NURS 304 Week 8
What are large-vessel stroke symptoms?
Aphasia, neglect, visual deficits, and transient binocular blindness
What are examples of antiplatelets?
Aspirin and Clopidogrel
What is fibrinolysis?
dissolution of a clot
What is the antidote to Heparin?
protamine sulfate
What are TIAs?
Brief transient episodes of focal brain, spinal cord, or retinal ischemia (caused by a thrombus or embolus) *resolve w/in 24 hours
What are thrombolytics?
Clot-busters! May be used for ischemic stroke, MI, or PE
What is disseminated intravascular coagulation (DIC)?
Condition of uncontrolled activation of clotting factors that results in widespread thrombi formation, followed by depletion of coagulation factors and platelets leading to massive hemorrhage
What is the role of an anticoagulant?
Drug that thins the blood to prevent blood clots or prevent established clots from getting bigger
What are examples of anticoagulants?
Heparin, Warfarin, Enoxaparin
What does higher PT and INR values indicate?
Higher risk for bleeding
What does aPTT measure?
How fast the blood clots
What is ischemic penumbra?
Indicates evolving stroke- area surround a core of dead or dying cells which are receiving marginal blood flow of a partial occlusion * often associated w/ embolic stroke
What are small-vessel stroke symptoms?
Motor deficits (hemiplegia) or sensory hemiplegia
Does Warfarin dissolve existing clots?
No; but does prevent them from forming
What is the role of an antiplatelet?
Prevent platelets from sticking together on a vessel wall (which can produce a clot) * especially effective in coronary arteries
What is hemostasis?
Process that maintains the integrity of the vascular compartment; includes vasoconstriction, formation of platelet plug, activation of clotting factors in blood, growth of fibrin into blood clot (to make it more stable and repair the tear in the damaged blood vessel)
What are important lab values to monitor w/ pts taking Warfarin?
Prothrombic time (PT) and International normalized ratio (INR)
What are lacunae?
Small cavities left from small-vessel strokes (lacunar infarct)
How does Warfarin work?
Suppressing production of Vitamin K (clotting factor)
What are precautions w/ anticoagulants, antiplatelets, and thrombolytics?
- Monitor for abnormal bleeding - Maintain fall precautions - Avoid IM injections - Monitor lab values when available - Initiate bleeding precautions
What are signs of abnormal bleeding?
- Petechiae - Bleeding gums - Bruising - Dark colored stools
What is included on bleeding precautions?
- Use electric razors - Avoid IM injections - Soft toothbrushes - Avoid unnecessary procedures - Use pressure dressings
What is normal INR value?
1
What are normal PT values for pt on Warfarin?
1.5 to 2.5 x normal levels
What is the goal aPTT value for a pt on IV Heparin?
1.5 to 2.5 x the normal rate
What are normal INR values for pt on Warfarin?
2 to 3
What is a normal aPTT value?
21 to 35 seconds
What is normal PT value?
21 to 35 seconds
About how long does Warfarin usually take to reach therapeutic effect?
3 days
A patient is on a heparin infusion. Which lab value is used to titrate this medication?
Activated partial thromboplastin clotting time (aPTT)
What is antidote to Warfarin?
Vitamin K
Can pts be on both heparin and warfarin at the same time?
Yes; can take
Can pts be on both heparin and warfarin at the same time?
Yes; can take few hours for Heparin level to be therapeutic but several days for Warfarin
