1. Chapter 23 Thrombo-Embolic diseases

2. 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)

3. 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

4. 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**

5. 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

6. 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)

7. 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

8. 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

9. 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

10. 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: mg 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

11. 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

12. Assisting With the Nursing Process dipryidamole (Persantine):
ASSESSMENT: measure vital signs
PLANNING: oral dose forms: 25, 50, 75mg tablets
IMPLEMENTATION: usual dose is mg 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

13. 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

14. 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

15. 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

16. 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)

17. 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

18. 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