1
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2
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3
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4
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- Atherosclerosis
- Immobility (particularly after surgery)
- Dysrhythmias (Atrial Fibrillation)
- Artificial Heart Valves
- These clients require prophylactic anticoagulation or……
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5
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- Thrombophlebitis
- Deep vein thrombosis (DVT)
- Myocardial Infarction (MI)
- Pulmonary Embolus (PE)
- Cerebrovascular Accident (CVA)
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6
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7
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- Heparin
- (SQ or IV)
- Half-life 1-2 hrs
- Enoxaparin (Lovenox)
- Warfarin (Coumadin)
- (PO)
- Half-life 0.5-3 days
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8
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- Turns off 3 main activating factors:
- II (thrombin)
- IX
- X
- And to a lesser extent XI & XII
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9
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- More specific for turning off activating factors:
- X
- And to a lesser extent II (thrombin)
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10
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- More specific for turning off activating factors:
- II
- VII
- IX
- X
- These factors rely heavily on Vitamin K for synthesis, so Warfarin
works by interfering with proper production of Vitamin K
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11
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12
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- aPTT (1.5 –2.0 x control) = Heparin
- (Activated Partial
Thromboplastin Time)
- INR (2.0-3.0 seconds for oral anticoagulation = Warfarin
- (International Normalized
Ratio)
- PT (1.5-2.5 x control) = Warfarin
- (Prothrombin Time)
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13
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14
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- Rationale for drug
- Correct dose
- Site assessment
- Check labs for therapeutic effects
- Monitor for adverse effects
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15
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- Increase risk of BLEEDING: avoid trauma
- Periodic blood tests for Coumadin Therapy
- Note OTC medications
- Note diet
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16
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- Acetylsalicylic Acid (Aspirin)
- Clopidogrel (Plavix)
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17
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- Increase risk of BLEEDING: avoid trauma
- ASA precautions
- No ETOH or cigarette smoking
- Note timing of antacids
- Note diet
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18
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