Vascular System + Blood

Question 1

Discuss management of anticoagulant overdose:

Question 2

Develop a care plan for clients receiving drugs affecting coagulation:

Question 3

Which prototype is lipid-lowering?

Answer 3

Atorvastatin (Lipitor)

Question 4

Which prototypes treat anemia?

Answer 4

Epstein alfa
Ferrous sulfate
Cyanocobalamin (vitamin b12)
Folic acid

Question 5

Prototypes for anti platelet:

Answer 5

Aspirin
Clopidogrel

Question 6

Prototypes for anticoagulants:
What is the function?

Answer 6

Heparin
Enoxaparin
Warfarin
Rivaroxaban
*anticoagulants disrupt clotting cascade making it difficult for blood to clot
*does not get rid of blood clot, prevents clot from getting bigger

Question 7

Thrombolytic prototype:

Answer 7

Alteplase

Question 8

Antilipemic drug: prototype and use?

Answer 8

HMG-COA Reductase inhibitors
“Statins”
Used for hyperlipidemia
*Inhibits cholesterol synthesis in the liver

Question 9

What is atorvastatin?

Answer 9

Question 10

What is aspirin?

Answer 10

Question 11

What is Clopidogrel?

Answer 11

Question 12

What are nursing assessments and interventions for anti platelet agents?

Answer 12

Assessment:
— indication for medication
— prevention of blood clots
Interventions:
— bleeding precautions
— avoid injury and falls
— hold prior to procedure/surgery
— educate patient on medication

Question 13

Question 14

Diagnostics labs: clotting times
PT
INR
PTT
What are the therapeutic goals? (Need to know)

Answer 14

Question 15

What are general nursing considerations regarding anticoagulants/Thrombolytics?

Answer 15

— all anticoagulants have AE of bleeding
*Non-fatal: hematuria, epistaxis, bruising
*FATAL: hemorrhagic stroke, internal bleeding, GI bleeds (higher risk in older adult)
— reduced risk for injury and falls
— BLEEDING PRECAUTIONS

Question 16

What are contradictions for anticoagulants?

Answer 16

PREGNANCY except for heparin/enoxaparin
— bleeding disorders
— hx of bleed
— theombocytopenia- low platelet

Question 17

What are drug-drug interactions with anticoagulants?

Answer 17

— anti platelet agents
— NSAIDS
— herbals
ALL INCREASE BLEEDING

Question 18

What is heparin?

Answer 18

Question 19

What is enoxaparin?

Answer 19

Question 20

Develop a care plan for IV heparin:

Answer 20

Question 21

What is warfarin?

Answer 21

Question 22

What are special considerations for warfarin?
Dosing
Lab draws
Diet

Answer 22

Dosing:
— daily (usually in evening or HS)
— if INR greater than 3.0 HOLD AND CALL PROVIDER
— expect an order for vitamin k if INR greater than 4.0 (PO or SQ)

Lab draws:
— dose change = next lab in 3 days
— long term monitoring = weekly or monthly

Diet:
Teach patient to maintain consistent intake; avoid vitamin k containing foods
*high intake may decrease warfarin effect

Question 23

What are foods high in vitamin K?

Answer 23

Green leafy foods:
— kale
— collard greens
— spinach
— Brussels sprouts
— broccoli
— asparagus
— sauerkraut
— soybeans
— edamame

Question 24

What are herbals to avoid when taking warfarin?

Answer 24

— St. John’s wart
— garlic
— ginkgo
— ginger root
— chamomile

Question 25

What is rivaroxaban?

Answer 25

Question 26

How do you manage your patient with anticoagulant overdose?

Answer 26

Assessment: CM of bleeding and VS: HR/BP/O2 Interventions: — notify provider — draw labs ordered: hemoglobin/hematocrit, platelets, clotting times — administer fluids (NS) and/or packed RBC as ordered — administer reversal agent

Question 27

What is alteplase?

Answer 27

Question 28

What are contraindications to alteplase?

Answer 28

Question 29

Client has been dx with DVT in R lower extremity. The primary care provider has prescribed enoxaparin 70mg SQ q 12hr with the first dose STAT. In addition, the provider has prescribed warfarin 5mg PO daily and a PT/INR draw in 3 days. Why has the primary HCP prescribed both medications simultaneously?

Answer 29

Making sure the client has adequate anticoagulation while warfarin reaches therapeutic level Warfarin onset = 36-48 hours Enoxaparin onset = 3-5 hours

Question 30

What are drug-drug interactions with anticoagulation drugs?

Answer 30

More than 1 anticoagulant/antiplatelet Aspirin Warfarin Herbal supplements Antibiotic therapy Increases bleeding

Question 31

What is epoetin alfa?

Answer 31

Question 32

What is ferrous sulfate?

Answer 32

KEEP OUT OF REACH FOR CHILDREN-FATAL IF OVERDOSED

Question 33

What is cyancobalamin?

Answer 33

Question 34

What is folic acid?

Answer 34

Question 35

What is pernicious anemia?

Answer 35

Also called addisons anemia — decrease in red blood cells — cannot absorb enough vitamin B12