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58 Cards in this Set
- Front
- Back
Thrombosis risks
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Tissue Ischemia
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Platelets response
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First responders, "nosey". Call their friends: adenosine diphosphate, serotonin, Calcium, other chemicals -> create a platelet plug, that can keep growing and growing.
If activating factors kick in, they may lead to a thrombus. |
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Vitamin K
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Required to activate clotting factors. Synthisized in the liver.
Therefore: pts with liver problems are at a high risk for bleeds |
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Anticoagulants
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Interfere with the normal coagulation process
Prevent or slow clot FORMATION More effective in prevention of venous thrombosis than arterial thrombosis. DO NOT DISSOLVE EXISTING CLOT, but may prevent clot from growing |
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Venous thrombosis vs Arterial thrombosis
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Venous blood flows slower.
higher risk for clots |
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Artificial heart valves related risk
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body may try to attack it d/t being a foreign object, platelets aggregate
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Heparin: action, administration method
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Naturally occurring substance in the liver.
Prevents conversion of PROTHROMBIN to THROMBIN Poorly absorbed in GI. Only given Subq or IV Don't give IM d/t hematoma. High alert med. Needs to be witnessed by 2nd professional for IV |
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Heparin indications:
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Prevent Venous thrombosis (ex. after surgery, profilactic)
Prevents PE or stroke Prevents DIC - clotting a lot while bleeding: "thrombosis in the presence of hemorrhage". Bleed occurs d/t excessive clotting using up all the clotting factors, and unable to control bleed |
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Heparin route and dose:
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Subcut & IV only.
IV: give bolus (loading dose) first. Halflife = 1-2h (short acting). side effects: thrombocytopenia bleeding |
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Heparin labs
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PTT - Partial thromboplastin time
aPTT - activated partial thromboplastin time Platelets For IV (continuous) use: Must take PTT, aPTT q6h! IV dose based on these values and continuously monitored |
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Values:
PTT / aPTT Platelets |
PTT = 26-39 sec
Platelets = 150-350 Always draw lab from arm not receiving the IV heparin. Never block a heparin line to a pt |
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Heparin antidote
dose onset |
Protamin Sulfate
1mg of PS / 100u heparin quick acting, ~5min |
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Before d/c IV heparin
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Should start pt on oral anticoagulants (coumadin)
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s/s of bleeding
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bruising, petechiae, bleeding gums,
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HIT (r/t heparin)
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Heparin Induced Thrombocytopenia
"allergic to heparin" Argatroban can be given instead, but there is no antidote. |
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Low Molecular heparin
name, indication |
Newer meds: Lovanox / Fragmin
DVT prevention Post Op thrombus formation Lower risk that heparin, but still need to check Platelets. |
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LMH contraindications
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Stroke
Peptic Ulcer Blood anomalies (hemophelia, etc') Eye, brain, spinal injury. |
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LMH route / dosage
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subcut / prefilled syringes
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LMH nsg responsibilities
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Monitor for s/s of bleeding
Do not take with aspirin or other antiplatelet medications If with Aspirin, make sure it's a lower dose, not the 325mg |
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Low molecular weight heparin - BBW
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Epidural and spinal hematoma resulting in paralysis
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Oral anticoagulants
action |
Inhibit production of vitamin K by the liver
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Oral Anticoags indications
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Prevention of thrombophlebitis
Pulmonary embolism prevention Post op treatment Atrial fibrillation |
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Oral anticoags onset of action
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3-5 days
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Contraindications for oral anticoags
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PUD
Ulcerative colitis hemophilia thrombocytopenia severe hypertension (d/t CVA connection) CVA |
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Coumadin labs:
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PT - Prothrombin time
INR - International Normalized Ratio. Standard all over the world. Should be 2-3 while on Coumadin |
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Coumadin administration
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given in the evening, once daily. because of labs being drawn in the morning
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Coumadin dosing
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based on INR. INR is drawn 10-12 hours after medication.
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Coumadin antidote
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Vitamin K.
