcut
4. Antidote=Protamine sulfate
5. PTT=1.5-2.5 x baseline= therapeutic range

Question 21

Enoxaparin specific points

Answer 21

1. same as Heparin, 1/2 life is longer
2. Subcut
3. Monitor for DVT
4. Monitor for bruising
5. Antidote= Protamine sulfate

Question 22

Anticoagulant Contraindication

Answer 22

1. Active bleeding
2. Head injury
3. Recent injury
4. Advanced liver & renal disease

Question 23

Anticoagulation Rx Interaction

Answer 23

1. Other antiplatelet/antithrombotic med
2. Spinal-epidural anesthesia
3. Foods c vita K
4. Some herbs
5. warfarin
6. Alcohol

Question 24

Anticoagulation Adverse Effects

Answer 24

1. Bleeding
2. Hypersensitivity
3. N/V/D
4. Heparin=HITT

Question 25

Anticoagulation RN Implication/Teaching

Answer 25

1. Know labs associated 2. Appropriate route 3. Have antidote available 4. Teach pt to watch for signs of bleeding 5. Use soft tooth brush 6. Warn pt of effects of alcohol

Question 26

Anticoagulation Assessment

Answer 26

1. Health Hx | 2. Assess coagulation studies initially

Question 27

Anticoagulant RN Dx

Answer 27

1. Risk for injury(Bleeding) 2. Activity Intolerance(Contact sports) 3. Ineffective tissue perfusion 4. Impaired tissue integrity 5. Risk for infection 6. Deficient knowledge, related to Rx therapy

Question 28

Anticoagulant Planning

Answer 28

Client goals & expected outcome 1. Reduction in blood coagulation 2. Verbalizes understanding of anticoagulation therapy

Question 29

Anticoagulant Implementation

Answer 29

1. Monitor for adverse clotting reaction & skin necrosis | 2. Monitor bleeding values

Question 30

Anticoagulant labs to monitor

Answer 30

1. PT 2. INR 3. PTT 4. CBC

Question 31

Thrombolytics

Answer 31

1. Breaks down/Dissolves existing clots 2. Prevents clots 3. Converts plasminogen to plasmin(breaks down fibrin) 4. Used in some life-threatening situations

Question 32

Name 1 Antithrombolytic

Answer 32

Alteplace

Question 33

Antithrombolytic usage

Answer 33

1. Acute MI 2. Massive PE 3. DVT

Question 34

Antithrombotic Contraindication

Answer 34

1. Active bleeding 2. Recent CVA 3. Severe HTN 4. Recent surgery 5. Pregnancy/postpartum 6. End stage renal/Liver disease

Question 35

Antithrombotics Interaction

Answer 35

1. Anticoagulant 2. Antiplatelet 3. Aminocaproic acid is antidote

Question 36

Antithrombolytic Adverse Effect

Answer 36

1. Hemorrhage 2. Anemia 3. Hypersensitivity

Question 37

Antithrombolytic RN Implication/Teaching

Answer 37

1. Hx 2. Given only IV 3. Monitor for bleeding 4. Monitor for anaphylactic reaction 5. Have antidote ready

Question 38

Antithrombolytic Assessment

Answer 38

1. Hx 2. Vital signs 3. Assess lab vlues