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CLS 6 QUIZ 1: things to know about Heparin

Terms in this set (55)

This is a ________ Drug (one of the top 10 ten _______)
-HIGH ALERT
-drug error
Serious _______ and _______ have occurred when administered incorrectly
-injuries
-death
Different errors that can occur to administer heparin incorrectly
-_______ mix-ups
Concentration
Different errors that can occur to administer heparin incorrectly
-Failure to _______ when temporarily ________ to give a bolus
-return to original rate
-increasing pump rate
Different errors that can occur to administer heparin incorrectly
-______ errors
Math
Different errors that can occur to administer heparin incorrectly
-_______ error when mistaking "_____" for "______" instead of units
-10-fold dose
-U
-O
Changes to labeling
-_______ and ______ type face/font size, simplified text
-Total unit _______ and _______
-"________" on vials of heparin sodium injection (just use the saline lock for flushing)
-Bolder; larger
-strength; volume
-Not for lock flush
Heparin is a drug that you always want to ________
check with another nurse
Heparin Label:
-Heparin pink label: ______ units
-Heparin orange label: _______ units
Heparingis not for a ________
-1000
-5,000
-lock flush
How does Heparin work?
-Potent anticoagulant - prevents the _______ from ________
-blood
-clot formation
How does Heparin work?
-Inactivates ________ in the coagulation pathway, inhibiting conversion of _______ to _______. This is not a _______ drug (it does not ________ the clot)
-Factor X
-prothrombin; thrombin
-thrombolytic
-destroy/break up
How does Heparin work?
-Prevents _______ of a stable fibrin clot by inhibiting _______
-formation
-Factor XIII
How does Heparin work?
-Cannot _______
break up a clot
What is heparin used for?
-Prevents and treats ______ and ______
-DVT
-PE (pulmonary embolism)
What is heparin used for?
-Prevents and treats clot formation associated with _________
AF (atrial fibrillation)
What is heparin used for?
-Treatment of other coagulation disorders like _______
DIC
What is heparin used for?
-Prevents clotting in ______ and ______ surgeries
-atrial
-cardiac
What is heparin used for?
-Lovenox and Fragminare low-molecular weight heparins used to treat or prevent (4)
-deep vein thrombosis (DVT)
-hip or knee replacement
-unstable angina
-acute coronary syndromes
DIC:
-This is where the blood is _______ and _______.
-clotting
-bleeding
How is Heparin administered? (3)
-IV injection
-IV infusion
-Deep subcutaneous injection
Never administer heparin _______ or ______
IM
PO
How is Heparin administered?
-IM injections lead to a risk for ______ at the ________
-Don't give PO because the polarity and large molecules can't _________ in the GIT
-hematoma; IV site
-cross the membranes
Heparin is okay to take during pregnancy, but moms will come off of it _______ before delivery because of ________
-a month
-blood loss.
Dosing of Heparin:
-Dosages expressed in ________
-Based on client weight in ______
-Given IV as _______ on an IV pump
-Available as ________ or _______
-______ units per mL up to _______ units per mL
-(USP) units
-kg
-units per hour
-single-dose; multidose
-10; 50,000
Recommended initial dose
-SC: _______ units/kg initially then ______ units/kg every ______ hours
-333
-250
-12
Recommended initial dose
-Continuous IV infusion: _______ units IV injection initially, then ______ to ________ units/_____ hours in _______ mL of _______ for infusion
-5,000
- 20,000 to 40,000
-24
-1,000
-0.9% NS
Titration based on ________
coagulation test results
Effective titration:
-**aPTT (activated partial thromboplastin time) in seconds: ______
-Clotting time: _______
-1.5 to times normal
-2.5 to 3 times normal
When dosing heparin confirm the ________
proper strength
-Anyone on heparin will get _______ to see how their body is responding to the heparin
lab work
Labs:
SC injection - Test for adequate dosing every _____ hours, periodic _______ and ______ counts
-4-6
-platelet
-hematocrit
Labs:
Continuous IV - _______ at baseline and ______ approx. every _______ hours or as needed
-Coagulation Profile
-aPTT; 4 - 6
Labs:
-Hct will go _______ if you're bleeding a lot
-If your platelets are down you're more likely to ______
-If hct is down their will be less _____ in the body.
