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58 Cards in this Set

  • Front
  • Back
Thrombosis risks
Tissue Ischemia
Platelets response
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.
Vitamin K
Required to activate clotting factors. Synthisized in the liver.
Therefore: pts with liver problems are at a high risk for bleeds
Anticoagulants
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
Venous thrombosis vs Arterial thrombosis
Venous blood flows slower.
higher risk for clots
Artificial heart valves related risk
body may try to attack it d/t being a foreign object, platelets aggregate
Heparin: action, administration method
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
Heparin indications:
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
Heparin route and dose:
Subcut & IV only.
IV: give bolus (loading dose) first.
Halflife = 1-2h (short acting).
side effects:
thrombocytopenia
bleeding
Heparin labs
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
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
Heparin antidote
dose
onset
Protamin Sulfate
1mg of PS / 100u heparin
quick acting, ~5min
Before d/c IV heparin
Should start pt on oral anticoagulants (coumadin)
s/s of bleeding
bruising, petechiae, bleeding gums,
HIT (r/t heparin)
Heparin Induced Thrombocytopenia
"allergic to heparin"
Argatroban can be given instead, but there is no antidote.
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.
LMH contraindications
Stroke
Peptic Ulcer
Blood anomalies (hemophelia, etc')
Eye, brain, spinal injury.
LMH route / dosage
subcut / prefilled syringes
LMH nsg responsibilities
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
Low molecular weight heparin - BBW
Epidural and spinal hematoma resulting in paralysis
Oral anticoagulants
action
Inhibit production of vitamin K by the liver
Oral Anticoags indications
Prevention of thrombophlebitis
Pulmonary embolism prevention
Post op treatment
Atrial fibrillation
Oral anticoags onset of action
3-5 days
Contraindications for oral anticoags
PUD
Ulcerative colitis
hemophilia
thrombocytopenia
severe hypertension (d/t CVA connection)
CVA
Coumadin labs:
PT - Prothrombin time
INR - International Normalized Ratio. Standard all over the world. Should be 2-3 while on Coumadin
Coumadin administration
given in the evening, once daily. because of labs being drawn in the morning
Coumadin dosing
based on INR. INR is drawn 10-12 hours after medication.
Coumadin antidote
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)
S/S to monitor with coumadin
Petechiae
Bruising
Tarry stools, vomiting blood, bleeding from rectum,
Coumadin teaching
Avoid foods high in vitamin K (green leafy vegetables)
the 3Gs: Garlic, Ginko, Ginger
Feverfew, Dongquai
These will cause excessive bleeding
Coumadin BBW
Major of fatal bleeding
Other Coumadin considerations
Birth defects in early pregnancy
Smoking increases drug metabolism, may need higher dose
Antiplatelets action
Suppresses thrombosis by preventing platelet aggrigation
More effective for arterial thrombosis
Antiplatelets indication
arterial thrombosis
MI and CVA prevention
Prevention of repeat MI
Will not help with existing clot
Antiplatelets drug
Aspirin: inhibits prostoglandin synthesis.
Prostoglandin causes platelet aggragartion
Aspirin action, indication, administration
prevents prostoglandin synthesis.
Used as: antiplatelet, analgesic, antipyretic, anti0inflammatory
given PO.
Dose changes with purpose
Nursing responsibilities for Aspirin:
Monitor for s/s of bleeding
GI problems - take with food
GI bleed
Ototoxicity tinnitus
herbal use: Garlic, Ginko, Danquai, Feverfew
not ginger
Persantine
Antiplatelet
Given to prevent thromboembolism after MI
Often given in conjunction with Coumadin, contraindicated with Heparin
Persantine Thalium test
given IV, for stress test
Advinox
Combination of aspirin and persantin.
Should give with milk,
monitor for hypotension
ADP drugs
Adenosine Diphosphate Blockers
Ex: Plavix.
Change the platelet membrane so they do not respond and aggregate.
Given PO
Plavix nursing responsibilities:
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.
Ticlid
ADP, same mechanism as plavix. given if pt cannot take ASA
Ticlid indication
ASA allergy
Thrombosis prevention in pt with intermittent claudication, sickle cell anemia, coronary artery or cereberovascular disease.
ReoPro
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
Antiplatelet contraindicators
Active bleeding disorder (hemophilia)
Neutropenia
Thrombocytopenia
Sever Liver disease
Thrombolitics tx goal
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
Thrombolitics action
dissolve clot by fibrinolitic action.
Thrombolitics Indication:
PE, DVT, acute MI, Stroke
Thrombolitics antidote
Amicar
Streptokinase (Streptase)
produced by hemolytic streptococcus
Given IV, half-life is very short: 20minutes
Thrombolitics Nursing responsibility
May cause hypotension at tx start.
monitor for s/s of bleeding
anaphylactic reaction - VASCULAR COLLAPSE
Must monitor pt for at least 24h
Urokinase (Kinlytic)
dissolves clots by converting plasminogen to plasmin
more expensive than streptokinase
Less risk of anaphylaxis
5-7 minutes half-life
Reperfussion dysrhythmia
after a clot is dissolved, the heart starts to go into fibrillation / dysrhythmia after perfusion is reestablished
Labs to monitor for Thrombilitic agents
Only given in critical care setting with close monitoring.
APTT. PT, Hct, Plt, Thrombin time
Hemorrheologic agents
"blood thinners".
Improve blood flow by reducing viscosity.
causes RBCs to be more flexible, reduces plt aggregation and fibrinogen concentration
Trental
Hemorrheologic agents
Given for intermittent claudication
Hemorrheologic agents considerations / SFX
Dyspepsia (take with food), dizziness, HA,
caution with hypotensives
Toxicity: Flushing of the skin and fainting