Nursing Implications for Medication Affecting Coagulants

Heparin
Intravenous
doses are double-checked with another
I
nurse
IV doses may be given by bolus or IV infusions
Anticoagulant effects seen immediately
Laboratory values done daily to monitor coagulation
effects (aPTT)
Protamine sulfate can be given as an antidote in case of
excessive anticoagulation
Monitor CBC for platelet count
Ensure that subcutaneous doses are given
subcutaneously, not IM
Subcutaneous doses should be given in the abdomen and
sites rotated
Do not give subcutaneous doses within 2 inches of:
The umbilicus, abdominal incisions, or open wounds,
scars, drainage tubes, stomas
Do not aspirate subcutaneous injections or massage
injection site
May cause hematoma formation

Warfarin
May be started while the patient is still on
heparin until PT-INR levels indicate adequate
anticoagulation
Full therapeutic effect takes several daysfirst dose changes blood levels in 48 hours
Monitor PT-INR regularlykeep follow-up
appointments
Antidote is vitamin K (IV or SQ), for quick
reversal fresh frozen plasma IV
Teach patients not to eat foods high in
vitamin K in moderation and consistently
Education should include:
Importance of regular laboratory testing
Signs of abnormal bleeding
Measures to prevent bruising, bleeding, or
tissue injury
Wearing a medical alert bracelet
Avoiding foods high in vitamin K (tomatoes,
dark leafy green vegetables)
Consulting physician before taking other
drugs or over-the-counter products, including
herbals

Thrombolytic Drugs
Educate patients on risk for bleed
No venipuncture for 24 hours
BLEEDING RISK is priority
t-Pa Given IV- after infusion complete no other
medications affecting coagulation can be given for
at least 24 hours

Nursing Implication for Medications used to treat Anemia

Assess:
patient history and medication history, including drug allergies
potential contraindications- almost all preparations can cause constipation; teach patients to increase fluid and
fiber
baseline laboratory values, especially Hgb, Hct, reticulocytes, others
Obtain nutritional assessment
Ferrous salts are contraindicated in patients with ulcerative colitis, PUD, liver disease, and other GI disorders
Keep away from children because oral forms may look like candy
Iron dextran is contraindicated in all anemias except for iron-deficiency anemia
For liquid iron preparations, follow manufacturers guidelines on dilution and administration
Instruct patient to take liquid iron preparations through a straw to avoid staining tooth enamel
Oral forms of iron should be taken between meals for maximum absorption, but may be taken with meals if GI distress occurs
Oral forms should be given with juice, but not with milk or antacids
Patients should remain upright for 15 to 30 minutes after oral iron doses to avoid esophageal corrosion
Patients should be encouraged to eat foods high in iron/folic acid
For iron dextran, a small test dose should be given
After 1 hour, if no reaction, the remainder of the dose can be given
Administer deeply into a large muscle mass using the Z-track method
Determine cause of anemia before administering folic acid
Administer oral folic acid with food
Folic acid may also be given IV and added to total parenteral nutrition solutions
Monitor for therapeutic responses
Improved nutritional status
Increased weight, activity tolerance, well-being
Absence of fatigue
Monitor for adverse effects

Perform a thorough patient history and physical examination

Assess baseline fluid volume status, intake and output, serum electrolyte values, weight, and vital signsespecially postural BPs
Assess for disorders that may contraindicate or necessitate cautious use of these drugs
Instruct patients to take the medication in the morning if possible to avoid interference with sleep patterns
Monitor serum potassium levels during therapy
Nursing Implications
Teach patients to maintain proper nutritional and fluid volume status
Teach patients to eat more potassium-rich foods when taking any but the potassium-sparing drugs
Foods high in potassium include bananas, oranges, dates, apricots, raisins, broccoli, green beans, potatoes, meats, fish, and legumes
Nursing Implications
Patients taking diuretics along with a digitalis preparation should be taught to monitor for
digitalis toxicity
Patients with diabetes mellitus who are taking thiazide and/or loop diuretics should be told to monitor blood glucose and watch for elevated levels
Nursing Implications
Teach patients to change positions slowly and to rise slowly after sitting or lying to prevent dizziness and fainting related to orthostatic hypotension
Encourage patients to keep a log of their
daily weight
Remind patients to return for follow-up visits and lab work
Nursing Implications
Patients who have been ill with nausea, vomiting, and/or diarrhea should notify their primary care provider because fluid and electrolyte imbalances
can result
Signs and symptoms of hypokalemia include muscle weakness, constipation, irregular pulse rate, and overall feeling of lethargy
Nursing Implications
Instruct patients to notify their primary care provider immediately if they experience rapid heart rates or syncope (reflects hypotension or fluid loss)
Excessive consumption of licorice can lead to additive hypokalemia in patients taking thiazides
Nursing Implications
Monitor for adverse effects
Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg cramps, restlessness, decreased mental alertness
Monitor for hyperkalemia with potassium-sparing diuretics
Monitor for hypokalemia with all other diuretics
Monitor magnesium level with thiazide diuretics
If giving metolazone with furosemide give metolazone 30 mins prior to furosemide
Nursing Implications
Monitor for therapeutic effects
Reduction of edema
Reduction of fluid volume overload
Improvement in manifestations of heart failure
Reduction of hypertension
Return to normal intraocular pressures

Nursing Implications of Diuretic Meds