-down
-bleed
-oxygen
Contraindications to Heparin:
-History of ________ and _______
-HIT (Heparin induced thrombocytopenia)
-thrombosis
Contraindications to Heparin: HIT (Heparin induced thrombocytopenia)
-Antibody-mediated reaction from _________
irreversible aggregation of platelets
Contraindications to Heparin:
-Antibody-mediated reaction can occur up to ________ following completion of heparin therapy
several weeks
Contraindications to Heparin:
-Known hypersensitivity (anaphylactic) to _______ or _______
-heparin
-pork products
Contraindications to Heparin:
-If unable to ________ on a _______ dose regimen
-monitor blood coagulation levels
-full
Contraindications to Heparin:
-In the presence of _________ unless the __________
-major bleeding
-benefits outweigh the risks
If someone has a problem with their _______ or an ______ they should not take heparin
-platelets
-autoimmune sensitivity
SAFETY ALERT!
-________ must ALWAYS _______ on heparin before it is administered
-Two nurses
-check doses
SAFETY ALERT!
-The average heparin flush is ______ units per mL and NEVER exceeds ______ units per mL.
-10
-100
SAFETY ALERT!
-________ and _________ can never be used interchangeably.
-Heparin sodium for injection
-heparin lock flush solution
SAFETY ALERT!
-Never give heparin IM. It can lead to _______ and ________
-hematomas
-client harm.
What is needed to administer Heparin IV? (4)
-Electronic IV pump
-Weigh the client and convert to kg
-Have another nurse independently check the dosage
-Make sure CBC and anticoagulation labs (aPTT) are ordered
Administering Heparin Subcutaneously:
-Use _______ syringe because the _______ is exact
-May be ________
-NEVER _______ doses when drawing it up; can give to _______ accuracy with TB syringe
-tuberculin (1 mL); dosing
-prepackaged
-ROUND; hundredths
Administering Heparin Subcutaneously: SAFETY ALERT!
-_______ carefully before administering heparin to ensure the client's safety.
-Verify (3)
-Obtain ______ verification.
-Read labels
-dosage, vial, and amount.
-independent
Cautions:
-Fatal _______ can occur at any site
-Specific sites include: (3)
-hemorrhages
-adrenal, ovarian, retroperitoneal
Cautions:
-Caution immediately after (7)
-spinal puncture
-heparin resistance
-hemophilia
-thrombocytopenia
-active ulcers
-liver disease
-renal disease
Incompatibilities: medications (6)
-Ciprofloxacin (UTI)
-Droperidol (antipsychotic, antiemetic)
-"mycins" (antibiotic)
-Promethazine (Finnergan)
-Other anticoagulants
-NSAIDS
Cautions:
Medications like (5) may counteract anticoagulant action
-Digitalis
-tetracyclines
-nicotine
-antihistamines
-IV nitroglycerin
Serious Adverse Reactions: (6)
-Hemorrhage
-HIT with or without thrombosis
-Thrombocytopenia
-Heparin resistance
-Hypersensitivity
-In infants - due to benzyl alcohol preservative administer preservative free to infants
Others Adverse reactions (14)
-local irritation
-histamine like reaction (necrosis of injection site)
-chills
-fever
-urticarial
-asthma
-rhinitis
-headache
-nausea
-vomiting
-itching and burning of the plantar site of the feet
-elevated ALT and AST
-osteoporosis (long term)
-alopecia
Reversal Agent
**Protaminesulfate 1% solution
Protaminesulfate 1% solution
-**Administer by _______ infusion no more than _____ mg/_____ minutes.
-Each mg neutralizes approx. ______ units of heparin
-Need to decrease ______ as heparin metabolizes
-For dosing consideration consider ½ life of heparin to be ________
-slow; 50; 10
-100
-infusion rate
-30 minutes
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