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85 Cards in this Set
- Front
- Back
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Thromboplastin
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acts on prothrombin to form thrombin, CALCIUM MUST BE PRESENT FOR THIS TO OCCUR.
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Fibrinogen
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protein found in blood plasma, produces fibrin
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Fibrin
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netlike substance in the blood that traps red and white blood cells and plaetlets and forms a matrix (skeleton) of the clot.
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Anticoagulants
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prevent formation of blood clots/THROMBI by a complex clotting mechanism of blood and INCREASING THE TIME IT TAKES FOR BLOOD TO CLOT.
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PROTAMINE SULFATE
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given to counteract HEPARIN, OVERDOSE
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Two major categories of Anticoagulants
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1. Coumarin and Indanedione
2. Heparin |
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Courmarin and Indanedione ACTION
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limits formation of blood coagulation factors II, VII, IX, and X in the liver by interfering with Vitamin K, LIMIT THE EXTENSION OF EXISTING BLOOD CLOTS OR THROMBI
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Heparin Action
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stops reactions that lead to the clotting of blood/formation of fibrin clots, increases the action of antithrombin III (HEPARIN COFACTOR) and several other coagulation factors (FACTOR X/Xa).
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Low-molecular Weight Heparin
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PREVENTS DEEP VEIN THROMBOSIS.
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Thrombi
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clots made of fibrin, platelets, and cholesterol.
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Emboli
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small pieces of a blood clot that circulate in blood, block vessels in areas of the heart.
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Thrombophlebitis
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inflammation and blood clot in a vein.
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Anticoagulant Therapy Uses
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- prevent new clot formation.
- stop existing clots from growing. - It is used in patients with heart valve disease, dysrhythmias, hemodialysis, and patients on bed rest. |
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Heparin USE
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IMMEDIATE EFFECT IS NEEDED.
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Coumarin USE
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LONGTERM THERAPY
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COUMARIN IS POSSIBLY EFFECTIVE FOR
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TRANSIENT CEREBRAL ISCHEMIC ATTACKS (TIA)
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Indanedione (Phenindione) USES
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treat pulmonary emboli and as prophylaxis in deep vein thrombosis, myocardial infarction, rheumatic heart disease w/ valve damage, and atrial dysrhythmias.
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Low Intensity Coumadin Therapy USE
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prothrombin time ratio between 1.2 and 1.5 decreases risk of stroke.
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COUMARIN AND HEPARIN MOST COMMON ADVERSE REACTIONS
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EXCESSIVE BLEEDING AND THROMBOCYTOPENIA
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Early signs of overdosage or internal bleeding include
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bleeding gums, oozing from cuts, unexplained bruising/nosebleeds, heavy/unexpected menses.
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Warfarin ADVERSE REACTIONS
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alopecia, rash, urticaria, cramping, diarrhea, intestinal obstruction, nausea, paralytic ileus, vomiting, excessive uterine bleeding, hemorrhage, with excessive dosage, leukopenia, and fever.
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Heparin ADVERSE REACTIONS
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hyptertension, headache, hematoma, irritation/pain at injection site, conjunctivitis, tearing of eyes, rhinitis, erectios, hemorrhag,e thrombocytopenia, shortness of breath, wheezing, chills, fever, alopecia.
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Heparin DRUG INTERACTIONS
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Increase heparin: coumarin, indanedione, methimazole.
Increase risk of bleeding when taken with heparin: acetysalicylic acid, coumarin, dextran, NSAIDS. Increase risk of GI bleeding/hemorrhage when used with heparin: ASA, corticotropin, ethacrynic acid, glucocorticoids, and NSAIDS. |
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Coumadin DRUG INTERACTIONS
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Increase PT response when used with Coumadin: allopurinol, ASA, anabolic steroids, antibiotics, androgens, sedatives, antacids, dextran, quinine, salicylates, thyroid drugs, vitamin E.
Decrease PT/INR response when used with coumadin: adrenocorticosteroids, antacids, antihistamines, barbiturates, contraceptives, thiazide diuretics, and vitamin K. |
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Nursing Implications with Coumarin
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- Coagulation, PT, INR tests ordered.
- Weight base dosing. |
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Weight base dosing for heparin
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Patients weight in KG infusing 80 units per kg as an IV bolus.
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What are the standard tests for determining the general effect of heparin on clotting?
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- Lee-White Coagulation Time
- Whole blood activated partial thromboplastin time (WBAPTT) - Activated partial thromboplastin time aPTT |
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Which test is most commonly used?
