anticoagulants - heparin and warfarin AND Hyperkalemia AND fluid volume deficit and excess

what is an anticoagulant

medications that prevent blood clots from forming in the body

what is the antidote for heparin

protamine sulfate

what are the adverse effects of heparin

1. bleeding

2. heparin-induced thrombocytopenia

what is heparin induced thrombocytopenia

when pt forms micro clots throughout the body, causing ischemia

when you’re on heparin, which levels should be monitored

aPTT levels should be between 60- 80 seconds on heparin but normally it’s between 20-45 seconds, if it’s any more than it’s too much coagulation

What are the signs of warfarin

1. bleeding

2. GI upset

3. hepatits

what are you monitoring when you’re on warfarin

PT-INR: INR levels should be between 2-3, PT levels should between 17-26

what is the antidote for warfarin

vitamin K

how do heparin and warfarin work together

when a patient first needs an anticoagulant, in a dire situation, they’ll take heparin because it’s fast acting. Once reached into therapeutic levels, pt will switch over to warfarin

what is the patient teaching for warfarin

maintain vitamin K levels

when would you use heparin

1. stroke

2. DVT

3. pulmonary embolism

what can warfarin be used for

1. DVT

2. Pulmonary embolism

3. Afib with thrombus

4. myocardial infarction

causes of hyperkalemia

DKA, metabolic acidosis, salt substitutes, and kidney failure

signs and symptoms of hyperkalemia

• dysrhythmias!!

• muscle weakness

• numbness/tingling

• nausea/vomiting

treatment for hyperkalemia

1. diuretic

2. kayexalate

3. insulin

4. decreased intake of potassium rich-foods

what is the normal level for potassium

3-5

what is fluid volume deficit

when fluid output > fluid intake and causes hypovolemia

fluid volume signs and symptoms

• hypotension

• tachypnea and tachycardia

• weak thready pulses

• thirsty

• prolonged capillary refill

• oliguria

• weak feeling

• flat jugular vein

treatment for hypovolemia and nursing consideration

1. replace fluids IV

2. closely monitor I&O

3. fall precautions

what is fluid volume excess

when intake of fluid or inadequate excretion of fluid

signs and symptoms of fluid volume overload

• hypertension

• bounding pulse

• jugular vein distention

• weight gain

• edema

• tachycardia

• dyspnea/crackles in the lungs

treatment and nursing care for fluid volume excess

1. diuretics

2. daily weights (1-2 Ibs/day or 3Ibs within a week → let the provider know)

3. skincare

4. provide oxygen

5. restriction and sodium restriction

6. monitor for complications (edema, heart failure)