Anticoagulant

• the general term for a substance that prevents or delays coagulation of the blood

Activated partial thromboplastin time (aPTT)

• a laboratory test used to measure the effectiveness of heparin therapy

Prothrombin time (PT) & International Normalized Ratio (INR)

• two tests used to monitor the effects of drug therapy with warfarin sodium

International Normalized Ratio (INR)

• a standardized measure of the degree of coagulation achieved by drug therapy with warfarin sodium

Protamine sulfate

• a substance that reverses the effect of heparin

Vitamin K

• a substance that reverses the effect of warfarin sodium

Alteplase

• a pharmaceutically available tissue plasminogen activator (tPA) that is created through recombinant DNA techniques

Embolus

• a blood clot that dislodges and travels through the bloodstream

The nurse is reviewing the use of anticoagulants. Anticoagulant therapy is appropriate for which conditions. (Select all that apply)

During teaching of a patient who will be taking warfarin sodium (Coumadin) at home, which statement by the nurse is correct regarding over-the-counter drug use?

A patient is at risk for a stroke. Which drug is recommended to prevent platelet aggregation for stroke prevention by the American Stroke Society?

When administering subcutaneous heparin, the nurse will remember to perform which action?

During thrombolytic therapy, the nurse monitors for bleeding. Which symptoms may indicate a serious bleeding problem? (select all that apply)

Which drug is most often used for deep vein thrombosis (DVT) prevention after major orthopedic surgery, even after the patient has gone home?

The nurse is preparing a patient's morning medications and, upon reviewing the list of drugs, notes that the patient is to receive heparin 5,000 units and enoxaparin (Lovenox), both subcutaneously. What is the nurse's priority action at this time?

The nurse is monitoring a patient who is receiving antithrombolytic therapy in the emergency department because of a possible MI. Which adverse effect would be of the greatest concern at this time?

A patient is receiving instructions regarding warfarin therapy and asks the nurse about what medications she can take for headaches. The nurse will tell her to avoid which type of medication?

The nurse is teaching a patient about self-administration of enoxaparin (Lovenox). Which statement should be included in this teaching session?

A patient is receiving dabigatran (Pradaxa), 150 mg twice daily, as part of treatment for atrial fibrillation. Which condition, if present, would be a concern if the patient were to receive this dose?

A patient has received a double dose of heparin during surgery and is bleeding through the incision site. While the surgeons are working to stop the bleeding at the incision site, the nurse will prepare to take what action at this time?

A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will follow which principles of warfarin therapy? (select all that apply)

Before deciding whether the patient receives Heparin or a low molecular-weight heparin (Enoxaparin), what are you looking for in your assessment of the patient?

• Assess past medical history for contraindications (chronic bleeding disorders such as hemophilia, renal disease (enoxaparin) peptic ulcers (can increase the chance of GI bleeding)
• Assess current medical issues (acute bleeding processes, hemorrhagic stroke, epidural catheter (enoxaparin)
• Assess current medications (look for drug interactions, aspirin, NSAIDS, garlic, other anticoagulants, antiplatelets, thrombolytics)
• Assess baseline labs (heparin- aPTT, platelets; enoxaparin- platelets, creatinine clearance

What nursing interventions would the nurse use to minimize adverse effects when administering Heparin or a low molecular-weight heparin (Enoxaparin)?

• Monitor aPTT every 2-3 days for subcut heparin, every 4-6 hours for intravenous heparin (control value is 25-35 seconds, therapeutic is 37.5-87.5 seconds; hold if greater than 87.5 seconds)
• Monitor platelet count every 2-3 days in acute care environments (Heparin and enoxaparin), Hold dose of heparin or enoxaparin if platelets drop and notify health care provider
• Monitor for signs of bleeding- decrease blood pressure, increased heart rate, easy bruising, excessive bruising, bleeding around IV catheter, bleeding from nares, blood in stool, blood in urine

What nursing interventions would the nurse use to minimize adverse effects when administering Heparin or a low molecular-weight heparin (Enoxaparin)? pt 2

• monitor for signs of coagulation- assess the calf area for heat , redness, pain and swelling (these are the signs of a deep vein thrombosis)
• avoid invasive procedures if overdose of heparin or enoxaparin occurs (administer antidote as prescribed (protamine sulfate)
• administer heparin subcut in abdomen area, avoid scars, bruises, incisions. Rotate sites. Do not massage injection site as this can increase bleeding and hematoma formation. Gently palpate previous injection sites to see if hematomas have formed

