Anticoagulants
Indications for Anticoagulants
Used to reduce the ability of the blood clot
Prevention of PE,DVT, Embolism
CANNOT DISSOLVE CLOTS THAT HAVE ALREADY FORMED
What blood levels do we monitor for heparin?
aPTT or anti-Xa
What labs should be monitor for warfarin
PT and INR regularly
Therapeutic PT 14-24 secs
Therapeutic INR- 2-3
Antiplatelet medications
Aspirin and Clopidogrel (plavix)
Anti- anemic medications
Epoetin alfa (man-made erthropoietin)
Heparin and derivatives
Enoxaparin
Warfarin
What is the therapeutic levels for aPTT and anti-Xa?
aPTT- 45-74 secs
anti-Xa- 0.3-1.3
How many days does it take for warfarin to take full effect?
3-7 days
Side/Adverse Effects of aspirin and Clopidogrel
aspirin- GI bleeding/stomach pain, Thromboctopenia platelets <150,000/mm3
Toxicity- Tinnitus/hearing loss, N/V, Tachypnea, increased temp
Clopidogrel-Hemorrhage, bleeding, thrombocytopenia (platelets <150,000/mm3)
Indications for anti-anemic
Anemia
Side effects/Adverse effects
Bleeding/hemorrhage
Monitor for: Nasal bleeding, gingival bleeding, rectal bleeding, large bleeding
Antidote for Heparin and enoxaparin is?
Protamine sulfate IV
Contriaindications for warfarin
bleeding disorders and pregnant clients
Nursing considerations for Aspirin
Take with food, 4g/day max dose, Stop 1 week prior to surgery, Give sodium bicarbonate for toxicity
Side effects for anti-anemic
HTN,thrombosis, headache, pruritius/Skin rash, N/V, fever, Arthralgia (joint pain), Cough
Which labs do we monitor for anticoagulants?
aPTT, anti-Xa
PT and INR
Platelets
When administring heparin you should have another nurse?
You should also get the most accurate ......... on a pt?
witness
weight
What foods should a client limit?
High in vitamin K (will make you clot)
Ex: Liver, cheese, egg yolk, leafy green veggies (broccoli, spinach, kale) and oils
Nursing considerations for Clopidogrel
Stop 1 week prior to surgery, No garlic, ginseng or gingko herb increases bleeding, monitor platelet count and for bleeding, Use cautiously with liver/renal disease, history of bleeding or HTN
Contraindications for anti-anemic
Pregnant women and those breastfeeding
DO NOT TAKE
When monitoring labs higher the number....
Means slower to clot
Enoxaparin you should monitor what labs?
Platelets
normal range for platelets 150,000-450,000
Bleeding precautions
Gentle oral care, electric razor instead of a straight razor, observe and report evidence of bleeding, avoid NSAIDS and Aspririn
Antiplatelets are to help?
Decrease the chances of clots
Nursing considerations for anti-anemic
Monitor iron levels before and during treatment,
Monitor CBC (Hgb, Hct, RBCs platelets), Monitor BP, Protect medication from light
*increase of RBCs means it is working