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NUR-635 Topic 16 DQ 1 • Online Nursing Essays

Sample Answer for NUR-635 Topic 16 DQ 1 Included After Question

Using one of the following diagnoses, discuss one of the thrombolytic drugs. Document the appropriate indication for use. Share the mechanism of action of this medication and hints for monitoring, including absolute contraindications and relative contraindications, as well as side effects and drug interactions, including interactions with CAM. What ethnic, cultural, and genetic differences need to be considered when prescribing these medications? Include the name of the medication in the subject line so that the medications can be followed. Include references using APA format. 

If your last name starts with A through D: Acute myocardial infarction (AMI) 
If your last name starts with E through H: Deep vein thrombosis (DVT) 
If your last name starts with I through L: Pulmonary embolism (PE) 
If your last name starts with M through P: Acute ischemic stroke (AIS) 
If your last name starts with N through Q: Acute peripheral arterial occlusion. 
If your last name starts with R through U: Intracardiac thrombus formation. 
If your last name starts with W through Z: Severe frostbite 

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education 

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2 

A Sample Answer For the Assignment: NUR-635 Topic 16 DQ 1

Title: NUR-635 Topic 16 DQ 1

If you have a patient on a blood thinner, whether it be Eliquis, xarelto, or some other, most facilities don’t have the reversal medication in stock. If a patient comes in with a serious bleed, what medication and dose can be given? 

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Hello, Professor Leslie about your inquiry on the availability of reversal medicine for patients on blood thinners such as Eliquis, Xarelto, or other direct oral anticoagulants, it is common for most facilities to not have such medication readily available. In the event of a patient presenting with a severe hemorrhage, what specific drug and dosage may be administered? At our hospital, when we observe visible signs of symptomatic gastrointestinal bleeding caused by direct oral anticoagulants like eliquis or xarelto in the ICU, the treatment approach involves discontinuing the oral anticoagulants, conducting immediate tests for complete blood count (CBC), prothrombin time/international normalized ratio (PT/INR), and fibrinogen levels, as well as preparing for a potential blood transfusion. Additionally, a type and screen test is performed.  At first, the patient is receiving units of packed red blood cells (PRBC) and we are also administering Prothrombin complex concentrate (PCC). Prothrombin complex concentrate (PCC) is derived using ion-exchange chromatography from the cryoprecipitate supernatant of extensive plasma pools, after the elimination of antithrombin and factor XI, as stated by Baskaran J in 2022.  Ion exchange-based processing procedures enable the synthesis of either three-factor (i.e., factors II, IX, and X) or four-factor (i.e., factors II, VII, IX, and X) prothrombin complex concentrate (PCC). Management of significant bleeding or the need for major surgery in patients using Direct Oral Anticoagulants (DOACs) involves reversing the anticoagulant effects of these medications. Prothrombin complex concentrate (PCC) may be used to counteract the anticoagulant effects caused by direct oral anticoagulants (DOACs) in situations when a more targeted antidote is not accessible.The user’s text is The ACC Expert Consensus Decision Pathway on the Management of Bleeding Patients on Oral Anticoagulation states that Prothrombin Complex Concentrate (PCC) is indicated for both Xa inhibitors and direct thrombin inhibitors in the absence of antidotes. Prothrombin complex concentrate (PCC) consists of factors II, IX, and X, together with varying quantities of factor VII concentrate. The concentration of clotting factors in PCC is roughly 25 times more than that seen in normal plasma. Prothrombin complex concentrate has various benefits compared to fresh frozen plasma (FFP), with the most significant being the need of a modest amount to reverse anticoagulation. Prothrombin complex concentrate (PCC) includes much greater quantities of clotting components in comparison to fresh frozen plasma (FFP); a single dosage of PCC is equivalent to 8 to 16 units of FFP. PCC may be safely given to individuals with cardiac or renal dysfunction who may not be able to handle significant amounts of plasma. PCC is devoid of leukocytes and has a reduced likelihood of inducing infusion responses. Antibodies that are responsible for causing transfusion-related acute lung injury (TRALI), which is defined as the sudden development of lung injury within 6 hours of receiving a blood transfusion and not caused by any other risk factors, are eliminated from prothrombin complex concentrate (PCC) during its production. As a result, PCC carries a minimal risk compared to fresh frozen plasma (FFP), making it a safer option. PCC products have a reduced risk of viral transmission due to their viral inactivation process. PCC dosage products are measured in units of factor IX. Customized dosage is determined by the severity of the condition, the degree and site of bleeding, and the patient’s clinical condition.  To achieve the normalization of INR (less than or equal to 1.2) within 1 hour of therapy, it is recommended to deliver a dosage of 50 units per kilogram. Owen et al. (2021) reported that PCC (Prothrombin Complex Concentrate) might lead to severe consequences such as pulmonary embolism, stroke, myocardial infarction, and deep venous thrombosis. The present PCC formulations include coagulation inhibitors, such as heparin, antithrombin, protein C, protein S, and protein Z, which could help to reducing the risk. The primary determinant for the development of thrombosis is the buildup of factor II, which might arise from substantial or frequent administration. The use of PCC is not recommended in individuals with a history of DIC, myocardial infarction, peripheral vascular disease, or stroke during the last three months, or a history of thromboembolic illness within the preceding three months. Documented cases of anaphylaxis or severe systemic responses to prothrombin complex concentrate, hypersensitivity to albumin, hypersensitivity to heparin, hypersensitivity to plasma proteins, and heparin-induced thrombocytopenia (HIT). Labour, obstetric delivery, and pregnancy: The impact of PCC on the fetus remains uncertain. Therefore, it is advised against using PCC in pregnant patients or during labor, unless there is a clear indication and the advantages exceed the potential risks (Sumama, CM, 2008). 

  

References: 

Baskaran J, Lopez RA, Cassagnol M. (2022). Prothrombin Complex Concentrate. [Updated 2022 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.  https://www.ncbi.nlm.nih.gov/books/NBK539716/ 

Owen EJ, Gibson GA, Human T, Wolfe R. (2021). Thromboembolic Complications After Receipt of Prothrombin Complex Concentrate. Hosp Pharm. 56(6):709-713.  

Samama CM. (2008). Prothrombin complex concentrates: a brief review. Eur J Anaesthesiol. (10):784-9. 

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