May reverse bleeding if it occurs in 24-48 hrs May be given subcut or IM. If bleeding profusely d/t Coumadin, can be given FFP - Fresh Frozen Plasma (has many clotting factors, unline in PRBC) |
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S/S to monitor with coumadin
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Petechiae
Bruising Tarry stools, vomiting blood, bleeding from rectum, |
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Coumadin teaching
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Avoid foods high in vitamin K (green leafy vegetables)
the 3Gs: Garlic, Ginko, Ginger Feverfew, Dongquai These will cause excessive bleeding |
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Coumadin BBW
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Major of fatal bleeding
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Other Coumadin considerations
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Birth defects in early pregnancy
Smoking increases drug metabolism, may need higher dose |
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Antiplatelets action
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Suppresses thrombosis by preventing platelet aggrigation
More effective for arterial thrombosis |
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Antiplatelets indication
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arterial thrombosis
MI and CVA prevention Prevention of repeat MI Will not help with existing clot |
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Antiplatelets drug
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Aspirin: inhibits prostoglandin synthesis.
Prostoglandin causes platelet aggragartion |
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Aspirin action, indication, administration
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prevents prostoglandin synthesis.
Used as: antiplatelet, analgesic, antipyretic, anti0inflammatory given PO. Dose changes with purpose |
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Nursing responsibilities for Aspirin:
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Monitor for s/s of bleeding
GI problems - take with food GI bleed Ototoxicity tinnitus herbal use: Garlic, Ginko, Danquai, Feverfew not ginger |
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Persantine
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Antiplatelet
Given to prevent thromboembolism after MI Often given in conjunction with Coumadin, contraindicated with Heparin |
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Persantine Thalium test
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given IV, for stress test
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Advinox
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Combination of aspirin and persantin.
Should give with milk, monitor for hypotension |
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ADP drugs
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Adenosine Diphosphate Blockers
Ex: Plavix. Change the platelet membrane so they do not respond and aggregate. Given PO |
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Plavix nursing responsibilities:
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caution with NSAIDS, d/t increased risk for bleed.
d/d interaction with PPI - (prilosec, protonix, prevacid): decrease Plavix effectiveness. Should give at different times of the day. |
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Ticlid
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ADP, same mechanism as plavix. given if pt cannot take ASA
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Ticlid indication
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ASA allergy
Thrombosis prevention in pt with intermittent claudication, sickle cell anemia, coronary artery or cereberovascular disease. |
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ReoPro
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Glycoprotein IIb / IIIa receptor blocker.
Most effective antiplatelet drug for coagulation PREVENTION ONLY IV Very expensive Can be given with ASA, Heparin, or Plavix 2hour onset of action |
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Antiplatelet contraindicators
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Active bleeding disorder (hemophilia)
Neutropenia Thrombocytopenia Sever Liver disease |
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Thrombolitics tx goal
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Goal: reestablish blood flow and limit tiissue damage. to reduce cardiac or neuro damage from clots. Should be given within 3-4hours for MI or stroke, within 12h in order to survive.
Can dissintigrate thrombus within 4h |
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Thrombolitics action
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dissolve clot by fibrinolitic action.
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Thrombolitics Indication:
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PE, DVT, acute MI, Stroke
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Thrombolitics antidote
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Amicar
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Streptokinase (Streptase)
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produced by hemolytic streptococcus
Given IV, half-life is very short: 20minutes |
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Thrombolitics Nursing responsibility
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May cause hypotension at tx start.
monitor for s/s of bleeding anaphylactic reaction - VASCULAR COLLAPSE Must monitor pt for at least 24h |
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Urokinase (Kinlytic)
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dissolves clots by converting plasminogen to plasmin
more expensive than streptokinase Less risk of anaphylaxis 5-7 minutes half-life |
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Reperfussion dysrhythmia
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after a clot is dissolved, the heart starts to go into fibrillation / dysrhythmia after perfusion is reestablished
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Labs to monitor for Thrombilitic agents
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Only given in critical care setting with close monitoring.
APTT. PT, Hct, Plt, Thrombin time |
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Hemorrheologic agents
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"blood thinners".
Improve blood flow by reducing viscosity. causes RBCs to be more flexible, reduces plt aggregation and fibrinogen concentration |
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Trental
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Hemorrheologic agents
Given for intermittent claudication |
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Hemorrheologic agents considerations / SFX
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Dyspepsia (take with food), dizziness, HA,
caution with hypotensives Toxicity: Flushing of the skin and fainting |