Chapter 23 Thrombo-Embolic diseases

thrombosis: process of clot formation thrombus: blood clot embolus: small part of thrombus that breaks off and travels through the vascular system until it lodges in a blood vessel (fig 23-1B, pg 293) embolus causes ischemia or infarction to the area below the obstruction ischemia: decreased supply of oxygenated blood to a body part, person has pain. Involved organ/tissues cannot function properly infarction: local area of tissue death (fig 23-2, pg 293)

major causes of thrombosis: diseases associated with abnormal clotting within blood vessels are: thrombo-embolic diseases major causes of thrombosis: immobility with venous stasis (slowed blood flow through a vein) surgery and post-op period leg trauma heart failure vaso-spasm cancer- lung, prostate, stomach, pancreas pregnancy contraceptive agents (ch.29) heredity

diseases caused by clotting within blood vessels are major causes of death, they include: deep vein thrombosis myocardial infarction (MI) dysrhythmias with clot formation coronary artery spasm leading to clot formation **see box 23-1 pg. 294 for methods used to treat**

Delegation Guidelines Drugs Used to Treat Thrombo-Embolic Disorders: Some drugs used to treat thrombo-embolic disorders are given parenterally- by subcutaneous or intravenous injection. Because you do NOT give parenteral dose forms, they are NOT included in this chapter. Should a nurse delegate the administration of such to you, you must: - remember that parenteral dosages are often very different from dosages other routes -Refuse the delegation. Make sure to explain why. Do NOT just ignore the request. Make sure the nurse knows that you cannot give drug and why

called anti-platelet agents prevent platelet aggregation (clumping) drugs used to treat Thrombo-embolic diseases Platelet Inhibitors: called anti-platelet agents prevent platelet aggregation (clumping) used to reduce arterial clot formation examples: aspirin dipyridamole (Persantine) clopidogrel (Plavix) ticlopidine (Ticlid)

Aspirin: used to relieve pain, fever, inflammation (ch. 17) drugs used to treat Thrombo-embolic diseases Aspirin: used to relieve pain, fever, inflammation (ch. 17) inhibits platelet clumping and prolongs bleeding time platelet loses its ability to clump and form clots for the duration of its lifetime (platelets live 7-10 days) aspirin used to reduce risk of MI in persons with previous MI or persons who have angina (ch 21) also used to reduce risk of re-current transient ischemic attacks and stroke caused by blood clots

transient ischemic attack (TIA): drugs used to treat Thrombo-embolic diseases Aspirin cont…..: transient ischemic attack (TIA): blood supply to brain is interrupted for a short time sometimes a TIA occurs before a stroke stroke: disease that affects the arteries that supply blood to the brain occurs when a blood clot blocks flow to the brain another cause: when a blood vessels in brain bursts (cerebral hemorrhage) brain cells in the affected area do not get enough oxygen and nutrients brain cells die, brain damage occurs functions controlled by that part of the brain are lost

Aspirin cont….. goals of therapy: reduce frequency of TIA drugs used to treat Thrombo-embolic diseases Aspirin cont….. goals of therapy: reduce frequency of TIA reduce frequency of stroke reduce frequency of MI

Assisting With the Nursing Process Aspirin: ASSESSMENT: observe alertness and orientation to person, time and place, observe persons balance, hearing, hand strength. Test stools for occult blood. PLANNING: see table 17-2 (ch. 17 p. 227) IMPLEMENTATION: to prevent blood clots: 81-325mg daily. Larger doses may be given, usually divided into 325mg in 2, 3, or 4 doses daily. Dose depends on person’s history of clot formation and other drugs they take. Give drug with meals EVALUATION: see ch. 17, pg 228

dipryidamole (Persantine): prevents excessive blood clotting drugs used to treat Thrombo-embolic diseases dipryidamole (Persantine): prevents excessive blood clotting used with other drugs to reduce risk of blood clots after heart valve replacement

Assisting With the Nursing Process dipryidamole (Persantine): ASSESSMENT: measure vital signs PLANNING: oral dose forms: 25, 50, 75mg tablets IMPLEMENTATION: usual dose is 75-100mg 4x/day with warfarin or 75mg is given 3 or 4x/day with aspirin EVALUATION: report and record: -dizziness, abdominal distress: these tend to resolve with continued therapy. -Observe for orthostatic hypotension, measure BP (standing/supine), provide for safety

clopidogrel (Plavix): helps prevent harmful blood clots drugs used to treat Thrombo-embolic diseases clopidogrel (Plavix): helps prevent harmful blood clots used to prevent strokes, MI

Assisting With the Nursing Process clopidogrel (Plavix): ASSESSMENT: measure vital signs, ask about GI symptoms PLANNING: oral dose forms: 75mg tablets IMPLEMENTATION: usual dose is 75mg once/day, drug is given with food or on an empty stomach EVALUATION: report and record: -nausea, vomiting, anorexia, diarrhea: these tend to resolve with early doses, tend to resolve, give drug with food -sore throat, fever, fatigue: may signal changes in white blood cells -bleeding: includes nosebleeds, easy bruising, bright red or “coffee ground” emesis, blood in urine, dark tarry stools

Assisting With the Nursing Process drugs used to treat Thrombo-embolic diseases ticlopidine (Ticlid): prevents excessive blood clotting used to prevent stroke Assisting With the Nursing Process ASSESSMENT: measure vital signs, ask about GI symptoms PLANNING: oral dose from is 250mg IMPLEMENTATION: usual dose is 250mg 2x/day, given with meals EVALUATION: report and record: -nausea, vomiting, anorexia, diarrhea: tend to occur with early doses, usually resolves, give with food -sore throat, fever, fatigue: may signal changes in white blood cells -bleeding: includes nosebleeds, easy bruising, bright red or “coffee ground” emesis, blood in urine, dark tarry stools

used to prevent arterial and venous thrombi drugs used to treat Thrombo-embolic diseases Anti-Coagulants: used to prevent arterial and venous thrombi often called “blood thinners” intent is to prevent blood clots from forming or growing larger cannot dissolve an existing clot common drugs: heparin: only given subcutaneously or intravenously warfarin (Coumadin)

very strong anti-coagulant drugs used to treat Thrombo-embolic diseases Warfarin: very strong anti-coagulant inhibits the activity of vitamin K (Vit K needed for blood clotting) used to prevent: venous thrombosis embolism associated with atrial fibrillation embolism associated with heart valve replacement pulmonary embolism MI

Assisting With the Nursing Process warfarin (Coumadin): ASSESSMENT: measure vital signs, check for bleeding: nosebleeds, bleeding gums, bruising, bright red or “coffee ground” emesis, blood in urine (hematuria), dark tarry stools. Ask about GI symptoms PLANNING: oral dose forms: 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10mg tablets IMPLEMENTATION: give dose only if nurse instructs you to do so, the nurse checks laboratory prothrombin times before drug is given. Oral dose usually 10mg daily for 2-4 days, maintenance dose is usually 2-10mg daily. EVALUATION: report and record: -bleeding: includes nosebleeds, easy bruising, bright red or “coffee ground” emesis, blood in urine, dark tarry stools -low blood pressure, rapid pulse, cold, clammy skin; faintness, changes in alertness: may signal internal bleeding