Coagulation

Question 1

Thrombus

Answer 1

A stationary clot

Question 2

Embolus

Answer 2

A clot that moved from its original location

Question 3

3 examples of thromboembolic disorders

Answer 3

Deep Venous Thrombosis (DVT), Strokes, and Myocardial Infarctions (MIs)

Question 4

Heparin: Mechanism of Action

Answer 4

Prevents clot formation and growth (does not break down)

Question 5

Heparin: MOA (2)

Answer 5

Enhances activity of antithrombin lll (AT-lll)

AT-lll inhibits thrombin (active factor IIa) and prothrombinase (Factor Xa)

Question 6

Heparin: Administration

Answer 6

Parenteral only

Question 7

Heparin: Monitoring

Answer 7

Activated partial thromboplastin time (aPTTs)

Question 8

Heparin: Half-life

Answer 8

Short, appropriately 1.5 hours

Question 9

Heparin: Antidote

Answer 9

Protamine Sulphate

Question 10

Heparin: Serious side effects

Answer 10

Abnormal bleeding

Heparin-induced thrombocytopenia (HIT)

Question 11

Heparin-induced thrombocytopenia (HIT)

Answer 11

Immune-mediated reaction

Antibodies activate platelets, leading to clot formation and a decrease in platelet count

Question 12

How do you know it’s HIT?

Answer 12

If platelets decrease by half in 24 hours after starting any type of Heparin

Very deadly

Question 13

HIT = Triple H’s

Answer 13

H- HIT
H - Half platelets gone in 24 hours
H - Heparin

Question 14

LMWH: Mechanism of Action

Answer 14

Enhance AT-lll activity

More specific in inhibiting factor Xa (than thrombin)

Question 15

LMWH: Administration

Answer 15

Subcut injection

Question 16

LMWH: Monitoring

Answer 16

Less lab monitoring (than unfractionated heparin)

Question 17

LMWH: Adverse effects

Answer 17

Fewer adverse effects

Lower risk of thrombocytopenia

Question 18

Warfarin (Coumadin): Mechanism of Action

Answer 18

Inhibits Vitamin K

Question 19

What is vitamin k essential for?

Answer 19

Synthesis of clotting factors in the liver

Question 20

Warfarin: Monitoring

Answer 20

International Normalized Ratio (INR)

Therapeutic INR = 2-3

Question 21

Warfarin: Antidote

Answer 21

Vitamin K

Question 22

Warfarin: Adverse Effects

Answer 22

Abnormal bleeding

Question 23

Warfarin: Pregnancy

Answer 23

Contraindicated due to teratogenic effects

Question 24

Contraindicated meaning

Answer 24

Not safe to use in certain conditions; should be avoided because risks outweigh benefits

Contra- (against) + Indicated (Recommended)

Question 25

IV Heparin and PO Warfarin

Answer 25

Both administered together for 2-3 days. Due to differing half-lives, warfarin takes several days to reach therapeutic effects.

Question 26

Anti-platelet Meds

Answer 26

Prevents platelet activation and aggregation Inhibits clot formation

Question 27

Aspirin Name

Answer 27

Acetylsalicylic Acid (ASA)

Question 28

Aspirin: MOA

Answer 28

Irreversibly inhibits formation of thromboxane

Question 29

Aspirin: What is thromboxane?

Answer 29

Potent promoter of platelet activation and aggregation

Question 30

Aspirin: Uses

Answer 30

Reduces risk of mortality following myocardial infarction (MI) Reduces incidence of stroke

Question 31

Aspirin: Adverse Effects

Answer 31

GI discomfort and bleeding Increased menstrual bleeding

Question 32

Aspirin: Contraindications

Answer 32

Should not be used with other anticoagulants due to increased risk of bleeding

Question 33

Nursing Responsibilities: Assessment

Answer 33

Health History Baseline Data Physical Assessment

Question 34

Nursing Responsibilities: Planning

Answer 34

Client Outcomes Client Education

Question 35

Nursing Responsibilities: Interventions

Answer 35

Monitor for bleeding Monitor vital signs Laboratory monitoring Complete blood count (CBC) Special Populations Anti-platelet agents

Question 36

Assessment: Complete health history includes..

Answer 36

Allergies Current meds (prescription, OTC, herbal) History of bleeding disorders or conditions affecting clotting

Question 37

Assessment: Baseline data includes…

Answer 37

Record vital signs (heart rate and BP) and clotting times (aPTT for heparin, INR for warfarin)

Question 38

Assessment: Physical assessment includes…

Answer 38

Assess for any signs of current bleeding

Question 39

Signs of current bleeding

Answer 39

Petechiae Ecchymoses (bruises) Hematuria (blood in urine) Melena (black stool) Epistaxis (nosebleed)

Question 40

Planning: Client outcomes

Answer 40

Decrease in blood coagulability (evidenced by therapeutic changes in clotting times - aPTT or INR) Client will be free from signs of excessive bleeding

Question 41

Planning: Client Education includes…

Answer 41

Mechanism of action Importance of adherence to regimen Precautions to prevent bleeding Potential adverse effects and s/s to report to HCP Dietary considerations Importance of regular lab monitoring

Question 42

Precautions to prevent bleeding

Answer 42

Avoid activities that increase injury risk Use soft toothbrush Avoid NSAIDs

Question 43

Warfarin: diet considerations

Answer 43

Interacts with vitamin k-rich foods Keep intake consistent (don’t increase or decrease) Ex. Green leafy vegetables

Question 44

Interventions: Special Populations

Answer 44

Exercise caution and monitor clients with: - Kidney disease (affects drug excretion) - Liver disease (affects synthesis of clotting factors and drug metabolism) - History of GI bleeding - Diabetes (micro-vascular changes that increase bleeding risk)

Question 45

Interventions: Anti-platelet Agents

Answer 45

Monitor for bleeding (especially GI) Bleeding risk increases when given with other anti-coagulants Prolonged pressure to control bleeding at puncture sites Monitor for GI upset Menstrual bleeding prolongation

Question 46

How many drug half-lives does it take to be eliminated from the body?

Answer 46

4 half-lives for elimination