(PrepU) Chapter 48: Drugs Affecting Blood Coagulation

The provider orders heparin for a 35-year-old female client. The nurse administers the drug only after confirming that the client:

does not have peptic ulcer disease. Contraindications of heparin include GI ulcerations (e.g., peptic ulcer disease, ulcerative colitis), active bleeding, severe kidney or liver disease, severe hypertension, and recent surgery of the eye, spinal cord, or brain. The drug should be used cautiously in clients with non-severe hypertension.

A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?

heparin Heparin is frequently used to prevent postsurgical venous thromboembolism. Antiplatelet drugs do not have this indication, and vitamin K would increase the client's risks.

The nurse is sending home a client who will remain on anticoagulant therapy. What should the nurse teach the client about taking this drug? Select all that apply.

"Brush your teeth gently with soft bristle brush." "Wear or carry a MedicAlert notification." "Warning signs of bleeding include fatigue, pallor, and increased heart rate." "Obtain follow-up lab work regularly as ordered." Clients should be taught to avoid bleeding risk by brushing teeth gently, using electric razors, and avoiding dangerous activities or falls that could cause bleeding. The client should have a MedicAlert to notify other health care providers of anticoagulant therapy. Teach clients to recognize the signs of blood loss and stress the importance of follow-up lab work. Clients should be taught to avoid adding any new medication, prescription, or OTC, without first talking to the health care provider or pharmacist to ensure safety.

While preparing a client for discharge, the nurse teaches about the proper use of warfarin, which has been prescribed by the physician. Which statement by the client indicates that additional teaching is required?

"I should use aspirin to control my arthritis pain." Aspirin is an antiplatelet agent that can increase the effect of warfarin. Clients taking warfarin should check with a health care professional before taking any analgesic. The other statements suggest that the client understands important aspects of warfarin therapy.

The client is currently receiving a continuous IV infusion of heparin. Which procedure should the nurse avoid when possible?

Giving intramuscular injections When caring for clients who are receiving anticoagulation therapy, nurses should, when possible, avoid procedures that present the risk of trauma or bleeding. Nursing procedures to avoid include intramuscular injections, venipuncture, and arterial puncture.

Which genetic clinical condition will likely, over the course of the client's lifetime, require the pharmaceutical introduction of clotting factors to assure the client's safety?

Hemophilia Hemophilia is a genetic lack of clotting factors that leaves the patient vulnerable to excessive bleeding with any injury. Treatment of classic hemophilia with antihemophilic factor provides temporary replacement of clotting factors to correct or prevent bleeding episodes or to allow necessary surgery. Bone marrow disorders are disorders in which platelets are not formed in sufficient quantity to be effective. Neither diabetes nor cystic fibrosis is treated with antihemophilic agents.

Mr. Hon has been admitted to the hospital and placed on anticoagulant therapy. For what blood-related disorder is this therapy used?

Hypercoagulation Anticoagulants are used to treat hypercoagulation, or excessive coagulation. They prevent the blood from clotting unexpectedly and maintain the flow of blood. Hemophilia is treated with human factor IX complex. Blood cancer is treated with therapies such as chemotherapy or radiation treatment. On the other hand, hemostasis is the process by which the body prevents excessive blood flow during an injury.

A nurse is caring for a client receiving warfarin drug therapy. The client informs the nurse that he is also taking chamomile, which is an herbal remedy. The nurse would alert the client to which adverse effects?

Increased risk for bleeding The nurse should inform the client about the increased risk for bleeding, which is an effect of the interaction between warfarin and the herb. Decreased effectiveness of chamomile, increased absorption of warfarin, and increased risk for hypertension are not effects of the interaction between warfarin and chamomile.

A 75-year-old client presents to the health care provider's office with bleeding gums and multiple bruises. When the nurse reviews the client's drug history, the nurse finds that the client is prescribed aspirin 81 mg/d. What drug may cause increased bleeding when used in conjunction with the aspirin?

NSAIDs NSAIDs, which are commonly used by older adults, also have antiplatelet effects. Clients who take an NSAID daily may not need low-dose aspirin for antithrombotic effects.

A client is taking warfarin to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin monitored?

PT and INR The warfarin dose is regulated according to the INR. The INR is based on the prothrombin time. The red blood cell count is not indicative of warfarin dosage. The aPTT is utilized to determine heparin dose. The platelet count is required to determine warfarin dose.

What values are used to monitor the effectiveness of warfarin therapy?

PT and INR Warfarin dose is regulated according to the international normalized ratio (INR), which is based on prothrombin time (PT). PT and INR are assessed daily until a stable daily dose is reached. Thereafter, PT and INR are determined every few weeks for the duration of warfarin therapy.

