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notes for mi 06[1]

notes for mi 06[1]

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Published by: mara5140 on Dec 23, 2008
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05/09/2014

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Medication notes for MI class

You are responsible for the medications that are listed under Myocardial Infarction on the grid on page 49 of your workbook. These notes are a synopsis of what was discussed in class. All of the information from the notes are derived from the group work you produced during the class and from the drug reference books you used (Lehne or your drug handbook).

I advise you to read the pages that are listed on the myocardial infarction
page (page 259) from your workbook.
Heparin:
Action:
\ue000PREVENTS clot formation
\ue000Suppresses coagulation by inactivating antithrombin\ue001 inactivates factor
Xa & thrombin
\ue000Inactivation of thrombin & factor Xa\ue001 suppresses formation of fibrin
\ue000Fibrin is the framework for clots that originate in the VENOUS system ie.
DVT\ue001 used in prevention of DVTs
Therapeutic uses:

\ue000Low dose therapy (5000u): prevention of DVTs post surgery
\ue000High dose therapy: used to treat pulmonary embolism, evolving stroke
\ue000MI clients:

1. used post PTCA since the procedure causes trauma to vessels &
risk of thrombus formation and re-occlusion is high
2. used post thrombolytic therapy (only alteplase & reteplase) to
reduce the risk of re-occlusion
Adverse effects:
\ue000hemorrhage
\ue000heparin-induced thrombocytopenia:
1. decrease in platelet counts (thrombocytopenia) but increase in
thrombotic events
2. immune-mediated, meaning it is an immune reaction from the
patient\u2019s own body
3. 1-3% of patients develop this problem
\ue000hypersensitivity reactions (allergy):
1. heparin is extracted from animal tissues
2. evidenced by allergic reactions: chills, fevers, development of
uticaria (hives)
Nursing Implications:
\ue000can be administered using deep SC, intermittent IV or continuous IV
administration
\ue000observe clients closely for signs of bleeding:
1.monitor for increase in HR, quality\ue001 thready, decrease in BP

2. assess for hematuria, blood in stool
3. assess skin for development of ecchymosis, petechiae, hematomas
4. assess for lumbar pain (adrenal hemorrhage), pelvic pain (ovarian

hemorrhage)
\ue000monitor for allergic reactions
\ue000educate client to:

1. use soft toothbrush, decrease gingival bleeding
2. use of electric razor when shaving
3. call for help when getting out of bed or when ambulating, minimize risk

of bumping into furniture or hospital equipment
Laboratory Monitoring: APTT versus INR
\ue000lab monitoring for clients on heparin: APTT (Lehne) but at some hospitals
(MUHC, for example), physicians use INR
\ue000both these lab tests allow physicians to adjust heparin doses accordingly
\ue000these lab results measure bleeding time; the time it takes for the client\u2019s
blood to form a clot
\ue000the goal when on heparin (or any anticoagulant therapy) is to prevent clots
from forming but not to the point where your client is spontaneously
bleeding
\ue000if the lab values indicate that the bleeding time is too long (ie client is
taking too long to form a clot), the heparin dosage will DECREASE
\ue000if lab values indicate that the bleeding time is too short (ie client forms a
clot in a short period of time), then the heparin dosage will INCREASE
\ue000APTT: activated partial thromboplastin time: actually measures the time (in
seconds) of formation of thromboplastin
\ue000In order to measure any coagulation studies (APTT), laboratories use

reagents however there are many different types of reagents, the results
will vary between laboratories (and even within the same lab, if the lab
decides to change their reagents)

\ue000INR results correct for the variability that exists between the different
reagents
\ue000INR: a ratio between client\u2019s prothrombin time (time In seconds to make
prothrombin) and the laboratory\u2019s normal average of the prothrombin time
(PT)
\ue000Target INR=2.0-3.0\ue001 recommended for prophylaxis of DVT or prevention
of further clotting in MIs
Coumadin (warfarin)
Action:

\ue000Suppresses coagulation by acting as an antagonist to vitamin K
\ue000Four (4) clotting factors need vitamin K for their synthesis
\ue000Suppression of Vitamin K\ue001 suppression of the four (4) clotting factors\ue001

anticoagulant effect
Therapeutic Uses:

\ue000Long term prophylaxis (prevention) of thrombus (clots)
\ue000Prevention of VENOUS thrombosis and pulmonary embolism
\ue000Reduce the risk of recurrent MIs and TIAs (transient ischemic attacks)

Adverse effects:
\ue000Hemorrhage: major complication of coumadin therapy
\ue000Fetal hemorrhage if used during pregnancy

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