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Activated Partial Thromboplastin Time aPTT
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What is the typic INR goal?
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2.0-3.0, except in mechanical cardiac valve replacement when a higher number is needed.
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Can Heparin be given orally?
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NO!! it is not effective if given orally, it should be given by IV, IV infusion, Deep Subcut.
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Can Heparin be given intramuscularly?
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NO!! because it can produce hematomas, irritation, and pain.
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Heparin Injectios
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- do not aspirate before injection.
- do not massage injection site. - If heparin in vial has solid at the bottom or is discolored do not use it. |
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S/S of Internal Bleeding
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abdominal pain, swelling of abdomen, back pain, bloody/tarry stools, blood or cloudy urine, constipation, coughing up blood, dizziness, severe headaches, vomiting up blood or coffee ground substance.
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Patient Teaching for Anticoagulant Therapy:
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- need regular INR time or coagulation blood tests.
- pressure should not be used to stop bleeding from cuts. - AVOID EATING EXCESSIVE AMOUNTS OF FOOD CONTAINING VITAMIN K.- tomatoes, onions, dark leafy greens, bananas, fish. - Avoid alcohol. |
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Promatine Sulfate
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basic alkaline protein acts as heparin antagonist to reverse heparin action, can also serve as an anticoagulant.
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Protamine Sulfate USE
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treat heparin overdose, also used after surgery to neutralize effects of heparin given during extracorporeal circulation on heart/lung machine.
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Protamine Sulfate ADVERSE REACTIONS
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bradycardia, lassitude (weariness), sudden drop in blood pressure, flushing of face/neck, feeling of warmth.
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Overdose of Protamine Sulfate
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produces anticoagulant effects.
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How is Protamine Sulfate given?
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slowly by IV injection over 1-3 min in doses of 50 mg during a ten minute period.
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What happens if Protamine Sulfate is given to rapidly?
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severe hypotension and anaphylactic like reactions are provoked.
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Thrombolytic Agents
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convert plasminogen to the enzyme plasmin which breaks down fibrin clots, fibrinogen, and other plasma proteins.
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Thrombolytic Agents are used to...
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LYSIS- DISSOVLING OF THROMBI
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Thrombolytic Agents USES
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- acute myocardial infaction for lysis of thrombi blocking coronary arteries.
- in acute pulmonary emboli for clot lysis when patient is hemodynamically unstable. - in acute ischemic stroke and acute arterial occlusion. |
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Thrombolyctic Agents ADVERSE REACTIONS
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BLEEDING, dysrhythmias, hypotension, polyneuropathy, cholesterol embolism, pulmonary embolism.
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Thrombolytic INTERACTIONS
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when given with other anticoagulants this can increase bleeding.
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When are Thrombolytic agents given??
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IN LIFE THREATENING SITUATIONS, WORK BEST HOUR AFTER THROMBOSIS.
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What should a patient that is having a myocardial infarction do?
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take a 600 mg aspirin.
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Antiplatelet Agents
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limit/inhibit platelet aggregation (clumping) and reduce thrombus formation.
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Antiplatelet USES
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reduces incidence of myocardial infarction, DRUG OF CHOICE FOR ISCHEMIC STROKE.
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CLOPIDOGREL (PLAVIX)
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antiplatelet agent, used for myocardial infarction prophylaxis in men, and as a preventative.
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ABCIXIMAB (REOPRO), EPTIFIBATIDE (INTEGRILIN), AND BIVALIRUDIN (ANGIOMAX)
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antiplatelet agent, used during cardiac catheter insertion and other cardiovascular procedures.
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Antiplatelet Agents ADVERSE REACTIONS
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bleeding, diarrhea, nausea, dyspepsia, rash, GI pain, neutropenia, purpura, vomting, gas, itching, dizziness, and anorexia.
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Antiplatelet DRUG INTERACTIONS
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antacids, cimetidine, digoxin, and theophylline interact with them.
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What are some nursing intervetions for antiplatelet agents?
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since they are used in critically ill patients to help limit damage from thrombosis vial signs and assisting with monitoring patients cardiovascular status is very important.
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FOLIC ACID (vitamin B9)
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required for normal RBC formation and nucleoprotein synthesis, it is used to treat anemais caused by folic acid deficiency, alcoholism, hepatic disease, hemolytic anemia, infancy, lactation, oral contraceptive use, and pregnancy, HELPS PREVENT SPINAL CORD MALFORMATIONS IN THE FETUS.
