With iv bleeding xcessive aminocaproic acid amicar

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Unformatted text preview: asminogen to form active complex Thrombolytic Thrombolytic Therapeutic uses Therapeutic – Acute coronary thrombosis (acute MI) – Deep venous thrombosis (DVT) – Massive pulmonary emboli Adverse effects – Bleeding – excessive fibrinolysis can be reversed with IV Bleeding xcessive aminocaproic acid (Amicar) aminocaproic – Antibody production allergic reaction Antibody – Hypotension (be careful with this and vasodilators) – Fever 33 Alteplase (tPa) Alteplase Converts plasminogen to plasmin Slightly better than streptokinase for Slightly treating MI, but is much more expensive treating Given in accelerated schedule Thrombolytic Thrombolytic Therapeutic uses – Myocardial infarction – Ischemic stroke – Massive pulmonary emboli 34 Alteplase (tPa) Alteplase Adverse effects – Bleeding Risk for intracranial bleeding higher than with Risk streptokinase streptokinase – Fever Advantages – Does not cause allergic reactions – Does not induce hypotension 35 Critical Thinking Exercise Critical Mrs. T. is receiving a continuous heparin Mrs. infusion. You note bruising on her arms and her aptt is 150 with control of 30. What drug might you anticipate giving this patient? What are a PTT and a PT? What drugs do these lab tests monitor? What 36 36 Critical Thinking Case Study Critical Ms. J had right hip replacement surgery 3 days ago. She was on low-dose Ms. heparin therapy to prevent DVT. On initial assessment of the patient, the nurse finds her right calf to be tender to palpation, with a red, warm vein on the posterior surface. The nurse reports this finding, and Ms. J is diagnosed with DVT of the right calf. She is placed on IV heparin therapy and bed rest. 1. What actions should the nurse take before administering the IV heparin? 1. - check calcium levels and get a baseline of her apTT, you want to get check her CBC (platelets, hemoglobin, hematocrit), then take her vitals, and an external assessment. Hematocrit will show she is bleeding 2. What medication should the nurse have on hand for a patient receiving 2. What IV heparin therapy? Protamine sulfate 3. When evaluating Ms. J’’s daily blood test results, the nurse notes s 3. decreasing hematocrit and blood cell counts, an aPTT of 90 seconds, and a platelet count of 95,000. How does the nurse interpret these 37 findings? Critical Thinking Exercise Critical Mr. J., age 50, is being admitted to the hospital for Mr. the third time this year. He has a history of alcohol abuse, diabetes, and heart failure. He is complaining of abdominal pain and vomiting bright red blood. His diagnosis is perforated ulcer. Mr. J. states that he has been taking warfarin for an irregular heart beat. warfarin 1. What factors may have contributed to Mr. J.’’s s acute bleeding episode? acute 2. What nursing diagnoses and patient outcomes What would be essential in this situation? would 1. 3. Give him IV and blood products and vit K What medications might be ordered for Mr. J.? 38 Critical Thinking Exercise Critical Mr. B. has experienced a transient ischemic Mr. attack...
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