NUR 2571 Assignment Medications affecting Coagulation

On the other hand, less common hemorrhagic disorders is characterized by excessive bleeding.

NUR 2571 Assignment Medications affecting Coagulation

These are treated by drugs that promote the clotting process. Some of these conditions include:

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• Hemophilia: characterized by genetic lack of clotting factors
• Liver disease: characterized by non-production of proteins and clotting factors necessary for clot formation
• Bone marrow disorders: characterized by insufficient quantity of platelets rendering them ineffective

Antiplatelet Agents

• This drug class exerts its action by decreasing the responsiveness of platelets to stimuli that cause it to clump or aggregate. Through this, formation of platelet plug is decreased.

Therapeutic Action

•  By blocking receptor sites on the platelet membrane, platelet adhesion and aggregation is inhibited.
• Also, platelet-platelet interaction as well as interaction of platelets to clotting chemicals are prevented.

Indications

• Primarily indicated for cardiovascular diseases that have potential for development of vessel occlusion.
• Other indications include maintenance of arterial and venous grafts, preventing cerebrovascular occlusion, and including them as adjunct to thrombolytic therapy for treatment of myocardial infarction.
• One drug, anagrelide, blocks the production of platelets in the bone marrow.

Children

• Only heparin and warfarin are indicated for children but these drugs alone require careful dose calculation.

Adults

• Caution is particularly important to prevent injury (e.g. using electric razor and soft-bristled toothbrush).
• It is also important that adults are educated on what to do should bleeding occurs (e.g. applying firm pressure) as well as what signs of bleeding should be watched out for.
• Other drugs taken should be documented because there are a lot of drug interactions with these drug class. It should also be emphasized that periodic blood tests is expected to monitor the effect of therapy.

Pregnant women

• For pregnant women, it is not advisable unless the benefit to the mother would clearly outweigh the risk for the fetus. On the other hand, for lactating women, it is generally inadvisable.

Older adults

• Are more susceptible to drug toxicity and drug-to-drug interactions.
• Careful monitoring of liver and kidney function is important for this age group.
• Therapy is always started at the lowest level possible and adjusted accordingly.

Pharmacokinetics

Contraindications and Cautions

• Allergy to antiplatelet agents. Prevent severe hypersensitivity reactions.
• Known bleeding disorder. Increased risk of excessive blood loss
• Recent surgery. Increased risk of bleeding in unhealed blood vessels
• Closed head injuries. Increased risk of bleeding in injured blood vessels of the brain
• History of thrombocytopenia. Anagrelide decreased bone marrow production of platelets.
• Pregnancy, lactation. Generally inadvisable because of potential adverse effects to fetus or neonate

Adverse Effects

• CNS: headache, dizziness, weakness
• GI: GI distress, nausea
• Skin: skin rash
• Hema: bleeding (oftenly occurs while brushing the teeth)

Interactions

• Increased risk of bleeding if combined with another drug that affects blood clotting.

Nursing Considerations

Here are important nursing considerations when administering antiplatelet agents:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

• Assess for the mentioned contraindications to this drug (e.g. hypersensitivity, acute liver disease, pregnancy etc.) to prevent potential adverse effects.
• Conduct thorough physical assessment before beginning drug therapy to establish baseline status, determine effectivity of therapy, and evaluate potential adverse effects.
• Obtain baseline status for complete blood count and clotting studies to determine any potential adverse effects.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

• Disturbed sensory perception related to CNS effects
• Acute pain related to CNS and GI effects
• Risk for injury related to CNS effects and bleeding tendencies

Implementation with Rationale

These are vital nursing interventions done in patients who are taking antiplatelet agents:

• Administer drug with meals to relieve GI upset.
• Provide comfort measures for headache because pain due to headache may decrease patient compliance to treatment regimen.
• Educate patient on ways to promote safety like using electric razor, soft-bristled toothbrush, and cautious movement because any injury at this point can precipitate bleeding.
• Educate patient on drug therapy including drug name, its indication, and adverse effects to watch out for to enhance patient understanding on drug therapy and thereby promote adherence to drug regimen.

Evaluation

Here are aspects of care that should be evaluated to determine effectiveness of drug therapy:

• Monitor patient response to therapy (e.g. increased bleeding time, prevention of occlusive events).
• Monitor for adverse effects (e.g. bleeding, headache, GI upset).
• Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.
• Monitor patient compliance to drug therapy.

Anticoagulants

• By interfering with clotting cascade and thrombin formation, anticoagulants are able to interfere with the normal clotting process.

Therapeutic Action

•  Warfarin, an oral agent in this class, reduces Vitamin K-dependent clotting factors. As a result, clotting process is prolonged.
• Two new oral agents, dabigatran and rivaroxaban, directly inhibits thrombin (last step in clotting process) and factor Xa, respectively.
• Heparin and antithrombin block formation of thrombin from prothrombin.

Indications

• Among the many indications for this drug class include: stroke and systemic emboli risk reduction, nonvalvular atrial fibrillation, and deep vein thrombosis.
• Heparin is used for prevention of blood clots in blood samples, dialysis, and venous tubing. It also does not enter breastmilk so it is the anticoagulant of choice for lactating women.
• Antithrombin is a naturally-occurring anticoagulant and is a natural safety feature in the clotting system.