Chapter 26: Coagulation Modifier Drugs Test, Enoxaparin, Pharmacology for Nurses: Practical
The key terms in this Pharmacology course include Coagulation Modifier Drugs, Patient, Nurse, Enoxaparin, Pharmacology for Nurses: Practical Applications
While observing a patient self-administer enoxaparin, the nurse identifies the need for further teaching when the patient performs which self-injection action?
Does not aspirate before injecting the medication
Injects the medication greater than 2 inches away from the umbilicus
Administers the medication into subcutaneous (fatty) tissue
Massages the site after administration of the medication
It is not recommended to massage the area of injection of anticoagulants because of the increased risk of hematoma formation.
The nurse is preparing a patient with acute chest pain for an emergency angioplasty. The nurse would anticipate administering which medication to prevent platelet aggregation?
Protamine
Tirofiban
Aminocaproic acid
Tirofiban is a glycoprotein IIb/IIIa inhibitor that blocks the enzyme essential for platelet aggregation. This is given to prevent the formation of further clots and is faster acting than warfarin. Protamine sulfate is the antagonist for heparin, not an anticoagulant. Aminocaproic acid is an antifibrinolytic, the opposite of what is needed in this situation. Enoxaparin
The nurse is caring for a patient admitted with gastrointestinal bleeding who is anticoagulated with warfarin. Which medication should the nurse anticipate administering?
Protamine
Vitamin E
Vitamin K
Calcium gluconate
Vitamin K is the antagonist for warfarin.
A patient is prescribed oral anticoagulant therapy while still receiving IV heparin infusion. The patient is concerned about risk for bleeding. What is the nurse’s best response?
“Because you are now getting out of bed and walking around, you have a higher risk of blood clot formation and therefore need to be on both medications.”
“Bleeding is a common adverse effect of taking warfarin. If bleeding occurs, your health care provider will prescribe an injection of medication to stop the bleeding.”
“It usually takes 4 to 5 days to achieve a full therapeutic effect for warfarin, so the heparin infusion is continued to help prevent blood clots until the warfarin reaches its therapeutic effect.”
“Because of your mechanical valve replacement, it is especially important for you to be fully anticoagulated, and the heparin and warfarin together are more effective than one alone.”
Warfarin works by decreasing the production of clotting factors. However, it takes 4 to 5 days for the body to use up present clotting factors and thus achieve a full therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved. Enoxaparin
The nurse determines the patient has a good understanding of the discharge instructions regarding warfarin with which patient statement?
“I should keep taking ibuprofen for my arthritis.”
“I will double my dose if I forget to take it the day before.”
“I should use a soft toothbrush for dental hygiene.”
“I should decrease the dose if I start bruising easily.”
The patient should reduce the risk of bleeding, such as using a soft toothbrush. The other choices are inaccurate.
For a patient receiving an IV infusion of alteplase which nursing actions should be taken? (Select all that apply.)
Assess for cardiac dysrhythmias.
Record vital signs and report changes.
Observe for signs and symptoms of bleeding.
Administer injections intramuscularly.
Monitor for an increase in liver enzymes.
Alteplase can cause bleeding as well as cardiac dysrhythmias. Vital sign changes can alert the nurse to these complications. Alteplase does not directly affect liver enzymes. Injections should not be administered intramuscularly because of the increased risk of bleeding.