CarePartners Nursing Care Plan Anticoagulant Therapy

Transcription

1 CarePartners Nursing Care Plan Anticoagulant Therapy ** If a CarePartners wound pathway, palliative care plan or oncology care plan is being used to guide the patient s care, this Nursing Care Plan may not be required. ** Patient Name: Date Initiated: Initials and Designation of Nurse Initiating Care Plan: Initial Assessment Select the appropriate box according to the purpose of the anticoagulant therapy. Prophylactic Administration of anticoagulant to prevent venous thrombosis Document reason for prophylaxis: (e.g. surgery, previous history of DVTs etc.) Deep Venous Thrombosis (DVT) Anatomical location of DVT: Describe limb affected by DVT : (color, size, temperature, pain, swelling, etc.) Limb measurement : (if appropriate) Pulmonary Embolism Patient-Centred Goals SMART: Specific, Measureable, Attainable, Relevant and Time-related Patient/caregiver will: 1. administer anticoagulant as ordered 2. be able to identify precautions associated with anticoagulant therapy and appropriate response to bleeding complications 3. be able to recognize signs of DVT and pulmonary embolism and describe appropriate response. Interventions/Teaching/Facilitating Self-Management/Discharge Planning Include nursing procedures/delegated acts that will be taught to UCPs Assessment: At each visit (document on flow sheet) 1. Adherence to medication regimen 2. Signs of possible bleeding (e.g. change in mental status; blood in urine & stool; headaches; stomach pains; vomiting blood; any bleeding that does not stop in minutes) 3. Resolution of DVT or development of new DVT (include assessment of affected limb) 4. Signs of pulmonary embolism 5. Frequency and results of laboratory testing (if applicable) 6. Patient is practicing self-management behaviours (ie. monitoring symptoms, making healthy choices, setting goals) Interventions (also refer to patient/caregiver teaching) 1. Measure vital signs at each visit (pulse, blood pressure, respirations) 2. Demonstrate, teach, assess administration of LMWH subcutaneously as ordered 3. Encourage client to verbalize concerns about possible negative outcomes and clarify misconceptions Anticoagulant Therapy Low Molecular Weight Heparin (record medication name, start date, end date, dose and frequency) : Coumadin (include dose, frequency and plan for blood work): Other non-pharmacological measures (e.g. activity, stockings, etc): Other orders: Note: If a goal or intervention is no longer part of the care plan, cross out with one line and initial. When adding a goal or intervention to the initial plan, record the date and your initials beside the new entry. Anticoagulant Therapy March2015 Page 1 of 6

2 CarePartners Nursing Care Plan Anticoagulant Therapy (Nursing Care Plan Continued) Patient Name: Patient/Caregiver Teaching Patient Response Date and initial/designation Medication dosage, actions, need to take at same time each day Administration of LMWH via subcutaneous injection Maintaining appointments for regular bloodwork (if on coumadin) Side effects of medication (ie bleeding) and response (see handout) Activities to avoid to prevent trauma Signs and symptoms of pulmonary embolus (ie chest pain, SOB, feeling of passing out, or palpitations) and need to obtain medical help immediately Avoidance of aspirin containing drugs and NSAIDs. Checking with pharmacist before taking over the counter medications, vitamins or herbal remedies. Need to avoid marked changes in eating habits such as increasing foods high in Vitamin K Use of medical alert identification for long term therapy (ie. greater than 1 month) Elimination of modifiable risk factors for DVT such as smoking, use of oral contraceptives, use of hormone replacement therapy, sedentary lifestyle and obesity Avoidance of restrictive garments such as girdles or garters Avoidance of sitting or standing in leg-dependent, motionless position for long periods of time Benefits of an exercise program (esp. walking, swimming and wading). Only if client activity is not restricted by the physician. Additional Teaching: Patient Safety Alert: Injectable LMWH comes in a variety of brand names. Different brand names cannot be used interchangeably unit for unit. Patient Safety Alert: Do not rely on the volume given by the nurse who administered the previous dose of LMWH to guide your volume calculation as this may perpetuate an error in calculation. Always determine the volume of LMWH to be administered by performing a calculation using the concentration on the vial and the ordered number of units or mg. Then compare your calculation result to what the previous nurse administered. Patient Safety Alert: Avoid using insulin syringes to administer LMWH if possible. The conversion of milliliters to insulin units increases the risk of a medication error. Patient Safety Alert: Always inform the ordering physician when the last dose of LMWH has been administered, even if the referral specifies a date when the LMWH is to be discontinued or a specific number of doses. Anticoagulant Therapy March2015 Page 2 of 6

