1

Ms

● DM, CHF, ANGINA, MI, LIVER CIRRHOSIS, COPD, EMPHYSEMA, CHOLECYSTITIS,

T-TUBES, PERIPHERAL VASCULAR DISEASE, HIATAL HERNIA, NITROGLYCERINE,
CAD

Topics: EMPHYSEMA, ASTHMA, NITROGLYCERIN, CHF, CHEST TUBES, CEPHULAC,

LIVER CIRRHOSIS, ANEMIA, DICUMAROL, CVA, CHEST TRAUMA, WATER SEALED
DRAINAGE SYSTEM

CONGESTIVE HEART FAILURE

HEART FAILURE: clinical syndrome characterized by signs and

symptoms of fluid overload or inadequate tissue perfusion.
- The underlying mechanism of HF involves impaired
contractile properties of the heart (systolic dysfunction) or
filling of the heart (diastolic) that leads to a lower- than-
normal cardiac output.

CLINICAL MANIFESTATIONS NURSING MANAGEMENT ASSESSMENT

Left-Sided HF • Oral and IV medications, - Signs and symptoms of

- Most often precedes
right-sided cardiac failure
• Pulmonary congestion:
dyspnea, cough, pulmonary
crackles, and low oxygen
saturation levels; an extra
heart sound, the S3, or
―ventricular gallop, may be
detected on auscultation.
• Dyspnea on exertion (DOE),
orthopnea, paroxysmal
nocturnal dyspnea (PND).
• Cough initially dry and
nonproductive; may become
moist over time.
• Large quantities of frothy
sputum, which is sometimes
pink (blood-tinged).
• Bibasilar crackles advancing
to crackles in all lung
fields.
• Inadequate tissue perfusion.
• Oliguria and nocturia.
• With progression of HF:
altered digestion; dizziness,
major lifestyle changes,
supplemental oxygen,
implantation of assistive
devices,
and surgical approaches,
including cardiac
transplantation.
• Lifestyle recommendations
include restriction of dietary
sodium; avoidance of
excessive fluid intake, alcohol,
and
smoking; weight reduction
when indicated; and regular
exercise.
Pharmacologic Therapy
- Alone or in combination:
vasodilator therapy
(angiotensinconverting
enzyme [ACE] inhibitors),
angiotensin II receptor
blockers (ARBs), select beta-
blockers, calcium channel
blockers, diuretic therapy,
cardiac glycosides (digitalis),
pulmonary and systemic fluid
overload are recorded and
reported immediately.
- Note report of sleep
disturbance due to shortness
of
breath, and number of pillows
used for sleep.
- Ask patient about edema,
abdominal symptoms, altered
mental status, activities of
daily living, and the activities
that cause fatigue.
- Respiratory: Auscultate lungs
to detect crackles and
wheezes. Note rate and depth
of respirations.
- Cardiac: Auscultate for S3
heart sound (sign heart
beginning to fail); document
heart rate and rhythm.
- Assess sensorium and LOC.
- Periphery: Assess dependent
parts of body for perfusion
and edema and the liver for
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lightheadedness, confusion, and others hepatojugular reflux; assess

restlessness, and • IV infusions: nesiritide, jugular venous distention.
anxiety; pale or ashen and milrinzne, dobutamine - Measure intake and output
cool and clammy skin. • Medications for diastolic to detect oliguria or anuria;
• Tachycardia, weak, thready dysfunction weigh patient daily.
pulse; fatigue. • Possibly anticoagulants,
medications that manage
hyperlipidemia (statins)
Right-Sided HF
• Congestion of the viscera
and peripheral tissues
• Edema of the lower
extremities (dependent
edema),
hepatomegaly (enlargement of
the liver), ascites
(accumulation of fluid in the
peritoneal cavity),
anorexia and nausea, and
weakness and weight gain
due to retention of fluid

Planning and Goals

- Promoting activity and reducing fatigue, relieving fluid
overload symptoms, decreasing anxiety or increasing the
patient’s ability to manage anxiety, encouraging the
patient to verbalize his or her ability to make decisions
and influence outcomes, and teaching the patient about
the self-care program.

ANGINA:
Chest pain” of cardiac origin
- Most common clinical manifestation of myocardial
ischemia
- also known as angina pectoris, is chest pain or pressure, usually caused by insufficient
blood flow to the heart muscle. It is most commonly a symptom of coronary artery disease.
Angina is typically the result of partial obstruction or spasm of the arteries that supply
blood to the heart muscle. The main mechanism of coronary artery obstruction is
atherosclerosis as part of coronary artery disease.

