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51 Cards in this Set

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Drugs used as to treat Thromboembolic Disorders
Has no fibrinolytic activity.
Used sq post-op to prevent occurence of thrombi.
Low doses prevents conversion of prothrombin to thrombin.
Nursing Process for Heparin
Check aPTT (Activated Partial Thromboplastin Time)
Heparin is measured in units
Antidote: protamine sulfate
Use caution with other meds that cause an anticoagulant effect... ASA (Asprin)
Hepain drug class
What does heparin do?
Makes blood thinner so that it will flow around the clot. Has no fibrinolytic activity.
Activated Partial Thromboplastin Time related to Heparin
Therapy considered to be in normal range if aPTT is 1.5-2.5 tmes the control.
If control is 30 seconds (time to form clot)
Then 1.5-2.5 times this is 45 - 75 seconds.
Heparin Antidote
Protamin sulfate
Heparin Cautions
Use caution with other meds that cause an anticoagulant effect... ASA (Asprin)
Coumadin's generic name
Coumadin Antidote
Vitamin K
Another treatment would be transfusion with plasma (FFP) or whole blood that has the clotting factor in it.
Inhibits the activity of Vitamin K
Coumadin is used to treat what prophylactically
Coronary occlusion
Heart Valves
Pt can be on coumadin and heparin
Labs to check for Coumadin
Protime/international normailized ratio
PT/INR for Coumadin
2-3 unless has mechanical prosthetic valves or recurrent systemic embolism then is 2.5-3.5
Potential side effects of blood thinners.
Bleeding Gums
Tarry Stools
Coffee Groud or blood emesis
Bleeding that is difficult to control
Use bleeding time as baseline, not PTT or INR values
Do not use with Asprin (ASA)
Reduces risk of stroke
Side effects: agranulaocytosis
Inhibit platelet aggregation with prolongation of bleeding time.
Given to reduce risk of recurrent TIA and stroke.
Reduce the risk of MI
Thrombolytic Agents
Cause the dissolution of fibrin clots
Dangerous: can cause stroke, bleeding including intracranial.
Destroys clots
Easy to use
Low cost
Possible allergic reaction next time it is used on you.
Potential for hemorage in other parts of the body.
Goalof Thrombolytic Agents
Goal is to lyse the clot, limit the damage to surrounding tissue, restore circulation
Makes the body's own mechanisms dissolove the clot.
Used for MI, PE, Stroke, DVT
Asprin Drug class
Platelet Inhibitor
Ticlid Drug Class
Platele Inhibitor
Coumadin Drug Class
Red Clot
A venous thrombus composed of fibrin and erthrocytes with a few platelets.
Form in response to venous stasis.
Most common form is DVT of the lower ext.
These can move upward and cause a PE
White Clot
Develop in the arteries in areas of high blood flow.
Form in response to injured vessels.
Consists of fribrin and platelets.
Common form is Coronary Artery Occlusion leading to MI.
Patient Education - Coumadin (warfarin)
Limit food high in Vitamin K
Walking, calf stretching
Minimize activites that could cause injury.
Rough housing
use of heavy equipment
Electric Razor only
Brush teeth with soft bristle brush
Bleeding Gums
Early sign of coumadin overdose.
Side effect of Coumadin(warfarin)
a discoloration due to extravasation of blood, as in a bruise.
What are diuretics
They act on the kidney in different locations to enchance the extretion of sodium.
Main uses for Diuretics
Heart Failure
Remove excess sodium and water
Fluid Overload
edema (pitting and nonpitting)
crackles in the lungs
Signs and Symptoms of Digoxin Toxicity
Vision Distrubances
Arrythmias - Tachy and Brady
Diuretic Therapy - Hypokalemia
Low Potassium
Due to diuresis, vomiting diarrhea
Diuretic Therapy - Hyperkalemia
High Potassim Levels
Can occur as an adverse effect of potassim-sparing diuretics.
Diuretic Therapy -
Low Soduim
Where sodium goes, water goes
Diuretic Therapy -
High Sodium levels
r/t excess IV fluids and patient may need diuretic.
Low Urine Output
<50 ml/hr - report
What times should you give a diuretic?
AM and early afternoon
Loop Diuretics
Ascending loop of Henely- Bumex, Edecrin, Lasix, Demadex
Lasix Generic Name
Lasix a Loop Diurectic
What is Lasix (furosemide) used for?
One of the most potent and effective diuretics currently available. In addition to treating edema caused by heart failure, renal disease and cirrhosis of the liver, lasix may be used to treat hypertension
How long does Lasix last
6 hours
Assessment before giving lasix's.
Check for hypotension, electrolytle imbalance, dehydration.
Know s/s of digoxin toxicity that can occur wtih excessive loss of potassium.
Gouty Arthritis
Caused by Lasix due to the inhibited excretion of uric acid.
Thiazide Diuretics - Distal tubule
acts on the distial tubule of the kidney to block reabsorption of sodium and choride ions from the tubule.
What do you treat with Thazide Diuretics?
Edema associated with heart failure, renal disease, hepatic disease, pregnancy, obesity, premenstrual syndrome.
Also used as a antihypertensive due to its vasodilatory action on the peripheral arterioles and as stated above.
Thiazide and Diabetes
Blood sugar needs to be monitored due to possiblity of hyperglycemic.
Side effects of Diuretics?
Can use often: No extreme side effects.
Potassium Sparing Diurectics
Acts at the distal renal tuble to retain potassium and excrete sodium, resulting in mild diuresis.
blocks the sodium-retaining and potassium and magnesium-excreting properties of aldosterone.
Salt Substitues
Assessment for Diuretics in General
Check electrolyte values
I&O important
Check pt weight daily
check B/P daily for orthostaic hypertension
Don't give at bedtime
Dig. toxicity can occur with loss of potassium.