Info

Drug Class

Dosage

Description

Rationale

Heparin

Varies with patient based dosing is common, with a starting bolus of 80 units/kg and an infusion of 18 units/kg per hour. Then dosage is calculated based on APTT results

Anticoagulant

Inactivates thrombin and factors X and IX by antithrombin III

Antithrombin III

Total doses equals: (desired level - initial level) X (0.6 X total body weight kg) IV q 8 hr with a desired level >125% Loading dose of 100 U/kg IV over 3 hr followed by continuous infusion of 100 U/kg per day

Anticoagulant

Replacement; used for moderately severe to severe DIC; increases effects of heparin

Drotrecogin

24 mcg/kg per hr IV by

Recombinant form

Antithrombotic effect;

alfa-activated

continuous infusion over

of human activated

inhibits factors Va and

(Xigris)

96 hr

protein C

VIIIa with indirect profibrinolytic activity

Analgesics

Varies with drug

Narcotics such as morphine and fentanyl

Relieves pain of hemarthrosis

Independent

When a bleeding disorder occurs in addition to another condition, the patient's and significant others' coping skills and resiliency may be at a low point. During this time, the patient and significant others need accurate information, honest reports about the patient's condition and prognosis, and an attentive nurse to listen to their concerns. Provide emotional support and educate them as to the interventions and expected outcomes. Help them understand the severity of the condition and the treatments; do not present false hopes. Offer to call a chaplain or religious counselor if needed. The patient is usually maintained on complete bedrest. Pad the side rails to help prevent injury. Reposition the patient every 2 hours, and provide skin care. Gently touch the skin when repositioning and bathing; vigorous rubbing could dislodge a clot and initiate fresh bleeding. Crusted blood can be gently cleaned with a mixture of hydrogen peroxide and water and cotton. If the patient has experienced hemarthrosis (bleeding into the joints), the condition is very painful. Manipulate any joint gently and with great care to minimize discomfort and to limit further bleeding.

Communicate to all healthcare personnel coming in contact with the patient about her or his bleeding tendency. Place notations on the chart cover and at the head of the bed to alert care-givers to the patient's bleeding condition. Keep all venipunctures to a minimum, and hold pressure to any puncture site for at least 10 minutes.

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