CLINICAL ASSESSMENT AND NURSING PHARMACOLOGIC

MANIFESTATIONS DIAGNOSTIC INTERVENTIONS THERAPY
METHODS

- Pain – choking or - Evaluation of clinical Treating Angina • Nitrates, the

heavy sensation in the manifestations of pain - Take immediate mainstay of therapy
upper chest and patient action if patient (nitroglycerin)
ranging from history reports pain or if the • Beta-adrenergic
discomfort to - Electrocardiogram person’s prodromal blockers (metoprolol
agonizing pain. changes (12-lead ECG), symptoms suggest and atenolol)
- Angina is stress testing, anginal ischemia • Calcium channel
accompanied by blood tests - Direct the patient to blockers/calcium ion
severe apprehension - Echocardiogram, stop all activities and antagonists
and a nuclear scan, or sit or rest in bed (amlodipine and
feeling of impending invasive procedures in a semi-Fowler’s diltiazem)
death. such as cardiac position to reduce the • Antiplatelet and
- The pain is usually catheterization and oxygen anticoagulant
retrosternal, deep in coronary angiography requirements of the medications (aspirin,
 3

the chest behind ischemic myocardium. clopidogrel, heparin,

the upper or middle - Measure vital signs glycoprotein [GP]
third of the sternum. and observe for signs IIb/IIIa agents
- Discomfort is poorly of respiratory [abciximab, tirofiban,
localized and may distress. eptifibatide])
radiate to the neck, - Administer • Oxygen therapy
jaw, shoulders, and nitroglycerin • Eperfusion
inner aspect of the sublingually and procedures – restore
upper arms asses the blood supply
(usually the left arm). patient’s response
- A feeling of weakness (repeat up to three
or numbness in the doses).
arms, wrists, - Administer oxygen Medical Management
and hands, as well as therapy if the patient’s - Decrease the oxygen
shortness of breath, respiratory rate demand
pallor, is increased or if the - Increase the oxygen
diaphoresis, dizziness oxygen saturation supply
or lightheadedness, level is decreased.
and nausea - If the pain is
and vomiting, may significant and
accompany the pain. continues after these
Anxiety may interventions, the
occurs with angina. patient is further
- An important evaluated for acute MI
characteristic of and may be
anginal pain is that it transferred to a
subsides when the higher-acuity nursing
precipitating cause is unit
removed or with
nitroglycerin. Reducing Anxiety
- Explore implications
that the diagnosis has
Gerontologic for the patient.
Considerations - Provide essential
NOTE: The elderly information about the
person with angina illness and
may not exhibit the methods of preventing
typical pain profile progression. Explain
because of the importance of
diminished responses following prescribed
of directives for the
neurotransmitters ambulatory patient
that occur with aging. at home.
• Presenting symptom - Explore various
(elderly) – dyspnea. stress reduction
- Elderly patients methods with patient
should be encouraged (eg,
to recognize their music therapy).
chest pain–like
symptom (eg, Factors that Trigger
weakness) as an Angina Episodes
indication - Sudden or excessive
that they should rest exertion
or take prescribed - Exposure to cold
medications. - Tobacco use
- Heavy meals
- Excessive weight
- Some
over-the-counter
drugs, such as diet
pills, nasal
decongestants, or
drugs that increase

