Hematologic System Medications

Whole blood

Administration Time Completed: 2 to 4 hr

Action/Therapeutic use: Whole Blood

Replace volume:

• hemorrhage

• surgery

• trauma

• burns

• shock

Monitor for Reaction: Whole Blood

• acute hemolytic

• febrile

• anaphylactic

• mild allergic

• hypovolemia

• sepsis

Packed RBCs

Administration Time Completed: 2 to 4 hr

Action/Therapeutic Use: Packed RBCs

• increased available RBC

• severe anemia

• hemoglobinopathies

• hemolytic anemia

• erythroblastosis fetalis

Monitor for Reaction: Packed RBCs

• acute hemolytic

• febrile

• anaphylactic

• mild allergic

• sepsis

Platelets

Administration Time Completed: 15 to 30 min

Action/Therapeutic Use: Platelets

• increase platelet counts

• active bleeding

• thrombocytopenia

• aplastic anemia

• bone marrow suppression

Monitor for Reaction: Platelets

• febrile

• sepsis

FFP

Administration Time Completed: 30 to 60 min

Action/Therapeutic Use: FFP

Replace clotting factors

• hemorrhage

• burns

• shock

• thrombotic thrombocytopenic (TTP)

• reverse effects of warfarin

Monitor for Reaction: FFP

• acute hemolytic

• febrile

• anaphylactic

• mild allergic

• hypervolemia

• sepsis

Pheresed Granulocytes

Administration Time Completed: 45 to 60 min

Action/Therapeutic Use: Pheresed Granulocytes

a. severe neutropenia

b. neonatal sepsis

c. neutrophil dysfunction

Monitor for Reaction: Pheresed Granulocytes

a. acute hemolytic

b. febrile

c. anaphylactic

d. mild allergic

e. hypervolemia

f. sepsis

Albumin

Administration Time Completed:

• 5% (1 to 10mL/min)

• 25% (4 mL/min)

Action/Therapeutic Use: Albumin

a. expand volume via oncotic changes

b. hypovolemia

c. hypoalbuminemia

d. burns

e. severe nephrosis

f. hemolytic disease of the newborn

Monitor for Reaction: Albumin

Risk for hypervolemia and pulmonary edema

Nursing Interventions and Client Edu: Albumin

a. client ID, name, and blood type must be verified by two nurses

b. prior to administration, assess baseline vital signs, including temperature

c. establish IV access, 18- to 20-gauge catheter

d. must have 0.9% sodium chloride primed tubing

e. for the first 15 min, stay with the client and infuse slowly, monitoring for any reaction. if a reaction occurs, perform the following interventions:

• stop blood immediately and take vital signs

• infuse 0.9% sodium chloride

• notify the provider

• d. follow facility policy (send urine sample, CBC, and bag and tubing to laboratory for analysis)

f. complete infusion of product within 4 hr

Hematopoietic Growth Factors

Action: Stimulate the bone marrow to synthesis the specific blood cells

Therapeutic Use: Epoetin alfa

a. stimulate RBC production

b. anemia related to:

• chronic kidney disease

• retorvir therapy

• chemotherapy

Side Effects: Epoetin alfa

Hypertension

Nursing Intervention: Epoetin alfa

a. subcutaneous or IV

b. do not agitate vial

c. monitor hematocrit and hemoglobin

Therapeutic Use: Filgrastim, injection Pegfilgrastim, IV over 2 to 4 hr

a. stimulate WBC production

b. neutropenia related to cancer

Side Effect: Filgrastim, injection Pegfilgrastim, IV over 2 to 4 hr

• bone pain

• leukocytosis

Nursing Intervention: Filgrastim, injection Pegfilgrastim, IV over 2 to 4 hr

a. subcutaneous or IV

b. do not agitate vial

c. monitor CBC

Therapeutic Use: Oprelvekin

a. stimulate platelet production

b. thrombocytopenia related to cancer

Side Effect: Oprelvekin

• fluid retention

• blurred vision

• cardiac dysrhythmia

Nursing Intervention: Oprelvekin

a. administer within 6 to 24 hr after chemotherapy

b. subcutaneous

Iron Preparations

Treat iron deficiency

Iron Preparations Medications

Oral

• Ferrous sulfate

• Ferrous gluconate

• Ferrous fumarate

Parental:

• Iron Dextran

• Intramuscular, IV

• Used for clients unable to take oral medications

Nursing Interventions: Iron Preparations (Oral)

a. dilute liquid preparations with juice or water and administer with a plastic straw or medication dosing syringe (avoid contact with teeth)

b. encourage orange juice fortified with vitamin C (facilitates absorption)

c. avoid antacids, coffee, tea, dairy products, or whole grain breads concurrently and for 1 hr after administration due to decreased absorption

d. monitor the client for constipation and gastrointestinal upset

Nursing Interventions: Iron Preparation (Intramuscular)

a. use a large-bore needle (19- to 20-gauge, 3-inch)

b. change needle after drawing up from vial

c. Z-track (ventrogluteal), never in the deltoid muscle

d. do not massage injection site

Nursing Intervention: Iron Preparation (IV)

a. administer a small test dose (25 mg over 5 min) observe patient for 15 min, then slowly administer additional preparation

b. use manufacturer’s recommendation for specific product

Anticoagulant

Action: modify coagulation by altering the clotting cascade or by removing or dissolving an existing clot

Anticoagulant: Parenteral

Action:

a. Modify or inhibit clotting or cellular properties to prevent clot formation (heparin)

b. Prevents conversion of prothrombin to thrombin by inactivating coagulation enzymes (low molecular weight heparin: enoxaparin)

Anticoagulant: Oral

Action:

a. prevent synthesis og coagulation factors VII, IX, X, and prothrombin (warfarin)

b. inhibiting thrombin formation (dabigatran)

c. inhibit factor Xa (rivaroxabin)

Therapeutic Use: Anticoagulant (Parenteral)

a. stroke

b. pulmonary emebolism

c. DVT

d. cardiac catheterization

e. MI

f. DIC

Therapeutic Use: Anticoagulant (Oral: Warfarin)

a. venous thrombosis

b. prevent thrombus formation for clients who have atrial fibrillation or prosthetic heart valves

c. prevent recurrent MI

d. prevent transient ischemic attacks (TIAs)

Therapeutic Use: Anticoagulant (Oral: Dabigatran etexilate)

a. reduce risk of stroke/embolism for clients with nonvalvular atrial fibrillation

Therapeutic Use: Anticoagulant (Oral: Rivaroxaban)

a. reduce risk of stroke/embolism for clients with nonvalvular atrial fibrillation

b. prevention of DVT and PE in clients undergoing total hip or knee arthroplasty

Precautions/Interactions: Anticoagulant (Parenteral)

a. administer subcutaneous or IV

b. incompatible with many medications (any bicarbonate base)

c. avoid NSAIDs, aspirin, or medications containing salicylates

Precautions/Interactions: Anticoagulants (Oral: Warfarin)

a. not safe for use during pregnancy (category X)

b. contraindications: thrombocytopenia, vitamin K deficiency, liver disease, alcohol use disorder

c. decreased effects with phenobarbital, carbamazepine phenytoin, and oral contraceptions

d. food sources high in vitamin K may decrease effects

Precautions/Interactions: Anticoagulants (Oral: Dabigatran)

a. caution if changing anticoagulation medication

b. discontinue 1 to 2 days prior to surgical procedures

Precautions/Interactions: Anticoagulants (Oral: Rivaroxaban)

a. no antidote for severe bleeding (prepare to administer activated charcoal to prevent further absorption)

b. wait 6 hr before restarting after removal of epidural catheter

Side Effects: Anticoagulants (Parenteral)

