Hematologic medication

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which statement will the nurse make?

"Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches therapeutic level."

A nurse is teaching a client who has a new prescription for clopidogrel. Which instruction will the nurse include?

"You might have to stop taking this medication 1 week before any planned surgeries."

The therapeutic INR value is between? for warfarin at therapeutic level

2-3

The nurse is educating the client on anticoagulant therapy about adverse effects. Which adverse effect of anticoagulant therapy is the most serious?

Abnormal hemorrhage

A client is receiving heparin therapy as part of the treatment for a pulmonary embolism. The nurse monitors the results of which laboratory test to check the medication's effectiveness?

Activated partial thromboplastin time (aPTT)

Acure MI, DVT, pulmonary emoli, ischemic CVA

Alteplase

aspirin clopidogrel

Antiplatelet

administer heparin and warfarin after surgery because why?

Heparin and warfarin are used to prevent further clot formation.

for all hematologic medications do not take with ?

NSAID's, use electric razor for shaving and a soft toothbrush, report signs of bleeding

A nurse is providing teaching to a client who is taking warfarin about monitoring the therapeutic effects. Which explanation should the nurse provide about the international normalized ratio (INR) test?

The INR is a standardized test that eliminates the variations between laboratory reports in prothrombin times. The INR is a standardized test which means the results will be the same, no matter which lab performs the test. It is used to measure warfarin therapeutic levels.

A client has had a recent prosthetic heart valve surgery and is receiving anticoagulant therapy. While monitoring the client's laboratory work, the nurse interprets the INR results. What does an INR of 1.5 indicate?

The client is not receiving enough warfarin to have a therapeutic effect. INR is used to evaluate warfarin therapy, not heparin therapy. The therapeutic range is between 2 and 3. An INR of 1.5 is too low, the client dose not have enough warfarin to be effective, the client requires more warfarin (dose increase).

A client will be receiving Alteplase for an acute myocardial infarction. The nurse explains to the client that this medication is used for which purpose?

To dissolve the clot in the coronary artery.

The nurse notes in the client's medication prescriptions that the client will be starting heparin therapy followed by warfarin. What is the primary goal of heparin and warfarin therapy?

To prevent further thrombus formation. Heparin and warfarin are used to prevent further clot or thrombus formation.

A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

Use an electric razor while on this medication.

ischemic CVA

a stroke caused by sudden blockage of a blood vessel in the brain

therapeutic effect alteplase

acute MI, deep vein thrombosis, massive pulmonary emboli, ischemic CVA, reestablishing patency of IV catheters (special form)

nursing interventions for alteplase

administer IV within 3 hours of onset of symptoms; administer aminocaproic acid for uncontrolled severe bleeding; monitor aPTT, PT, INR, Hgb, Hct, bleeding time (coagulation panel)

nursing intervention for the hematologic medication Alteplase

administer within 3 hours of onset of symptoms administer aminocaproic acid for uncontrolled severe bleeding monitor aPTT, PT, INR, Hgb, Hct, bleeding time(coagulation panel)

heparin enoxaparin warfarin

anticoagulant

heparin, enoxaparin

binds with antithrombin to inactivate factor Xa and thrombin

adverse effects of all hematologic medications

bleeding

Clopidogrel

blocks ADP receptors

warfarin

blocks activation of vitamin K

thrombolytics are used to?

break up or dissolve blood clots which are the main cause of heart attack and stroke

Inhibition of platelet aggregation with MI, Ischemic CVA, TIA, coronary stents

clopidogrel

Which hematologic medication should be discontinued 1 week prior to surgery?

clopidogrel

Alteplase mechanism of action

converts plasminogen to plasmin

clopidogrel

discontinue 1 week before surgery, take with food to minimize GI effects

DIC

disseminated intravascular coagulation

nursing interventions enoxaparin

do not expel air bubble in the syringe; administer deep subcutaneous in abdomen; administer protamine sulfate for overdose; monitor excessive bleeding, black stool

nursing intervention for the hematologic medication enoxaparin

do not expel the air bubble in the syringe administer deep subcutaneous in abdomen

warfarin

do not take while pregnant , may take 3-5 days for full therapeutic effect

A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which medication should the nurse plan to administer for DVT prophylaxis?

enoxaparin subcutaneous; Preventive doses of enoxaparin are low and the client does not require monitoring of PT or PTT, making it the preferred treatment for DVT prophylaxis following orthopedic surgery. Warfarin therapy is started after dosing with enoxaparin. Both medications are given until warfarin reaches therapeutic levels.

NSAIDs and hematologic medications can be take simultaneously for an increased antiplatelet effect.

false

administer protamine sulfate for overdose

heparin enoxaparin

Prevention of venous thrombosis

heparin enoxaparin warfarin

therapeutic effect clopidogrel

inhibition of platelet aggregation (MI, ischemic CVA, TIA, coronary stents)

nursing intervention for the hematologic medication warfarin

monitor INR monitor PT administer vit K for overdose

nursing interventions warfarin

monitor PT and INR(2-3); administer vitamin K for overdose; administer orally, monitor for black stool and excessive bleeding

nursing interventions heparin

monitor aPTT administer protamine sulfate for overdose; subcutaneously or IV monitor for excessive bleeding or black stools

nursing intervention for the hematologic medication heparin

monitor aPTT administer subcutaneously or IV

nursing intervention for the hematologic medication clopidogrel

monitor platelet count

nursing interventions clopidogrel

monitor platelet count; administer orally; monitor for black stools and excessive bleeding

therapeutic effect enoxaparin, warfarin

prevention of venous thrombosis

therapeutic effect heparin

prevention of venous thrombosis, DIC

alteplase

report headache or unilateral weakness

alteplase

thrombolytic

TIA

transient ischemic attack

All of the hematologic medications have an adverse effect of bleeding.

true

Heparin remains running while the client starts warfarin therapy since warfarin has a long half-life.

true

Which hematologic medication is contraindicated during pregnancy?

warfarin

administer orally

warfarin clopidogrel aspirin