commonly known as a heart attack, occurs when blood flow decreases or stops in
one of the coronary arteries of the heart, causing infarction (tissue death) to the
CLINICAL MANIFESTATIONS:
- Chest pain that occurs
suddenly and continues
despite
rest and medication is the
primary presenting symptom.
- Some patients have
prodromal symptoms or a
previous
diagnosis of coronary artery
disease (CAD), but about half
report no previous symptoms.
- Patient may present with a
combination of symptoms,
including chest pain,
shortness of breath,
indigestion,
nausea, and anxiety.
- Patient may have cool, pale,
and moist skin; heart rate
and the respiratory rate may
be faster than normal. These
signs and symptoms, which
are caused by stimulation of
the sympathetic nervous
system, may be present for
only
a short time or may persist.
heart rate and
blood pressure.
Planning and Goals
- Prevention of angina
Reduction of anxiety
MYOCARDIAL INFARCTION:
heart muscle.
PHARMACOLOGIC THERAPY:
• Nitrates (nitroglycerin) to
increase oxygen supply
• Anticoagulants (aspirin,
heparin)
• Analgesics (morphine sulfate)
• Angiotensin-converting
enzyme (ACE) inhibitors
• Beta-blocker initially, and a
prescription to continue its
use after hospital discharge
• Thrombolytics (alteplase
[t-PA, Activase] and reteplase
[r-PA, TNKase]): must be
administered as early as
possible
after the onset of symptoms,
generally within 3 to 6 hours.
MEDICATIONS:
• Nitrates
- Nitroglycerine, Isosorbide
dinitrate (Isordil), Isosorbide
mononitrate (Imdur)
• Beta Blockers
• Calcium Channel Blockers
• Thrombolytics/ Fibrinolytics
4
NURSING INTERVENTIONS:
- Pain management: MONA
• Morphine
o 2- to 10-mg IV q 5-15 minutes
o AE: respiratory depression,
hypotension,
bradycardia, severe vomiting
o Antidote: Naloxone (Narcan)
0.2 – 0.8 mg IV
o Oxygen: 2-4L/min by nasal
cannula
o Nitroglycerin
o Aspirin
- Positioning – semi fowlers
- Provide a quiet & calm
environment
Relieving Pain and Other Signs
and Symptoms of Ischemia
- Administer oxygen in tandem
with medication therapy to
assist with relief of symptoms
(inhalation of oxygen
reduces pain associated with
low levels of circulating
oxygen).
- Assess vital signs frequently
as long as patient is
experiencing pain.
- Assist patient to rest with
back elevated or in cardiac
chair
to decrease chest discomfort
and dyspnea.
Improving Respiratory
Function
- Assess respiratory function
to detect early signs of
complications.
- Monitor fluid volume status
to prevent overloading the
heart and lungs.
- Encourage patient to
breathe deeply and change
position
often to prevent pooling of
 5

fluid in lung bases.

EMPHYSEMA
: Abnormal distention of the airspaces beyond the terminal
bronchioles and destruction of the walls of the alveoli

ETIOLOGY/GENETIC CLASSIFICATION ASSESSMENT NURSING

RISK: FINDINGS MANAGEMENT

• Major cause: • Panlobar or • Exertional dyspnea - - Administer O2 via

Smoking panacinar 1st symptom nasal cannula (2-3
• Alpha1-Antitrypsin – destruction of the • shortness of breath L/min)
Deficiency (AAT) - • AAT entire alveolus with minimal activity • High flow of O2 may
is made by the liver uniformly; diffuse & • Chronic productive lead to loss of hypoxic
and is normally more severe in the cough with drive
present in the lungs lower lung areas mucopurulent sputum - Teach abdominal
• Function: regulates • Centrilobular or • Decreased breath breathing (using the
proteases from centriacinar sounds, wheezing, diaphragm
working on lung – openings occur in crackles effectively), pursed-lip
structures the bronchioles and • “Barrel shaped chest” breathing
• If AAT is deficient, allow spaces • Use of accessory • Most important risk
COPD develops even if to develop as tissue muscle of respiration factor for COPD is
the person walls breakdown; • Toxic CO2 levels smoking
is not exposed to upper lung Lethargy, stupor, • Chest physiotherapy
cigarette smoke or sections coma (carbon & postural drainage
other irritants • Paraseptal or distal dioxide narcosis)
• Air pollution acinar
(minimal) – only the alveolar
- Pink Puffer ducts and alveolar MEDICAL
sacs are affected; MANAGEMENT:
Signs & symptoms: upper half of the lung
• Barrel chest “Each type can occur - Meds:
• Severe dyspnea alone or in Bronchodilators,
• Thin-framed body combination in the mucolytics,
same lung” antibiotics,
Diagnosis corticosteroids
• Spirometry (limited basis to assist
• CXR: hyperinflation with broncho
with FLATTENED dilation & removal of
diaphragm secretions)
• ABG: - Physical therapy:
o mild-mod hypoxemia deep breathing, CPT,
postural drainage
- NCLEX: The nurse
went to patient with
emphysema and
saw the O2 in just 2mL
because the patient
cannot
breathe properly what
she did is she
increased the O2
saturation and loss
drive results in
respiratory distress.
- Take note 2mL lang
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ang need sa O2

Major Functions of The Liver

• Bile production and excretion
• Excretion of bilirubin, cholesterol, hormones and drugs
• Metabolism of CHO, CHON and fats
• Storage of glycogen, vitamins and minerals
• Synthesis of plasma proteins, such as albumin and
clotting factors
• Detoxification

