Nursing 211

N211: Health Differences Across the Lifespan I Surgical interventions for arterial disease are embolectomy (removal of clot); endarterectomy (removal of clot and stripping of plaque); arterial bypass (Teflon or Dacron graft or autograft); percutaneous transluminal angioplasty (PTA), compression of plaque; amputation (removal of extremity). Surgical interventions for venous disease are vein ligation, thrombectomy or debridement. Treatment is aimed at vasodilation, pain relief, and maintaining skin integrity. Do NOT use a heating pad to keep extremities warm. Medical management includes antiplatelet (aspirin), vasodilators (Trental), anticoagulants (Coumadin), Lipid reducers (Questran, Mevacor). Nursing Interventions include encourage walking and other leg exercise, watch for signs of decreased peripheral circulation. Avoid temperature extremes, prolonged standing, constrictive clothing or crossing the legs at the knee when seated. Provide instruction about foot care and exercise programs. Develop a plan for smoking cessation. Monitor extremities for color, temperature, sensation and pulse quality. Schedule client activities within the client’s tolerance level. Encourage client to keep extremities elevated (if venous) when sitting and to change position frequently. Teach client to wear support hose or antiembolic stockings, wear shoes when ambulating. Decreased blood flow results in diminished sensation in the lower extremities. Any heat source can cause severe burns before the client realizes the damage is being done.

Anticoagulants Drugs

Adverse Reactions Hemorrhage Agranulocytosis Leukopenia Hepatitis Heparin induced thrombocytopenia Hemorrhage Agranulocytosis Leukopenia Hepatitis

Page 13 Assess PT, Hgb, Hct, platelets Given orally Avoid foods high in vitamin K Nursing Implications Assess PTT, Hgb, Hct, platelets Assess stools for occult blood Avoid IM injections Antagonist: Protamine Sulfate of 148

Indications

Administered parenterally (SQ or IV) as an antagonist to thrombin and to prevent the conversion of fibrinogen to fibrin Blocks the formation of Prothrombin from vitamin K

Heparin Sodium

Warfarin Sodium (Coumadin)

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