• hemorrhage

• heparin-induced thrombocytopenia

• toxicity/overdose

Side Effects: Anticoagulants (Oral: Warfarin)

a. hemorrhage

b. toxicity/overdose

Side Effects: Anticoagulants (Oral: Dabigatran, Rivaroxaban)

a. bleeding

b. GI discomfort (dabigatran)

c. bleeding, bruising, headache, or eye pain (rivaroxaban)

Nursing Interventions and Client Edu: Anticoagulants (Parenteral)

a. heparin: monitor APTT every 4 to 6 hr for IV administration

b. monitor for signs of bleeding

c. safety precautions to prevent bleeding

d. administer subcutaneous heparin to abdomen, 2 inches from umbilicus (do not aspirate or massage)

e. rotate injection sites and observe for bleeding or hematoma

f. administer protamine sulfate for heparin toxicity (1 mg neutralizes 100 units of heparin)

Nursing Interventions and Client Edu: Anticoagulants (Oral: Warfarin)

a. administer once daily

b. monitor INR or PT

c. teach client that bleeding risks remains up to 5 days after discontinued therapy

d. teach clients to avoid NSAIDs and medications with aspirin

e. teach clients to wear medical alert bracelet

f. client may self-monitor for PT/INR using a coagulation monitor

g. teach measure to prevent injury and bleeding

h. administer vitamin K for warfarin toxicity

i. garlic, ginger, ginkgo (may increase bleeding), and ginseng (blocks effects of warfarin)

j. glucosamine interferes with warfarin and increases bleeding risk

k. avoid alcohol

Nursing Interventions and Client Edu: Anticoagulants (Oral: Dabigatran, Rivaroxaban)

a. teach client to take medication daily and avoid skipping doses

b. if a dose is missed, it should not be taken within 6 hrs of the next scheduled dose

c. tablets should not be crushed, broken, or chewed

d. teach client to avoid NSAIDs and medication with aspirin

e. teach client to monitor for signs of bleeding and report to provider

f. teach client to monitor for signs of GI bleeding

Antiplatelet

Action: prevent platelets from aggregating (clumping together) by inhibiting enzymes and factors that normally promote clotting

Antiplatelet Medications

• aspirin

• abciximab

• clopidogrel

• ticlopidine

• pentoxifylline

• dipyridamole

Therapeutic Use: Antiplatelet

a. prevention of acute myocardial infarction or acute coronary syndromes

b. prevention of stroke

c. intermittent claudication

Precatutions/Interactions: Antiplatelet

a. contraindicated in thrombocytopenia

b. caution with peptic ulcer disease

Side Effect: Antiplatelet

• prolonged bleeding

• gastric bleeding

• thrombocytopenia

Nursing Interventions and Client Edu: Antiplatelets

a. monitor for signs of prolonged bleeding

b. teach client to report tarry stool, ecchymosis

Thrombolytic

Action: Dissolve clots that have already formed by converting plasminogen to plasmin, which destroys fibrinogen and other clotting factors

Thrombolytic Medications

• Alteplase

• Tenecteplase

• Reteplase

Therapeutic Use: Thrombolytic

a. acute myocardial infarction

b. DVT

c. massive pulmonary emboli

d. ischemic stroke (atleplase)

Precautions/Interactions: Thrombolytic

a. contraindicated for intracranial hemorrhage, active internal bleeding, aortic dissection, and brain tumors

b. use caution when using in clients who have severe hypertension

c. concurrent use of anticoagulants or antiplatelet medications increase risk of bleeding

Side Effect: Thrombolytic

a. serious bleeding risks from recent wounds, puncture sites, weakened vessels

b. hypotension

c. possible anaphylactic reaction

Nursing Interventions and Client Edu: Thrombolytic

a. administration must take place within 4 to 6 hr of symptom onset

b. continuous monitoring is required

c. clients will begin anticoagulant therapy to prevent repeated thrombotic event