LIVER CIRRHOSIS

- Chronic, progressive disease characterized by

inflammation, fibrosis, and degeneration of the liver
parenchymal cells
- Destroyed liver cells are replaced by scar tissue, resulting
in architectural changes & malfunction of the liver

• Types
o Laênnec’s cirrhosis
- associated with alcohol abuse and malnutrition;
characterized by an accumulation of fat in the
liver cells, progressing to widespread scar
formation.

o Postnecrotic cirrhosis
- results in severe inflammation with massive
necrosis as a complication of viral hepatitis
o Cardiac cirrhosis
- occurs as a consequence of RSHF; manifested by
hepatomegaly with some fibrosis.

o Biliary cirrhosis
- associated with biliary obstruction, usually in the
common bile duct; results in chronic impairment
of bile excretion

ASSESSMENT PATHOLOGY Consequences of Portal HPN:

• Anorexia, weakness, weight 1) In portal hypertension • Hepatomegaly= initially, then

loss (liver is unable to
metabolize nutrients and store
fat-soluble vitamins)
• Fever (in response to tissue
injury)
• Jaundice, pruritus, tea
colored urine (due to bilirubin
in
- plasma shift into interstitial
spaces within the liver due
to increase pressure. The
collection of fluids shifts
out of the Glisson’s capsule
and accumulate in the
peritoneal cavity
2) The liver is unable to
the liver shrinks in size as
fibrosis replaces the liver
parenchyma
• Splenomegaly= due to
increased backpressure of the
blood
• Caput medusae (dilated veins
over the abdomen)
 7

the blood) metabolize protein, thereby • Spider angioma

• remember!!! bilirubin is
conjugated initially before
excretion
• Increased Bleeding
tendencies. (liver is unable to
store Vit.
K. There is also impaired
production of clotting factors)
hypoalbuminemia occurs
- result to decreased oncotic
pressure, fluids shift out of
the IVC, and accumulate in the
peritoneal cavity.
3) The liver is unable to excrete
adrenal cortex hormone, one
of which is aldosterone
- Hyperaldosteronism leads to
retention of sodium and
water
4) Esophageal varices = 2° to
backpressure
5) Internal hemorrhoids, leg
varicosities, and dependent
edema
- due to venous stasis,
increasing hydrostatic
pressure.
This leads to shifting of
plasma into interstitial space
(telangiectasia / dilated
capillaries over
the face and anterior trunk)=
due to increased estrogen
• Palmar erythema. This is also
due to elevated estrogen
level in males.
• Ascites
• Males (estrogen) will result to:
- Decreased libido, Impotence,
Fall of body hair, Atrophy
of testicles, gynecomastia
• Females (androgen)
- Hirsutism
- acne
- deepening of voice
- Virilism (development or
premature development of
male secondary sexual
characteristics)

ASTHMA

- Asthma is a condition in which your airways narrow and swell and may produce extra
mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing)
when you breathe out and shortness of breath

During an asthma attack, three things can happen:

● Bronchospasm: The muscles around the airways constrict (tighten). When they tighten, it
makes your airways narrow. Air cannot flow freely through constricted airways.

● Inflammation: The lining of your airways becomes swollen. Swollen airways don’t let as much
air in or out of your lungs.

● Mucus production: During the attack, your body creates more mucus. This thick mucus
clogs airways.

What types of asthma are there?

Asthma is broken down into types based on the cause and the severity of symptoms. Healthcare
providers identify asthma as:

● Intermittent: This type of asthma comes and goes so you can feel normal in between asthma
flares.

● Persistent: Persistent asthma means you have symptoms much of the time. Symptoms can
be mild, moderate or severe. Healthcare providers base asthma severity on how often you
 8

have symptoms. They also consider how well you can do things during an attack.

Asthma has multiple causes:

● Allergic: Some people’s allergies can cause an asthma attack. Allergens include things like
molds, pollens and pet dander.

● Non-allergic: Outside factors can cause asthma to flare up. Exercise, stress, illness and
weather may cause a flare.

