What is hemostasis?
when a blood vessel is injured a series of events occurs to form a clot and stop the bleeding.
What is a thrombosis or thrombus?
Formation of a blood clot
Where do DVT usually occur and what is the most common type?
DVT usually occur in the lower ext and most common type is venous thrombosis
What causes aterial thrombosis?
Atherosclerosis or arrhythmias, such as atrial fibrillation.
What is an embolus?
Its when a thrombus detaches itself from the wall of the vessel and is carried along through the bloodstream.
What is pulmonary embolism (PE)
the embolus goes to the lung and obstructs a pulmonary vessel
What are anticoagulants?
- prevent the formation and extension of a thrombus IN THE VENOUS SYSTEM. They are also called blood thinners.
- Peak activity is reached 1.5 to 3days after therapy is started.
- Oral = anisindione, warfarin sodium, Parenteral = heparin (based on weight) MIRADON, heparin sodium lock flush solution COUMADIN
- parental anticoagulants: Low-molecular-weight-weight heparins(LMWH) = dalteparin sodium FRAGMIN, enoxaparin soduim LOVENOX, tinzaparin sodium INNOHEP
What are the actions of an anticoagulant?
Nurse = Heparin cant be taken orally cuz its inactivated by gastric acid in the stomach so it has 2 be injected.
- they interfere w/ the clotting the clotting mechanism of the blood.
- warfarin and anisindione interfere with the manufacturing of vitamin k-dendent clotting factors by the liver. This results in the depletion of clotting factors II(prothrombin) which is ESSENTIAL 4 clotting
What are anticoagulants used for?
- Prevention of
- Prophylaxis and tx of DVT
- Tx of atrial fibrillation w/ embolization
- Tx of PE
- Adjuvant tx of MI
- Prevention of thrombus formation after valve replacement surgery
- Parenteral anticoagulants used 4:
- prevention of postop DVT and PE in certain pts hving surgery like ABD surgery.
- prevention of clotting in arterial and heart surgery, equipment used 4 extracorporeal, dialysis procedures, blood transfusions, blood samples 4 lab.
- prevention of repeat cerebral thrombosis pts who had a stroke
- tx of coronary occlusion, acute MI, peripheral arterial embolism
- dx & tx of DIC, severe hemorrhagic disorder
- maintaining patency of IV caths
What are adverse reactions of anticoagulants?
Bleeding may be seen in many areas of the body ex bruising and petechia, bladder, bowel, stomach, uterus, and mucous membranes.
- Other a/r but rare:
- nausea, vomiting, abd cramping, diarrhea
- rash or urticaria
- hepatitis, jaundice, thrombocytopenia, blood dyscarasias (disorder)
nurse = make sure you know if they are allergic to PORK cuz LMWHs are contraindicated in peeps allergic 2 PORK
- Most serious a/r:
- asthma-like reactions and anaphylactic reaction
What are anticoagulant contraindications and precautions?
active bleeding (except when caused by DIC)
- hemorrhagic disease
- uncontrolled hypertension
- GI ulcers
- Recent surgery of eye or central nervous system, aneurysms
- Severe renal or hepatic diseas
- PORK ALLERGIES
- heart failure
- renal or hepatic disease
- CAUTION IN PEEPS W/ POTENTIAL BLEEDING OR HEMORRHAGE
- AND TELL CHICKS WHO CAN GET PREGO 2 USE RELIABLE BIRTH CONTROL
What are antiplatelent drugs?
prevent thrombus formation in the ARTERIAL SYSTEM.
- abciximab (reopro), cilostazol (pletal), clopidogrel (plavix), eptifibatide (integrillin), ticlopidine (ticlid), tirofiban (aggrastat), treprostinil (remodulin)
What are antiplatelet drug actions and uses?
- Decrease platelets' ability 2 stick 2gether (aggregate) in the blood so stopping a forming clot
- Tx patients @risk 4 acute coronary syndrome, MI, stroke, and intermittent claudication
What are a/r in antiplatelet drugs
- dizziness and headache
- nausea, diarrhea, constipation, dyspepsia
What are contraindications and Precautions in antiplatelets
- Pregos or lactating
- active bleeding
- TTP (thrombotic thrombocytopenic purpura)
- pancytopenic patients
- renal or hepatic impairment
Nurse = antiplatelet drugs should be stopped 1wk b4 any surgical procedure.
What are Thrombolytic aka fibrolytic drugs?
- these class of drugs dissolves blood clots that have already formed within the walls of the blood vessel.
- Reopen blood vessels after they bcome occluded
Thrombolytic aka fibrolytic
alteplase recombinant (activase), reteplase recombinant (retavase), streptokinase (streptase), tenecteplase (TNKase), urokinase (abbokinase)
What are the actions and uses of thrombolytic drugs?
- Actions:break down fibrin clots and reopens blood vessels after occlusion and prevents tissue necrosis
- Acute MI by lysis(break up) of blood clots in coronary arteries
- Blood clots causing PE and DVT
- Suspected occlusions in central venous catheters
What are a/r in thrombolytic drugs?
Bleeding most common can be internal and involve GI tract, genitourinary tract and brain and can be external like broken skin
Nurse = signs and syptoms of internal bleeding LOW B/P, HEMO &HCT LOW, WEAKNESS IN PT.
What are the contraindications and precautions in thrombolytic drugs?
- history of stroke
- recent intracranial surgery
peeps who recently undergone major surgery (w/in 10days)
- trauma w/in last 10days
- vaginal or cesarean section delivery
- GI bleeding
- diabetic retinopathy
- any bleeding condition and peeps using oral anticoagulants
What are the preadministration assessments the nurse has 2 do b4 giving these drugs?
- Question pt about all drugs taken during the previous 2 to 3wks
- Take PT, INR and asses result b4 drug is given cuz dose is based on results
- Vital signs
- In heparin monitor activated partial thromboplastin time(APTT)
- In DVT peeps look @ lower ext 4 color or skin temp, pedal pulses, redness tenderness, chk 4 homan's sign suggests DVT
Ongoing assessment performed by nurse on these drugs
- assess 4 any signs of bleeding and hmorrhage inspect gums, nose, stools, urine, nasogastric drainage
- Level of conciousness if hv intracranial bleeding
- Withhold drug if PT exceeds 1.2 to 1.5x the control value or the INR ratio exceeds 3
- Monitor periodic platelet counts, hematocrit and tests 4 occult blood in stool should be performed thruout therapy
- Monitor & report reactions like chills, fever, hives
- take v/s every 4hrs
- Observe 4 signs of thrombus formation every 2to4hrs
Oral administration of anticoagulants:
- b4 giving warfarin check the prothrombin flow sheet or lab rpt 2 review current PT/INR results
- Loading dose may be prescribed for 2to 4days
- Know that these drugs take 3 to 5 days to reach therapeutic effects
- HEPARIN is preferred as a loading dose
Parenteral administration of anticoagulants
- heparin preparations, unlike warfarin must be given by SC or IV
- Maximum effects occur w/in 10mins of administration and clotting time returns 2 normal w/in 4hrs unless more doses are given
- Infusion pump must be used 4 safe administration of heparin by continuous IV and chk it every 1 to 2hrs
- Check needle site