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ANTICOAGULANTS ANTIPLATELETS AND THROMBOLYTICS drugs used to maintain or…

- - - - These drugs are also used for pulmonary embolism, DVT, noncoronary arterial occlussion from an acute thromboembolism, and thrombolic stroke.
        
        Commonly used Thrombolytics:
        :explode: urokinase (Abbokinase)
        :explode: alteplase tPA (Activase)
        :explode: reteplase rPA (Retavase)
        :explode: tenecteplase TNK-tPA (TNKase)
        :explode: streptokinase (Streptase)
        
        :warning:Side Effects and Adverse Reactions:warning::
        Allergic reactions can complicate thrombolytic therapy. Anaphylaxis (vascular collapse) occurs more frequently with streptokinase than with the other thrombolytics. If the drugs are administered through an intracoronary catheter after myocardial infarction, reperfusion dysrythmia or hemorrhagic infarction at the myocardial necrotic area can result. The major complication of thrombolytic drugs is hemorrhage. The antithrombolytic drug aminocaproic acid (Amicar) is used to stop bleeding by inhibiting plasminogen activation, which inhibits thrombolysis.
        
        Nursing Process:
        
        Patient Teaching
        
        :star: Explain thrombolytic treatment to patient and family. Be suportive.
        
        Side Effects
        
        :star: Advise patient to report any side effects, such as lightheadedness, dizziness, palpitations, nausea, pruritus, or urticaria.
        
        Nursing Interventions
        
        :star: Monitor vital signs. increased pulse rate followed by decreased blood pressure usually indicates blood loss and impending shock. Record vital signs, and report changes.
        :star: Observe for signs and symptoms of active bleeding, from the mouth or rectum. Hemorrhage is a serious complication of thrombolytic treatment. Aminocaproic acid can be given as an intervention to stop the bleeding.
        :star: Examine patient for active bleeding for 24 hours after thrombolytic therapy has been discontinued: q15min for the first hour, q30min until 8 hours, and the hourly.
        :star: Observe for signs of allergic reaction to thrombolytics, such as itching, hives, flush, fever, dyspnea, bronchospasm, hypotension, and/or cardiovascular collapse.
        :star: Avoid adminstering aspirin or NSAIDs for pain or discomfort when patient is receiving a thrombolytic. Acetaminophen can be substituted.
        :star: Monitor Electrocardiogram for precense of reperfusion dysrythmias as blood clot is dissolving; antidysrhythmic therapy may be indicated.
        :star: Avoid venipuncture/arterial sticks.
        
        Planning
        
        :star: Patient's blood clot will be dissolved.
        :star: Patient's vital signs will be monitored for stability during and after thrombolytic therapy.
        :star:Patient will not have excessive bleeding from thrombolytic therapy.
        
        Nursing Diagnoses
        
        :star: Decreased cardiac output related to excessive bleeding
        :star: Anxiety related to fear of the unknown secondary to coronary artery disease.
        :star: Impaired tissue integrity related to a thrombus or embolus secondary to heart attack, stroke.
        :star:Risk for injury related to thrombus or embolus
        
        Assessment
        
        :star:Assess baseline vital signs for comparison with future values.
        :star:Check baseline complete blood count (CBC), prothrombin time (PT), or international normalized ratio (INR) values before administration of thrombolytics.
        :star: Obtain medical and drug history. Contraindicationsfor use of thrombolytics include recent cerebrovascular accident (CVA), active bleeding,severe hypertension and anticougulant therapy. Report if patient takes aspirin or nonsteroidal antinflammatory drugs (NSAIDs). Thrombolytics are contraindicated for patients with a recent history of traumatic injury, specially head injury.
        
        Evaluation
        
        :star: Determine effectiveness of drug therapy: clot has dissolved, vital signs are stable, no signs or symptoms of active bleeding, and patient is pain free.
- - - - INTERVENTIONS
        Review any medications, vitamins, minerals, and supplements being taken that can interfere with therapy such as aspirin, NSAIDs, certain antibiotics, fish oil, garlic supplements, and ginko biloba
        Depending on the anticoagulant ordered, monitor INR, aPTT, ACT, anti-factor XA levels, CBC, creatinine, factor X levels, hemoglobin, hematocrit, platelets and liver enzymes
        Monitor and reduce risk of bleeding especially with patients that have an active gastric ulcers, prior bleeding history, low platelets, hepatic or renal failure, rheumatic disease, cancer and >85yrs of age
        Observe and teach patient to report any signs of bleeding such as black or bloody stools, bloody urine, coffee-ground or bloody vomit, nosebleeds, oozing or visible bleeding from trauma site or incision, excessive menstrual bleeding, petechiae, echymosis. Observe vital signs for bleeding such as hypotension and tachycardia
        Avoid IM injections, minimize venipunctures, use small gauge needles for venipunctures if needed, apply manual pressure for at least 10 min on venipuncture sites
        Assess for heparin-induced thrombocytopenia - which can be a complication due to therapy
        
        PATIENT CARE
        Avoid restrictive clothing for patient
        Apply moisturizing lotion to skin
        use electric razors /not straight razors perform physical care in a gentle manner/reposition pt gently and regularly
        instruct patient not to forcefully blow nose -prevent epistaxis
        Humidify O2 if it is ordeered
        use soft toothbrushes or foam swabs for oral care
        Limit tape application/use paper tape/ remove carefully
        administer stool softeners to avoid straining
        lubricate tubes adequately (ex; suction)
        use support pads, mattresses, therapeutic beds
        apply SCD or compression stockings with attention to proper size , application and use
        Perform risk for fall and skin breakdown assessments and implement all safety measures as needed