Treatment

Prevention and long-term control are key to stopping asthma attacks before they start. Treatment
usually involves learning to recognize your triggers, taking steps to avoid triggers and tracking your
breathing to make sure your medications are keeping symptoms under control.
 9

Long-term asthma control medications ,

● Inhaled corticosteroids. These medications include fluticasone propionate (Flovent HFA,
Flovent Diskus, Xhance), budesonide (Pulmicort Flexhaler, Pulmicort Respules, Rhinocort),
ciclesonide (Alvesco), beclomethasone (Qvar Redihaler), mometasone (Asmanex HFA,
Asmanex Twisthaler) and fluticasone furoate (Arnuity Ellipta).

● Anticholinergic agents. Like other bronchodilators, ipratropium (Atrovent HFA) and

tiotropium (Spiriva, Spiriva Respimat) act quickly to immediately relax your airways, making it
easier to breathe. They're mostly used for emphysema and chronic bronchitis, but can be
used to treat asthma.

● Bronchodilators: These medicines relax the muscles around your airways. The relaxed
muscles let the airways move air. They also let mucus move more easily through the airways.
These medicines relieve your symptoms when they happen and are used for intermittent
and chronic asthma.

● Oral and intravenous corticosteroids. These medications — which include prednisone

(Prednisone Intensol, Rayos) and methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol) —
relieve airway inflammation caused by severe asthma.

● Anti-inflammatory medicines: These medicines reduce swelling and mucus production in

your airways. They make it easier for air to enter and exit your lungs. Your healthcare
provider may prescribe them to take every day to control or prevent your symptoms of
chronic asthma.

● Biologic therapies for asthma: These are used for severe asthma when symptoms persist
despite proper inhaler therapy.

Tests to measure lung function

● Spirometry. This test estimates the narrowing of your bronchial tubes by checking how
much air you can exhale after a deep breath and how fast you can breathe out.

● Peak flow. A peak flow meter is a simple device that measures how hard you can breathe out.
Lower than usual peak flow readings are a sign that your lungs may not be working as well
and that your asthma may be getting worse. Your doctor will give you instructions on how to
track and deal with low peak flow readings.
 10

ANEMIA

- Deficiency of RBCs, Hgb, Hct

• Hct -percentage of PRBCs/ dl of blood
- Anemia results from:
• Blood loss
• Inadequate or abnormal RBC production
• Destruction of RBCs

TYPES OF ANEMIA Iron Deficiency Anemia Pernicious Anemia

Microcytic, Hypochromic - Caused by a deficiency of

anemia caused by:
• Inadequate intake of iron
• Decreased absorption of iron
in GIT
• Excessive loss of iron
intrinsic factor (substance
normally secreted by the
gastric mucosa)
- Intrinsic Factor is necessary
for absorption of Vitamin B12

(excessive bleeding or blood
loss)
ASSESSMENT FINDINGS • Reduced energy, Cold
sensitivity, Fatigue, DOE
• HR even at rest
• decreased CBC, Hgb, Hct,
serum Fe
CLINICAL MANIFESTATIONS • Dyspnea, chest pain, muscle
pain or cramping,
tachycardia
• Weakness, fatigue, general
malaise
• Pallor of the skin and mucous
membranes
(conjunctivae, oral mucosa)
• Jaundice (megaloblastic or
hemolytic anemia)
• Smooth, red tongue
(iron-deficiency anemia)
11
- Vitamin B12 is needed for the
maturation of erythrocytes
- without Vitamin B12
- Paresthesia: Vitamin B12 is
needed for normal nerve
function
- Client’s history, Symptoms,
Blood & BM studies
• Microscopic exam: large &
immature erythrocytes
• Schilling test
- measures absorption of
radioactive Vitamin B before
and after parenteral
administration of intrinsic
factor
- Definitive test for pernicious
anemia
- used to detect lack of
intrinsic factor
- The Schilling test is
performed by administering
58Co- labeled cobalamin and
collecting urine for 24 h and is
dependent upon normal renal
and bladder function. As a
consequence, cobalamin
absorption may be abnormal
in Pernicious anemia
- Usually seen in elderly
(production of IF decreases
with
age & gastric mucosal
atrophy) & in client’s w/ history
of surgical removal of
stomach, bowel resection
(ileum)
- Stomatitis, glossitis (a
smooth, beefy-red tongue)
- Pallor, fatigue, DOE
- Severe cases: jaundice,
irritability, confusion,
- Numbness & tingling in the
arms & legs & difficulty with
gait or balance (neurologic
involvement)
- Stomatitis, glossitis (a
smooth, beefy-red tongue)
- Pallor, fatigue, DOE
 12

