Coagulation Modifier Drugs

Special Consideration

Patient-Centered Care

Question: A patient had received a double dose of heparin during surgery and is bleeding through his incision site. While the surgeons are working to stop the bleeding at the incision site, what actions will the nurse prepare to do at this time?

a) obtain order for packed red blood cells.

b) prepare to give intravenous vitamins K as an antidote

c) call the blood bank for an immediate platelet transfusion

d) prepare to give intravenous protamine sulfate as an antidote.

• Teach the importance of low to moderate exercise to prevent DVT's.
• Teach signs and symptoms of DVT and PE (severe chest pain, cough) and to report immediately.
• Teach patient to self-administer anticoagulant injection at the same time every day, and rotate sites.
• Teach patient no to message the site or aspirate the needle, and apply gentle pressure for 1 min.
• Use a soft bristle toothbrush to avoid gum bleeding
• Use electric razor when shaving
• Avoid driving or hazardous activities, may cause drowsiness.
• Do not take any aspirin or aspirin containing products unless health care provider approved (e.g. ibuprofen, Advil, naprosyn).
• Encourage patient to carry an identification card at all time and the importance of it.

Precautions: Anticoagulants should be used with caution alcoholism, geriatric patients and pregnancy. Perons with hemophilia and related disorders, leukemia with bleeding, peptic ulcer disease, thrombcytopenia purpura, blood dyscrasias, acute nephritis, and subacute bacterial endocarditis should not use these products.

Herbal Interactions:

• fever few
• gingko
• ginger
• garlic
• ginseng
• capsicum pepper

Implementation

Planning - Patient goals and expected outcomes

Interventions and rationales

• Monitor for adverse reactions hemmorhage (most life threatening), agranulocytosis, leukopenia, eosinophinophilia, thrombocytopenia due to anticoagulant effects.
• Monitor for any signs of hypovolemia (confusion, abdominal pain, blood in stool, blood urine, vomiting blood, chest pain, abdominal swelling).
• Monitor for adverse effects such as increased blood pressure, headache, hematoma formation, hemorrhage, shortness of breath, chills, diarrhea, rash and fever
• Monitor patient every shift for signs of bruising, bleeding of the gums or incision, lower extremity (dvts (+) homan's sign) and increase assessments if condition changes.
• Vital signs q4h and auscultate lungs fields and heart sounds to monitor for infection
• Incentive spirometry q2h and mobilize patient every 2 hours to prevent infection (pneumonia), increase lung capacity and increase tissue perfusion
• Monitor blood glucose levels because blood glucose increases with stress and stressors (illness, surgery)

CLIENT WILL:

• ambulate in room for 10 minutes with assistance (nurse/physio) twice per shift
• demonstrate proper transfer techniques with assistive devices (bed to cane/walker, cane/walker to chair) twice per shift
• demonstrate basic understanding of lower extremity dvt
• verbalize a basic understanding of the drug, uses , side effects and adverse effects and report immediately adverse effects.
• demonstrate proper self-administration with return demonstration of medication administration.
• remember to take his medication at the same time each day and do not abruptly discontinue medication
• be adherent to lifestyle changes required and to the medication therapy.

Potential Nursing Diagnosis

• Acute pain r/t surgical incision
• High risk for falls and injury r/t surgery and pain management
• High risk for infection r/t surgery and immobility
• Impaired physical mobility r/t surgical intervention and new prosthetic
• Deficient knowledge r/t surgery, drug therapy and changes in mobility.
• Ineffective coping r/t little home support and mobility issues

Assessment Throughout Administration

• Assess pain
• Monitor vitals (blood pressure, pulses, increasing temp, increased resp)
• Assess B/P; watch for increasing signs of hypertension
• Assess skin for any bleeding gums, petechiae, ecchymosis, black tarry stool, urticaria, and bruising.
• Monitor for therapeutic effects
• Continue to monitor lab values (hemoglobin, RBC, platelets, INR, PTT, aPPT as ordered)
• Assess for any blood in urine or stool, bleeding gums, bruising.
• Assess for any swelling in lower extremities may be indicative of (+) thrombus in calf
• Monitor for toxic effects

Anticoagulants

• inhibit the action or formation of clotting factors
• prevent clot formation

Anti platelet

• Inhibit platelet aggregation
• Prevent platelet plugs

Thrombolytic

• Lyse (break down) existing clots

Hemostatic

• Promote blood coagulation

Assessment - baseline prior to Administration

• Medical history of the patient (including family hx)
• Obtain a complete health history (including current medications, OTC, herbals)
• Patient allergies
• Baseline vitals (including height and weight)
• Lab and diagnostics :PTT, INR, aPTT,PT, ABG's, hematocrit, whole blood clotting , blood glucose, urinalysis, ECG and X-Ray.
• Patient's mental status
• Head to toe

Case Study

George Reynolds, a 54 year old patient who presents to the surgery department for his scheduled total hip replacement. He has been living with osteoarthritis for the past 5 years and his pain is becoming unbearable. He also has been a diabetic for the past 10 years, but is well managed with oral anti-diabetics.

After a thorough pre-operative assessment and lab tests, it has been confirmed that Mr. Reynolds will need to be on coagulation modifying drug therapy after his surgery.

Mr. Reynolds does not have any family close by, he lives alone and will need patient education on the coagulation modifiers before he is able and well enough to be at home.

Coagulation Modifier Drugs