I am a nursing instructor with over 20 years of nursing experience and a Masters Degree in Nursing Education.
You want to know what the difference is between a nursing consideration and a nursing implication? Implication means to be involved in something. Therefore, what is the nurse's involvement in giving this medication? Her involvement is to assess a patient before medication administration and monitor for side effects and effectiveness of the medication after administration.
What then is a nursing consideration? To consider something is to think about it. In nursing, we use critical thinking. We take all the information that we know about a patient and a situation and combine them to come up with considerations. With medication administration, a nursing consideration would include the following:
- Are there any reasons why this patient shouldn't have this medication?
- What will the effect of this medicine be on this patient?
- Is there anything I need to ask or teach this patient before or after the administration?
- What vital signs do I need to monitor?
These are only a few examples. Still fuzzy about the difference? Although nursing considerations and implications are slightly different, most nursing resources and textbooks use them interchangeably. A medication insert may only have listed one name or the other, but usually not both. Nursing consideration and implications are generally summed up as being what a nurse needs to know and do in a particular situation.
What is rivaroxaban? Rivaroxaban is a medication used in anticoagulation therapy. Its pharmaceutical classes are antithrombotics and factor Xa inhibitors. In general, it slows clotting times. Its manufacturer lists five indications for rivaroxaban. An indication is a reason why a medication would be prescribed. The uses include knee or hip surgery, atrial fibrillation that does not involve a valve, deep vein thrombosis, or pulmonary embolism. In all cases, it's used preventatively, but it can also be used as a treatment in the cases of deep vein thrombosis and pulmonary embolism.
Considerations & Implications
Some things should be considered before a patient begins therapy with rivaroxaban. Let's look at our patient and see if they fall into any of these categories:
- Liver failure
- Kidney disease
- Child or infant
- Pregnant or breastfeeding
- Prosthetic heart valve
- Epidural catheter placement or removal
- Recent surgery or surgery scheduled
If the patient falls under any one of these categories, rivaroxaban isn't indicated for your patient. You should contact the prescribing provider to discuss your concerns and possible alternatives. Another reason to consider contacting the provider is if your patient has a low creatinine clearance level (CrCl). The acceptable levels will vary depending on its indication for use and your patient's age. Generally, rivaroxaban shouldn't be administered if the CrCl is below 15 ml/min, but the cut-off may be 30 ml/min in some situations.
Since rivaroxaban has potential reactions listed with over 350 prescriptions, over-the-counter, herbs, and vitamins, it's important to ensure that a pharmacist has reviewed the medication profile of the patient. Lastly, a nurse must always check a patient's listed allergies before administering any medication.
Let's now look at what nurses need to consider while administering rivaroxaban. Nurses should administer medications as directed, i.e., with food, without food, with water or without. A nurse should know the dosage of rivaroxaban before administering it. A 10 mg tablet can be taken with or without food, but 15mg and 20 mg tabs must be taken with food. These medications can be crushed and administered with applesauce if they are followed immediately by food.
Some patients need medications administered by a g-tube. In this case, the nurse must follow the same guidelines. Crush and administer tablets in 50 ml of water, if it's a 10 mg tablet that's sufficient, but if it's a 15mg and 20mg tablet it must be followed by food or tube feeding.
Now let's look at what nurses have to consider after administering rivaroxaban. The primary concern in monitoring your patient who's receiving rivaroxaban is to monitor for bleeding, either apparent or occult (the latter meaning ''hidden''). Some signs or symptoms of apparent bleeding include the following: bruising, nosebleeds, blood in the urine or stool, and bleeding from a surgical site. Some symptoms of occult bleeding include the following: hypotension (low blood pressure) or a reduced hematocrit (a sign of circulating red blood cells). Additionally, if your patient does have an epidural catheter you should monitor for changes in mental status.
Finally, there are some lab considerations to be taken into account. During therapy, a patient's liver and kidney function should be monitored. There isn't a lab test to monitor rivaroxaban effectiveness or concentration, so the main thing for nurses is to be especially vigilant with patients who are prescribed new therapy to see if it's appropriate and to monitor for signs and symptoms of bleeding. Effectiveness is monitored by the absence of new blood clots.
First and foremost, the patient should be taught about the signs of symptoms of bleeding and the importance of reporting them as soon as they are noticed. Next, it's important to instruct the patient not to stop or start any new medications, herbals, or over-the-counter medications. They should also not drink alcohol because it has the potential to increase bleeding. This is because of the many potential interactions, as noted. Also, they should be taught not to stop rivaroxaban abruptly and when and how to make up missed doses.
Two special populations that require additional teaching are older patients and women of child-bearing age. Older adults should be taught that they have a higher risk of bleeding events and complications. If a woman becomes pregnant or decides to breastfeed she should notify her physician.
All right, let's now take a moment or two to review. As we learned in this lesson, rivaroxaban is a medication used for anticoagulation. A nurse needs to be aware of which patients should and more importantly should not take it. He or she needs to know that the larger doses must be given with food. The main side effect of rivaroxaban is bleeding so, therefore, the nurse needs to know how to identify both apparent and occult bleeding. Lastly, a nurse should always take the time to ensure effective patient teaching is provided.
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