• Beefy, red, sore tongue - Severe cases: jaundice,

(megaloblastic anemia) irritability, confusion,

• Angular cheilosis (ulceration - Numbness & tingling in the

of the corner of the arms & legs & difficulty with
mouth) gait or balance (neurologic
involvement)
• Brittle, ridged, concave nails
and pica (unusual
craving for starch, dirt, ice) in
patients with iron-
deficiency anemia

MEDICAL MANAGEMENT Treat & eliminate the cause
• Correction of faulty diet, oral
supplement or parenteral
administration of iron is
prescribed
- Administration of Vitamin B12
(IM) weekly & monthly for
maintenance

• Blood Transfusion in severe

case

• People aged 50 years or older

should have periodic
colonoscopy, endoscopy, or
x-ray examination of the GI
tract to detect ulcerations,
gastritis, polyps, or cancer.

• Administer prescribed iron

preparations (oral,
intramuscular [IM], or IV).

• Have patient continue iron

preparations for 6 to 12
months.

NURSING MANAGEMENT •Monitor for signs and - Provide a Vitamin B12-rich

symptoms of abnormal
bleeding especially from the
GIT
• Oral iron supplements for
mild iron losses (FeSO4)
diet
- Liver, Organ meats, Dried
beans, Nuts, Green leafy
vegetables, Citrus fruit,
Brewer’s yeast

• prophylactic use:300-325mg - Avoid highly seasoned,

therapeutic use- 600- coarse, or very hot foods if
1200 mg daily in divided dose client has stomatitis & glossitis

• Take iron with or immediately - Provide mouth care before &

after a meal to avoid GI
upset
• Take with orange juice or
vitamin C source ( absorption)
• Use straw (elixir preparations)
to prevent staining of teeth
after meals using a soft
toothbrush and nonirritating
rinses
- Bed rest may be necessary if
anemia is severe

• Expect iron to color stool

dark green or black

Provide dietary teaching

 13

regarding foods high in iron

• Liver especially pork & lamb

• Red meat, Organ meats,
Kidney beans
• Whole-wheat breads and
cereals
• Leafy green vegetables
• Carrots, Egg yolk, Raisins

IRON DEFICIENCY ANEMIA

PERNICIOUS ANEMIA
14
15
 16

CHEST TRAUMA
17
18
19
20
 21

CVA
22
23
 24

CEPHULAC, DICUMAROL AND NITROGLYCERIN

USES SIDE EFFECTS USES SIDE EFFECTS

CEPHULAC Gas, bloating, Nitroglycerin Headache,

This drug is used burping, dizziness,
by mouth or stomach extended-relea lightheadednes
rectally to treat or rumbling/pain, se capsules are s, nausea, and
prevent
complications of nausea, and used to flushing may
liver disease cramps may prevent chest occur as your
(hepatic occur pain(angina) in body adjusts to
encephalopathy).
It does not cure people with a this
the problem, but A very serious certain heart medication.
may help to allergic condition
improve mental
status. Lactulose reaction to this (coronary
is a colonic drug is rare. artery
acidifier that However, get disease). This
works by
decreasing the medical help medication
amount of right away if belongs to a
ammonia in the you notice any class of drugs
blood. It is a
man-made sugar symptoms of a known as
solution. serious allergic nitrates.
reaction, Angina occurs
-If you are
 25

taking this including: rash, when the heart

medication by itching/swelling muscle is not
mouth for liver (especially of getting enough
disease, take it the blood. This
as directed by
face/tongue/th drug works by
your doctor,
usually 3 to 4 roat), severe relaxing and
times a day. To dizziness, widening blood
improve the trouble vessels so
taste, you may breathing. blood can flow
mix it into fruit more easily to
juice, water, the heart.This
milk, or a soft medication will
dessert. The not relieve
goal is to have chest pain once
2 to 3 soft it occurs. It is
stools each
also not
day
intended to be
taken just
before physical
activities (such
as exercise,
sexual activity)
to prevent
chest pain.

USES SIDE EFFECTS

Dicoumarol is an oral anticoagulant dizziness; lightheadedness; red or

agent that works by interfering with
the metabolism of vitamin K. In
addition to its clinical use, it is also
used in biochemical experiments as an
inhibitor of reductases.
black, tarry stools; coughing up or
vomiting fresh or dried blood that
looks like coffee grounds; severe
headache; and weakness.

-For decreasing blood clotting. Often

used along with heparin for treatment
of deep vein thrombosis