University of South Carolina RN ADULT MEDICAL SURGICAL 2019 PROCTOR REMEDIATION.

RN ADULT MEDICAL SURGICAL 2019 PROCTOR
REMEDIATION

ANTICOAGULANTS

HEPARINS

- Therapeutic uses: stroke; PE; DVT; prophylaxis for post-op venous thrombosis; 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


This study source was downloaded by 100000840403022 from CourseHero.com on 02-12-2022 18:28:48 GMT -06:00


https://www.coursehero.com/file/62861134/RN-ADULT-MEDICAL-SURGICAL-2019-PROCTOR-REMEDIATIONdocx/

, RN ADULT MEDICAL SURGICAL 2019 PROCTOR
REMEDIATION

- 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

CONTRAINDICATIONS

- Pregnancy/breastfeeding
- Thrombocytopenia/uncontrollable bleeding
- During/following surgeries of eyes; brain; spinal cord; lumbar puncture; regional anesthesia
- Clients w/ vitamin K deficiencies; liver disorders; alcohol use disorder
- Clients w/ hemophilia; dissecting aneurysm; PUD; severe HTN; threatened abortion

INTERACTIONS

- Concurrent use of HEPARIN; ASPIRIN; ACETAMINOPHEN; GLUCOCORTICOIDS; SULFONAMIES;
PARENTERAL CEPHALOSPORINS, INCREASES RISK OF BLEEDING
- Concurrent use of PHENOBARBITAL; CARBAMAZEPINE; PHENYTOIN; ORAL CONTRACEPTIVES;
VITAMIN K
- Foods high in vitamin K: dark green leafy vegetables, cabbage, broccoli, brussel sprouts, mayo,
canola/soybean oil
- RESVERATROL, SAW PALMETTO, FEVERFEW, GARLIC, GINGER, GLUCOSAMINE, GINKGO BILOBA

NURSING ADMIN

- Oral, once daily, same time each day
- Baseline vitals
- Monitor PT (18-24 sec); INR (2-3)
- Baseline/monitor CBC, platelet count, Hct
- Have vitamin K for warfarin toxicity
- Wear medical alert bracelet
- Soft bristle toothbrush and electric razor



SKIN CANCER

ABCDE TO EVALUATE MOLES

- Asymmetry
- Borders
- Color
- Diameter
- Evolving




This study source was downloaded by 100000840403022 from CourseHero.com on 02-12-2022 18:28:48 GMT -06:00


https://www.coursehero.com/file/62861134/RN-ADULT-MEDICAL-SURGICAL-2019-PROCTOR-REMEDIATIONdocx/