RN ADULT MEDICAL SURGICAL 2019 PROCTOR REMEDIATION(Very Helpful Study Guide)

RN ADULT MEDICAL SURGICAL 2019 PROCTOR REMEDIATION ANTICOAGULANT SHEPARINS - Therapeutic uses:stroke; PE; DVT; prophylaxisfor post-op venousthrombosis; treatment of DIC - Heparin toxicity: admin PROTAMINE slowly IV no faster than 20 mg/min or 50 mg in 10 min; do not exceed 100 mg in 2hr; prevent protamine toxicity - Hemorrhage secondary to heparin toxicity: monitor vitals; observe for bleeding (increased HR; decreased BP, bruising, petechiae, hematomas, black tarry stools); monitor aPTT (keep value 1.5 – 2 x baseline); stop heparin admin - Epidural/spinal hematoma risk - Monitor platelet count throughout treatment;stop heparin for platelet count 100,000 LMW HEPARINS - Therapeutic uses: DVT prevention and treatment; PE; prevent complications of angina; non-Q wave MI; STEMI - Enoxaparin - Hemorrhage: monitor vitals; monitor platelet count; observe for bleeding; avoid aspirin ACTIVATED FACTOR XA INHIBITOR - Therapeutic uses: DVT and PE prevention postop; acute DVT or PE treatment in conjunction w/ warfarin - Fondaparinux - Hemorrhage: monitor vitals; monitor platelet count; monitor for bleeding; avoid aspirin CONTRAINDICATIONS - Thrombocytopenia - Use during/following surgeries of eyes/brain/spinal cord/lumbar puncture/regional anesthesia - Use caution in clients w/ hemophilia; increased capillary permeability; dissecting aneurysm, PUD, severe HTN, hepatic/kidney disease, threatened abortion INTERACTIONS - Increased risk of bleeding w/ antiplatelet agents: ASPIRIN; NSAIDS - Increased risk of bleeding w/ RESVERATROL; SAW PALMETTO; GARLIC; GINGER; GLUCOSAMINE; GINKGO BILOBA NURSING ADMIN - Must be given via SUBQ injection or IV infusion - Rotate sites - Monitor for indications of bleeding - Use electric razor - Use soft toothbrush VITAMIN K INHIBITORS (COUMARINS) WARFARIN - Prevention of venous thrombosis and PE - Prevention of thrombotic events w/ a-fib or prosthetic heart valves - Reduce risk of recurrent TIA or MI COMPLICATIONS - Hemorrhage: monitor vitals; observe for bleeding; obtain baseline PT and INR - Warfarin toxicity: admin vitamin K1 - Hepatitis: monitor liver enzymes; assess for jaundice