The nurse is scheduled to administer the following medications at 0900: heparin subcutaneous, cefazolin IVPB, and atenolol po. The morning labs are platelets 150,000 mcL, WBC 10,000 mcL, APTT 100 seconds. Which is the nurse's priority in this situation?

Place the client in supine position with legs elevated for BP 88/50. All the listed medications can interact with heparin, and increase the risk for bleeding. The nurse should place the client in supine position with legs elevated since the client is hypotensive, BP 88/50. Placing a client in this position will help increase the blood pressure by increasing the return of blood to the heart. Next, the nurse should call the primary care provider (PCP) about the abnormal APTT and the BP 88/50 and the recent void of red urine. The PCP will provide orders regarding whether to hold heparin or administer a reduced dose of the anticoagulant later, and what to do about the atenolol since the blood pressure is low, and may order follow-up labs, hemoglobin and hematocrit, and urinalysis for blood. The other actions are appropriate when caring for a client receiving the list of medications listed, but are not as important considering that the client may be bleeding. When a client receives anticoagulation, the nurse should instruct the client to use an electric razor, and a soft toothbrush to decrease the risk for bleeding. The client is taking an antibiotic, so the nurse should determine if there is an improvement in the infection. The client should have body temperature return to normal, and a decrease in the white blood count, and the symptoms of the infection improve and disappear.

A nurse is caring for a 64-year-old female client who is receiving IV heparin and reports bleeding from her gums. The nurse checks the client's laboratory test results and finds that she has a very high aPTT. The nurse anticipates that which drug may be ordered?

Protamine sulfate If a client who receives IV heparin is found to be highly anticoagulated, protamine sulfate may be prescribed. Protamine sulfate, which is a strong base, reacts with heparin, which is a strong acid, to form a stable salt, thereby neutralizing the anticoagulant effects of heparin. Protamine sulfate does not produce the same effects for coumadin, alteplase, or ticlopidine.

A client exhibits signs and symptoms of heparin overdose. The nurse would anticipate administering:

Protamine sulfate Protamine sulfate is the antidote for heparin overdose. Vitamin K is the antidote for warfarin overdose. Urokinase is a thrombolytic. Drotrecogin alfa is a C-reactive protein that has anticoagulant effects.

The nurse is caring for a 73-year-old client receiving warfarin. When the nurse performs the initial shift assessment, the nurse observes blood in the client's urinary drainage bag. After reporting the observation to the physician, which substance will the nurse likely administer?

Vitamin K Genitourinary bleeding is an adverse effect of warfarin. Vitamin K, a hemostatic agent that controls bleeding caused by warfarin overdose, will likely be administered to this patient.

A nurse has an order to administer heparin. Before initiating this therapy, a priority nursing assessment will be the client's:

aPTT. Before initiating therapy, it is important to review the client's aPTT, hematocrit, and platelet count. These tests provide baseline information on the client's blood clotting abilities and identify conditions that may cause heparin therapy to be contraindicated. The client's heart rate and pulse, electrolyte levels, and blood sugar levels would not be priority nursing assessments.

What laboratory value will the nurse prioritize when providing care for a client prescribed intravenous heparin?

aPTT Prescribers use the activated partial thromboplastin time (aPTT), which is sensitive to changes in blood clotting factors, except factor VII, to regulate heparin dosage. D-dimer test is used to help rule out deep vein thrombosis (DVT) and pulmonary embolism (PE). A platelet count measures how many platelets are present in the blood. Platelets are parts of the blood that help the blood clot. Factor XIII levels are assessed when diagnosing/managing hemophilia A.

A direct thrombin inhibitor (DTI) has been added to a client's medication regimen to treat the onset of acute coronary syndrome. The nurse should anticipate administration by what route? Select all that apply.

intravenous oral Both parenteral and oral DTIs are available. The medication is not available in any of the other administration options.

The nurse discovers a client receiving warfarin is bleeding. What drug should the nurse prepare to counteract this drug?

vitamin K Injectable vitamin K is used to reverse the effects of warfarin. Protamine sulfate is used to reverse the effects of heparin. Vitamin E reduces effects of warfarin but is not used for that purpose. Calcium gluconate would not be indicated for this client.

A client who is receiving warfarin has blood in his urinary drainage bag. What medication will likely be prescribed by the health care provider?

vitamin K Vitamin K is the antidote for warfarin overdose. Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Platelets are a blood product, not a medication. Protamine sulfate is the antidote for heparin therapy.