Haematology Medications in Nursing

Question: Discuss about theHaematology Medications in Nursing. Answer: Introduction Warfarin indirectly alters the synthesis of clotting factors ii, vii, ix and x by hindering the manufacture of vitamin K which is crucial in the production of the factors (Brenner Stevens, 2012). Also, it prevents the manufacture of anticoagulant proteins C and S which leads to an escalation of the clot-eliminating process in the body. After ingestion, it typically takes less than twenty-four hours for it to achieve a therapeutic effect. In the case of Mr. Pap, there is a thrombus in one of his deep veins. Administration of an anticoagulant agent is necessitated to get rid of the solid body,. Warfarin is a typical example which works by altering the various factors that collectively form the coagulation cascade hence eradication of any clot in the system. Warfarin can cause excessive bleeding especially if the blood clotting proteins are severely affected (Williams Wilkins, 2014). Stoppage of the medication after initiation of hemorrhage does not counter the effect; the bleeding may progress for even a week. Patients are advised to sensitize their doctors in case they have a previous history of a condition that causes prolonged bleeding such as a prolonged menstrual period. Warfarin can also cause drug-induced skin necrosis. This generally occurs nine days after initiation of the therapy and usually affects obese women. Some patients report of the effect after several months or years of treatment. Necrosis is usually manifested in the regions of the body that are well endowed with fatty tissues such as the thighs, abdomen, breasts and extremities. A typical sign of necrosis is the presence of a lesion on the surface of the skin which is usually painful (Fox, 2015). The lesion presents with an abrupt onset besides being erythematous a nd tender in nature. Necrosis comes about due to an imbalance between vitamin k dependent clotting factors and protein S or C. If the lesions dont resolve, there is an increased chance of developing hemorrhagic bullae which ultimately leads to necrosis. When these signs are depicted, withdrawal of the therapy is advised. This does not help in resolving the condition but rather curbs against further deterioration of the situation. Patients who may need to be prolonged therapy are subjected to lower doses which are done in line with heparin bridge therapy. Fresh frozen plasma and packed red blood cells are the most efficient ways of reversing any hemorrhagic complication linked to warfarin administration. For an effective reversal, a dosage of 15ml/kg is given soon after concerns of the drug arise (Beck, 2011). In clinical settings where fresh frozen plasma may not be available, recombinant factor VIIa (rFVIIa) therapy is advocated. The therapy works by correcting INR in the shortest time possible. It has an advantage over FFP because it doesnt have to undergo many procedures such as thawing to be administered. Moreover, it does not result in transfusion-associated side effects like the former. The two therapies should be necessitated after consultation with a medical toxicologist or the poison control center. This is because as at now there is no clear universal dosage for them. Any deviation from the required amount may lead to adverse effects. Vitamin k1 is the alternative antidote which is credited for being effective in cases involving long-term management. Reversal of the side effects takes place after around ten hours. The main shortcoming linked to this is the acute cardiovascular collapse that it predisposes patients to (Pallister, 2012). This is usually attributed to the cascade of anaphylactic reactions that take place in the body. When the vitamin is administered using the subcutaneous or the intramuscular route, it makes patients vulnerable to hematoma. Furosemide (Lasix) is a drug that belongs to the group of drugs that are collectively referred to as diuretics. When administered with warfarin at the same time, it leads to a hypoprothrombinemia effect. The introduction of warfarin into the body culminates to some percentage of it combining with blood proteins before the anticoagulation process is initialised (Beck, 2011). Furosemide, on the other hand, hinders this combination making it possible for more of the warfarin to be available in the blood. This ultimately leads to an increased anticoagulation rate. When the two are used concurrently, clotting of blood is hindered. This predisposes individuals to excessive bleeding. Close monitoring is essential in curbing this especially when there is a medical condition which necessitates the two to be administered at the same time (Fox, 2015). Alternatively, laboratory investigations can be done to determine the correct amount of warfarin that can be administered in view of reducing its bioavailability in the body. Warfarin has an adverse drug interaction with sildenafil which belongs to a group of drugs called phosphodiesterase inhibitors. There is an escalated risk of bleeding especially in patients ailing from pulmonary hypertension. When the two have to be administered concurrently, a dose adjustment is needed to curb the adverse reaction from taking place. This entails checking of one's international normalized ratio (INR) or prothrombin time which acts as a baseline for which an appropriate dose is selected. Aspirin administration to patients who are on warfarin predisposes them to bleeding. It inhibits platelets function by altering the protein binding displacement process. It has also been linked to causing a hypoprothrombinemia effect (Pallister, 2012). This is the reduced secretion of prothrombin hormone