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What is hemostasis?
when a blood vessel is injured a series of events occurs to form a clot and stop the bleeding.
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What is a thrombosis or thrombus?
Formation of a blood clot
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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
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What causes aterial thrombosis?
Atherosclerosis or arrhythmias, such as atrial fibrillation.
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What is an embolus?
Its when a thrombus detaches itself from the wall of the vessel and is carried along through the bloodstream.
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What is pulmonary embolism (PE)
the embolus goes to the lung and obstructs a pulmonary vessel
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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.
- Anticoagulants:
- 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
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What are the actions of an anticoagulant?
- 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
Nurse = Heparin cant be taken orally cuz its inactivated by gastric acid in the stomach so it has 2 be injected.
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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
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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
- alopecia
- rash or urticaria
- hepatitis, jaundice, thrombocytopenia, blood dyscarasias (disorder)
- Most serious a/r:
- asthma-like reactions and anaphylactic reaction
nurse = make sure you know if they are allergic to PORK cuz LMWHs are contraindicated in peeps allergic 2 PORK
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What are anticoagulant contraindications and precautions?
Contraindications:
active bleeding (except when caused by DIC) - hemorrhagic disease
- TB
- Leukemia
- uncontrolled hypertension
- GI ulcers
- Recent surgery of eye or central nervous system, aneurysms
- Severe renal or hepatic diseas
- PORK ALLERGIES
Precautions:
fever - heart failure
- diarrhea
- diabetes
- malignancy
- hypertension
- renal or hepatic disease
- psychosis
- depression
- CAUTION IN PEEPS W/ POTENTIAL BLEEDING OR HEMORRHAGE
- AND TELL CHICKS WHO CAN GET PREGO 2 USE RELIABLE BIRTH CONTROL
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What are antiplatelent drugs?
prevent thrombus formation in the ARTERIAL SYSTEM.
Antiplatelet drugs - abciximab (reopro), cilostazol (pletal), clopidogrel (plavix), eptifibatide (integrillin), ticlopidine (ticlid), tirofiban (aggrastat), treprostinil (remodulin)
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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
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What are a/r in antiplatelet drugs
Common a/r
heart palpitations - bleeding
- dizziness and headache
- nausea, diarrhea, constipation, dyspepsia
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What are contraindications and Precautions in antiplatelets
- Pregos or lactating
- CHF
- active bleeding
- TTP (thrombotic thrombocytopenic purpura)
Caution in:
Elderly - pancytopenic patients
- renal or hepatic impairment
Nurse = antiplatelet drugs should be stopped 1wk b4 any surgical procedure.
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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 drugs:
alteplase recombinant (activase), reteplase recombinant (retavase), streptokinase (streptase), tenecteplase (TNKase), urokinase (abbokinase)
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What are the actions and uses of thrombolytic drugs?
- Actions:break down fibrin clots and reopens blood vessels after occlusion and prevents tissue necrosis
Uses:
- Acute MI by lysis(break up) of blood clots in coronary arteries
- Blood clots causing PE and DVT
- Suspected occlusions in central venous catheters
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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.
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What are the contraindications and precautions in thrombolytic drugs?
Contraindicated:
active bleeding - history of stroke
- aneurysm
- recent intracranial surgery
Precautions:
peeps who recently undergone major surgery (w/in 10days) - stroke
- trauma w/in last 10days
- vaginal or cesarean section delivery
- GI bleeding
- hypertension
- diabetic retinopathy
- any bleeding condition and peeps using oral anticoagulants
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What are the preadministration assessments the nurse has 2 do b4 giving these drugs?
Nurse:
- 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
- CBC
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Ongoing assessment performed by nurse on these drugs
Nurse:
- 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
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Oral administration of anticoagulants:
NURSE:
- 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
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Parenteral administration of anticoagulants
Nurse know
- 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
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