What nursing interventions would the nurse use to minimize adverse effects when administering Heparin or a low molecular-weight heparin (Enoxaparin)? pt 3

• administer enoxaparin in love handles area (anterolateral abdomen)
  • prefilled syringes come with an air bubble in them and this should not be dispelled prior to injection.
  • This is considered an "air lock" which helps keep the medication in the subcutaneous tissue.
  • Rotate sites, do not massage injection site as this can increase bleeding and hematoma formation. Gently palpate previous injection sites to see if hematomas have formed

What nursing interventions would the nurse use to minimize adverse effects when administering Heparin or a low molecular-weight heparin (Enoxaparin)? pt 4

• do not administer heparin or enoxaparin IM as this can cause large hematomas (muscle is more vascular that adipose tissue)

What would the nurse ensure the patient understands when administering Heparin or a low molecular-weight heparin (Enoxaparin)?

• use soft bristle toothbrush to help prevent bleeding gums. Use electric razor when shaving
• do not massage injection sites because this chance of bleeding and hematoma formation
• teach patient how to self inject enoxaparin if being discharged home on therapy
• teach patient to report unusual bleeding and bruising

Before deciding whether the patient receives Warfarin, what are you looking for in your assessment of the patient?

• assess past medical history for contraindications: (chronic bleeding disorders such as hemophilia, renal disease (enoxaparin) peptic ulcers (can increase chance of GI bleeding)
• assess current medical issues (acute bleeding processes, hemorrhagic stroke, pregnancy)
• assess current medications (look for drug interactions, aspirin, NSAIDS, garlic, other anticoagulants, antiplatelets, thrombolytics)
• assess dietary intake of food high in vitamin K
• assess baseline labs (PT, INR)

What nursing interventions would the nurse use to minimize adverse effects when administering Warfarin?

• Monitor PT/INR every 2-3 days during initial therapy, once patient reaches therapeutic level, monitor PT every 2-4 weeks
  • (PT range should be 1.25-2.5 the control value = 13.5-37.5 therapeutic PT. INR should be between 2-3 for VTE prophylaxis and could be up to 3.5 for mechanical heart valve patients.)
• Monitor for signs of bleeding- decrease blood pressure, increased heart rate, easy bruising, excessive bruising, bleeding around IV catheter, bleeding from nares, blood in stool, blood in urine)

What nursing interventions would the nurse use to minimize adverse effects when administering Warfarin? pt 2

• monitor for signs of coagulation- assess the calf area for heat, redness, pain and swelling (these are signs of a deep vein thrombosis)
• If INR will result in maybe a held dose and dose readjustment by healthcare provider
• protect the patient from harm if INR elevated above therapeutic levels, fall precautions, avoid invasive procedures

What would the nurse ensure the patient understands when administering Warfarin?

• use soft bristle tooth brush to help prevent bleeding gums. Use electric razor when shaving
• teach patient to be consistent in intake of foods high in vitamin K (for example, if you want to eat salad 3 times a week, then eat salad 3 times a week every week; if you decide to stop eating salad, make sure your healthcare provider knows
• Take medication as prescribed

What would the nurse ensure the patient understands when administering Warfarin? pt 2

• follow up lab work every 2-4 weeks' try not to skip these appointments

What are examples of antiplatelet drugs?

Before deciding whether the patient receives antiplatelet drugs, what are you looking for in your assessment of the patient?

• past medical history (look for chronic bleeding disorders, gastric disorders, gastric ulcers, recent GI bleeding, recent hemorrhagic stroke)
• drug history, both looking at prescription and non-prescription (NSAIDS increase chance of bleeding, anticoagulants increase chance of bleeding)
• assess labs-platelet count, hemoglobin, hematocrit

What would the nurse's plan include when using antiplatelet drugs?

• the patient will be free from s/s of CVA or MI

What nursing interventions would the nurse use to minimize adverse effects when administering antiplatelet drugs?

• monitor for signs of bleeding throughout therapy
• administer with food to help prevent GI ulceration and bleeding

What would the nurse ensure the patient understands when administering antiplatelet drugs?

• teach patient to notify healthcare providers of antiplatelet therapy. Notify surgeons and dentists, should be held 3-7 days before surgery (however, that is up to the healthcare provider )
• teach to take with food to prevent GI ulceration and bleeding
• Teach to look for signs of GI ulcer (epigastric pain) and GI bleeding (dark tarry stools, coffee ground emesis); report these symptoms to healthcare provider if they should occur
• Teach s&s of stroke and MI and to seek emergency help