3 Patient Handout: Anticoagulant Therapy Your doctor has ordered medication for you to make it less likely that your blood will clot. There are some things you need to do to take this medication safely. 1. Take the medication at the same time everyday. 2. If your doctor has ordered blood tests to see how well the medication is working, always attend the appointment for the blood test. 3. When you take this medication you will bleed more easily than most people. Seek medical help if you develop the following: Any bleeding that does not stop after a reasonable amount of time (usually minutes) Blood in your urine or bowel movements, or tarry, black bowel movements Unusual bleeding from your gums, throat, skin, or nose or heavy menstrual bleeding A severe headache or severe stomach pains Weakness, dizziness or confusion Vomiting of blood 4. Consult your doctor before you take aspirin containing drugs or non-steroidal anti-inflammatory drugs such as ibuprofen. 5. Avoid any trauma or injury that might cause bleeding. This includes vigorous brushing of your teeth, contact sports and rollerblading. 6. Limit alcohol intake to a small to moderate amount. 7. Obtain medical alert identification. Indicating what anticoagulant is being taken. 8. Avoid marked changes in your eating habits. Especially avoid increasing the amount of foods with Vitamin K (green leafy vegetables, broccoli, asparagus, sauerkraut). 9. Always talk to your doctor or pharmacist before taking an over the counter medication, vitamins or herbal remedies. 10. Inform all health care professionals that you take an anticoagulant, including your dentist. 11. Obtain immediate medical care if you have chest pain, shortness of breath, a feeling of passing out or a racing heart. Anticoagulant Therapy March2015 Page 3 of 6

4 Goals for Self Administering Subcutaneous Injections Choose at least 1-2 strategies that you or your caregiver feel confident you can follow and work on them for a period of a week. Use your personal action plan to help guide you. Once you feel confident that you are managing these goals, select at least 1-2 more. I will call my doctor if I notice signs of increased bruising, unusual bleeding, pain at the injection site, trouble breathing, or any new other new or unusual symptoms. I will choose the injection site that I would prefer to use for the injection. (avoiding 1-2 around belly button, scars bruises, etc.) I will pinch the skin and hold it until the injection is finished being given. I will discard the used syringe into a proper sharps container immediately after the injection is given. I will work on quitting smoking. I will be down to cigarettes a day by my next visit to the doctor. I will keep an updated list of all the medications I take and bring the list with me when I see my doctor. I will prepare the syringe by removing from the box, checking the label for accuracy, and gathering the supplies needed. I will administer the injection with the help of my nurse. I will check with my doctor or pharmacist before taking any over-the-counter medications for pain or cold symptoms. I will decrease the risk for bleeding by avoiding contact sports, walking bare foot, and using a soft toothbrush and an electric shaver. I will give my injection around the same time each day. I will remind myself by: I will clean the site with an alcohol swab. To avoid bruising I will hold firm pressure (no rubbing) over the site of injection for 3-5 minutes after the injection is given. I will exercise days a week for minutes a day. The exercise I choose to do is: I will decrease the risk for developing a blood clot by exercising and avoiding restrictive clothing, such as; tight socks, girdles, tight pants, etc. For more information on how to administer a subcutaneous injection, please go to: or For more information on how to stay safe when taking Coumadin, please go to: Anticoagulant Therapy March2015 Page 4 of 6

5 Personal Action Plan Today s Date: Name: 1. Goals: Something you WANT to do: 2. Describe your plan: How? Where? What? When? How often? 3. Barriers (what is standing in the way of meeting your goals?): 4. How can you overcome barriers? 5. Importance of achieving goal: Confidence in achieving goal: Follow-Up (Date that I will reassess my goal and progress?): PAP v2 10Sept2014

6 Today s Date: Monday September 8th SAMPLE Personal Action Plan 1. Goals: Something you WANT to do: Begin exercising Name: Jane Doe 2. Describe your action plan: How? Walkihg Where? What? When? How often? Around the block 2 times After dinner 4 days a week 3. Barriers (what is standing in the way of meeting your goals?): 1. Have to clean up the supper dishes 2. Bad weather 4. How can you overcome barriers? 1. Ask kids and husband to help clean up dishes on those evenings. 2. Buy some rain gear 5. Importance of achieving goal: Confidence in achieving goal: Follow-Up (Date that I will reassess my goal and progress?): Will report progress in one week (Sept 15 th ) at next visit and re-evaluate plan. PAP v2 10Sept2014