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Folic Acid ADVERSE REACTIONS
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bronchospasm, erythema, malaise, pruritis, rash, discolored urine.
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Folic Acid Dosages:
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Men: 0.15-0.2 mg/day
Women: 0.15-0.18 mg/day Pregnant: 0.4 mg/day |
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Patient teaching for Folic Acid
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- if used for parenteral use protect from light.
- eat foods high in folic acid to prevent deficiency. - should improve blood tests in 2-5 days. |
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Foods high in Folic Acid
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leafy green veggies, vegetables and fruits, yeasts, and oragn meats.
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VITAMIN B12
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is water soluble, contains cobalt, PRODUCED BY BACTERIUM STREPTOMYCES GRISEUS.
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Vitamin B12 Functions
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- metabolic processes in protein, fat, and carb metabolism.
- required for DNA synthesis. - has an identical hemopoietic activity identical to the antianemia factor of the liver. |
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Vitamin B12 USES
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used to treat B12 deficiency Anemias PERNICIOUS ANEMIA, malabsorption syndromes, hemorrhage, blind loop syndrome, pregnancy, chronic liver disease, thryroidtoxicosis, and renal disorders.
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Symptoms of Vitamin B12 Deficiency
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dyspepsia, sore tongue, breathlessness, stiff back (vegan back).
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NASCOBAL
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vitamin B12 nasal spray used for persons in remission after undergoing IM therapy for pernicious anemia.
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NASCOBALADVERSE REACTIONS (require to start B12 IM injections again)
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infection, headache, glossitis, nausea, rhinitis.
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Vitamin B12 ADVERSE REACTIONS
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Allergy: pruritus, swelling of entire body, severe anaphylactic reaction.
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CYCANOCOBALAMIN ADVERSE REACTIONS
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mild pain, localized skin irritation, diarrhea.
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Vitamin B12 DRUG INTERACTIONS
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alcohol, colchicine, para aminosalicylic acid lower absorption of vitamin B12.
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BEST FOOD SOURCES FOR VITAMIN B12
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oysters, clams, nonfat dry milk, limburger cheese, seafood.
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***VITAMIN K***
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helps hepatic formation of active prothrombin (FACTOR II), proconvertin (FACTOR IX), and stuart factor (FACTOR X), ESSENTIAL FOR NORMAL BLOOD CLOTTING.
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MENADIONE (K3) AND PHYTONADIONE (K1)
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ARE SYNTHETIC LIPID SOLUBLE FORMS OF VITAMIN K
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MENADIOL SODIUM DIPHOSPHATE (K4)
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CHANGED IN THE BODY TO MENADIONE
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Vitamin K USES
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treat or prevent blood clotting disorders that result in damaged formation of factors II, VII, IV, and X.
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VITAMIN K IS HELPFUL IN REVERSING THE EFFECTS OF WHAT DRUG OVERDOSAGE?
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COUMADIN/WAFARIN
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Vitamin K ADVERSE REACTIONS
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headache, rash, urticaria, gastric upset, redness, pain/swelling of injection site, rapid/weak pulse, dizziness, flushing, sweating, and unusual taste sensations.
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Vitamin K INTERACTIONS
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Decreases effects of anticoagulants.
Mineral Oil and Cholestyramine inhibit GI absorption of oral Vitamin K. |
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How is vitamin K given?
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subcutaneously or IM is the preferred routes, DO NOT GIVE IN IV BECAUSE ANAPHYLAXIS CAN OCCUR!!
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IRON
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essential for synthesis of myoglobin and hemoglobin, increases hemoglobin to correct iron deficiency.
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Iron USES
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treat iron deficiency anemia, used to prevent hypochromic anemia during infancy, childhood, and pregnancy.
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Iron ADVERSE REACTIONS
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constipation, cramping, diarrhea, epigastric/abdominal pain, GI irritation, allergic reactions.
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Symptoms of IRON OVERDOSE
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lethargy, sleepiness, nausea, vomitting, abdominal pain, diarrhea, and dyspnea.
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Iron INTERACTIONS
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antacids, milk, eggs.
- Vitamin E decreases Iron. |
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LARGE IRON DOSES CAN CAUSE A FALSE POSITIVE TEST FOR
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OCCULT BLOOD USING THE TOLUIDINE TEST
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Nursing Implications/Patient Teaching for IRON
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- help collect stools for occult blood tests after patient is on a red meat diet for 3 days.
- Iron should be taken on an empty stomach or with something acidic. |
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Food sources for Iron
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fish, meat, and dried fruits.
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