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NURB 3150 Test With Complete Solution
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NURB 3150 Test With CompleteSolution
Hemostasis Answer Any process that stops bleeding (compression, surgery,
cauterization)
Coagulation Answer Process of clotting
Thrombus Answer Blood clot
Embolus Answer A blood clot that has dislodged from the vessel wall and is moving
through the bloodstream
Fibrin Answer Stringy protein produced by fibirnogen during the clotting process, major
component of blood clots increased
Fibrinolysis Answer Reverse of clotting process, mechanism by which clots are listed
(broken down)
Coagulation modifiers Answer anticoagulants
antiplatelets
antifibrinolytics
thrombolytics
Anticoagulant therapy Answer Primarily prophylactic and used when likelihood of cot
formation is high
Anticoagulant therapy Answer Prevent fibrin deposits, extension of thrombus and
thromboembolic complications
Anticoagulant action Answer Decrease blood coagulability, no effect on existing
thrombus
Oral or parenteral
Heparin Answer Solution for CVADs
Binds to antithrombin III and turns off the coagulation pathway to prevent clots from
forming
Heparin Answer Does not dissolve clots, just prevents new ones from forming
Heparin Answer Metabolized in liver and excreted from kidney
,Dosed in units
Heparin indications Answer When there is a need for rapid anticoagulation
-surgery of heart and blood vessels
-dialysis
-sudden arterial occlusion
-DVT and thrombophlebitis (prevent PE)
-Disseminated Intravascular Coagulation
Heparin CI Answer Preexisiting conditions that would be life threatening if bleeding
occurred
-threaten abortion
-aneurysm
-ICB
-severe HTN
-hemophilia
-thrombocytopenia
Heparin Answer Cautious use in conditions with increased risk of bleeding
-childbirth
-trauma
-active ulcer Ds
-liver Ds
Heparin Answer AEs
-bleeding and hemorrhage
HIT (heparin induced thrombocytopenia)
Coagulation studied Answer PRIOR TO INITIATION- baseline aPTT, PT, CBC and
platelets
6 hours AFTER- check PTT again IN OPPOSITE ARM
25-35 sec Answer Normal PTT
45-70 (1.5-2.5 times normal) Answer Therapeutic PTT
,Parenteral heparin subq Answer Onset- 20-60min
5000 unit q 6 hour
Do not aspirate or rub
Hold for 3 seconds
Roatate sites
Double check w another nurse
Tuberculin syringe
IV heparin Answer Onset immediate
Loading dose
Continuous infusion on pump, provided constant blood level and less risk for
complications
Heparin Answer Document ml/hr and u/hr
Heparin Answer Watch for s/s of bleeding (blood in stool, hematuria, epistaxis)
Avoid shaving w razor
Soft toothbrush
Limit needle sticks
Can precipitate HIT so look for SUDDEN decrease in platelets
Protamine sulfate Answer Heparin antidote
Give slowly no faster than 50 mg over 10 min
Rapid infusion can cause HyTN, bradycardia, flushing
May cause pulmonary edema and anaphylaxis
Check ACTs (activated clotting times)
Low molecular weight heparin Answer Work similarly to unfractionated heparin but
smaller and less protein bound
Much more predictable anticoagulation response
Frequent lab monitoring is NOT needed
Longer half life
More effective than SQ heparin
, low molecular weight heparin Answer Given SQ only except occasional enoxaparin Iv
2 inches from umbilicus
Often given until Coumadin is effective
Low molecular weight heparin types Answer Fragmin/dalteparin u/kg
Lovenox/enoxaparin mg/kg
Innohep/tinxaparin
Coumadin (warfarin) Answer Inhibits Vitakin K synthesis- inhibiting activation of several
clotting factors in the liver- prevention of clot formation
Prevents extension of formed clots and formation of new clots
Long term therapy
Short term- started while on heparin s to build up to therapeutic level
Coumadin Answer Indications-
Chronic A Fib
Prophylaxis and treatment of DVT
Mechanical heart valves
Coumadin Answer Pharm- highly protein bound
Metabolized in liver, excreted in kidney
Onset-2-3 days
Duration- 2-5 days
Maximum effect 3-5 days
Half life- 0.5-3 days
Coumadin Answer Load 5-10mg x _days then 2-4 mg/day
Usually given at 1600 to ensure time to get lab results and adjust dose if needed
Coumadin Answer Monitoring therapy-
Protime (PT)
INR
Get lab results daily at start of tx
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