Vascular System + Blood Flashcards
Discuss management of anticoagulant overdose:
Develop a care plan for clients receiving drugs affecting coagulation:
Which prototype is lipid-lowering?
Atorvastatin (Lipitor)
Which prototypes treat anemia?
Epstein alfa
Ferrous sulfate
Cyanocobalamin (vitamin b12)
Folic acid
Prototypes for anti platelet:
Aspirin
Clopidogrel
Prototypes for anticoagulants:
What is the function?
Heparin
Enoxaparin
Warfarin
Rivaroxaban
*anticoagulants disrupt clotting cascade making it difficult for blood to clot
*does not get rid of blood clot, prevents clot from getting bigger
Thrombolytic prototype:
Alteplase
Antilipemic drug: prototype and use?
HMG-COA Reductase inhibitors
“Statins”
Used for hyperlipidemia
*Inhibits cholesterol synthesis in the liver
What is atorvastatin?
What is aspirin?
What is Clopidogrel?
What are nursing assessments and interventions for anti platelet agents?
Assessment:
— indication for medication
— prevention of blood clots
Interventions:
— bleeding precautions
— avoid injury and falls
— hold prior to procedure/surgery
— educate patient on medication
Diagnostics labs: clotting times
PT
INR
PTT
What are the therapeutic goals? (Need to know)
What are general nursing considerations regarding anticoagulants/Thrombolytics?
— all anticoagulants have AE of bleeding
*Non-fatal: hematuria, epistaxis, bruising
*FATAL: hemorrhagic stroke, internal bleeding, GI bleeds (higher risk in older adult)
— reduced risk for injury and falls
— BLEEDING PRECAUTIONS
What are contradictions for anticoagulants?
PREGNANCY except for heparin/enoxaparin
— bleeding disorders
— hx of bleed
— theombocytopenia- low platelet
What are drug-drug interactions with anticoagulants?
— anti platelet agents
— NSAIDS
— herbals
ALL INCREASE BLEEDING
What is heparin?
What is enoxaparin?
Develop a care plan for IV heparin:
What is warfarin?
What are special considerations for warfarin?
Dosing
Lab draws
Diet
Dosing:
— daily (usually in evening or HS)
— if INR greater than 3.0 HOLD AND CALL PROVIDER
— expect an order for vitamin k if INR greater than 4.0 (PO or SQ)
Lab draws:
— dose change = next lab in 3 days
— long term monitoring = weekly or monthly
Diet:
Teach patient to maintain consistent intake; avoid vitamin k containing foods
*high intake may decrease warfarin effect
What are foods high in vitamin K?
Green leafy foods:
— kale
— collard greens
— spinach
— Brussels sprouts
— broccoli
— asparagus
— sauerkraut
— soybeans
— edamame
What are herbals to avoid when taking warfarin?
— St. John’s wart
— garlic
— ginkgo
— ginger root
— chamomile
What is rivaroxaban?
How do you manage your patient with anticoagulant overdose?
Assessment:
CM of bleeding and VS: HR/BP/O2
Interventions:
— notify provider
— draw labs ordered: hemoglobin/hematocrit, platelets, clotting times
— administer fluids (NS) and/or packed RBC as ordered
— administer reversal agent
What is alteplase?
What are contraindications to alteplase?
Client has been dx with DVT in R lower extremity. The primary care provider has prescribed enoxaparin 70mg SQ q 12hr with the first dose STAT. In addition, the provider has prescribed warfarin 5mg PO daily and a PT/INR draw in 3 days.
Why has the primary HCP prescribed both medications simultaneously?
Making sure the client has adequate anticoagulation while warfarin reaches therapeutic level
Warfarin onset = 36-48 hours
Enoxaparin onset = 3-5 hours
What are drug-drug interactions with anticoagulation drugs?
More than 1 anticoagulant/antiplatelet
Aspirin
Warfarin
Herbal supplements
Antibiotic therapy
Increases bleeding
What is epoetin alfa?
What is ferrous sulfate?
KEEP OUT OF REACH FOR CHILDREN-FATAL IF OVERDOSED
What is cyancobalamin?
What is folic acid?
What is pernicious anemia?
Also called addisons anemia
— decrease in red blood cells
— cannot absorb enough vitamin B12