to the blood. Moreover, it is very effective in getting rid of clots in the arteries because it initiates a cascade of processes that are geared towards eliminating atheroma substances within the vessels. Most clinical settings prefer using if because it reduces a patient's vulnerability to stroke, but it should not be employed as a substitute to curb against clotting. It has a capability of altering some proteins in the blood which are crucial in clotting. This inhibits coagulation cascade hence increasing chances of bleeding. Both drugs have a protagonist effect .Close monitoring should be done in cases where they have to be used. The enrolled nurse should administer the prescribed dosage of the drug. No measure should be employed to reduce or escalate the amount needed unless a consultation is sought from a qualified medical officer or consultant. In addition, close monitoring of the patients condition is important in determining whether the drug is achieving its recommended therapeutic effect. Any concerns raised by the patient should be accorded maximum attention. This can be done by advocating any problems that manifest ill-health during the therapy. Continued patient education should be provided to allay anxiety and concerns of the patient (Schumacher Chernecky, 2013). Sensitization on the increased vulnerability to bleeding should be done and if possible training should be provided on ways of arresting bleeding at an individual level. Routine documentation of the progress and any procedure done to the patient should be done by the nurse in order to facilitate review and accountability. Patient's International Normalized Ratio (INR) should be checked prior to warfarin administration. This is because it forms a basis which guides the physician to prescribe a precise dosage of the drug. The test depicts the amount of time that blood takes before clotting. When the value of the INR is high, it means that the blood under investigation takes a lot of time to clot and hence increased vulnerability to bleeding (Hillman Hillman, 2011). On the other hand, a lower value reduces the risk of bleeding, necessitating a higher dosage because there is an eleveted chance of developing a clot in the system. In addition, plasma heparin concentration activated partial thromboplastin time (aPTT) and complete blood count should be investigated to determine the patients anticoagulation efficiency before initiation of therapy. A therapeutic INR range of between two and three is considered normal for patients under deep venous thrombosis (DVT) prophylaxis. Coumadin and Marevan contain different amounts of anticoagulant chemicals. Coumadin is available in 1mg, 2mg or 5mg tablets while Marevan is available in 1mg, 3mg and 5mg tablets (Mealey, 2013). The strengths considerably differ hence none should be used in place of the other. Studies have been done to show that none of the tablets is bioequivalent to necessitate substitution. It is not advisable to interchange them since that can culminate into the administration of either higher or lower doses of the drugs. This ultimately predisposes a patient to adverse effects linked to extreme changes in the INR Mr. Pap should adhere to the medication timelines. This is significant because a particular dosage of the drug takes effect for a limited duration of time beyond which an addition is recommended in order to achieve the ultimate therapeutic effect (Haymaker, Hayes Phipps, 2011). Moreover, a disregard in time can culminate to situations where the patient takes an overdose due to a reduction in the intervals of taking it. It should not be taken when symptoms escalate or stopped when the patient feels better. The patient should never use any drug without consulting his physician. There are many drugs which either antagonize or synergize the action of warfarin (Pallister, 2012). Either way, the health of the patient is likely to be compromised because of an increase or decrease in its bioavailability which does not resonate well with the physicians prescriptions. Emphasis should be geared towards discouraging the eating of foods rich in vitamin K. Examples include spinach, parsley and cabbage. These foods reduce the effectiveness of the drug by working against what is being eradicated. Ingestion of other substances that make up a balanced diet is important in curbing other ill effects besides making the body have the energy required in tolerating the treatment regimen. Any deviation from the standard wellbeing should necessitate seeking medical advice. This would be due to effects attributed to the drug or deterioration of the body (Schumacher Chernecky, 2013). Consultation should be sought from the nearest health facility before proceeding to the hospital of choice. For instance severe headache, bloody urine and vomiting of blood should sensitize medical attention. Minor side effects which frequently show up due to warfarin usage should be known so as not to raise much alarm when they manifest. For instance itching and general body, weakness should only be prioritized when they are so much advanced Evaluation of comprehension of the knowledge given can be done through by asking him to restate the instructions given (White Ewan, 2011). The patients relatives can be used to determine whether he is implementing the education accorded. Reviewing the patients progress in subsequent visits can help in the evaluation. For instant keeping of INR values within the normal ranges depicts high compliance. References Brenner, G, M Stevens, C, W 2012,Pharmacology, Pa: Saunders, Philadelphia. Beck, W, S 2011,Haematology, Mass: MIT Press, Cambridge. 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