Page 134 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 119

TABLE 3–9 Anticoagulants
Drug Action Use Precautions
Aspirin Stops platelets Immediately May cause GI upset. Use
from clumping during and for H2 blockers or proton
together to form long-term pump inhibitors if GI
a plug that blocks management upset/bleeding. Can be
a coronary artery of angina and used if taking other
ACS analgesics like acet-
aminophen (Tylenol).
Heparin Prevents the for- In ACS Monitoring of the aPTT
Low molecular mation and is done frequently to
weight heparin growth of blood prevent under- or over-
(LMWH) like clots dosing of heparin
enoxaparin LMWH may be LMWH do not need
(Lovenox) or used to treat ACS laboratory monitoring
dalteparin instead of heparin All heparin products
(Fragmin) require close monitoring
for bleeding
Monitor the platelets for
reduction that can occur
with heparin
Thrombolytic Busts apart clots First-line drug 1. Does not dissolve the Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
therapy formed during used in ACS; plaque that lays the
Includes clot- acute coronary chest pain of basis for clot forma-
busting drugs syndromes lead- longer than tion. May need
like t-PA ing to MI 20 minutes atherectomy or open
(tissue plasmi- Decreases perma- not relieved heart for this.
nogen activa- nent damage by NTG and 2. Bleeding, as they are
tor), alteplase done in MI and rest with ECG not specific for coro-
(Activase), and improves ventric- changes nary arteries and can
reteplase ular functioning cause hemorrhage in
(r-PA) recent trauma or
hemorrhagic stroke.
3. Best given 3–6 hours
post onset of symp-
toms.
4. Door-to-needle time
should be no longer
than 30 minutes.
5. Monitor lab oratory
values like H&H for
bleeding.