Rivaroxaban: Nursing Considerations & Implications

Instructor: Charity Hacker

I am a nursing instructor with over 20 years of nursing experience and a Masters Degree in Nursing Education.

Nurses are the last safety check between a patient and a medication that is being administered. In this lesson, we will learn all the things that a nurse needs to know about Rivaroxaban before and during its administration.

Medication Nursing Consideration and Implications

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 and his or her environment 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 consideration would include the following: are there any reasons why this patient should not 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; and 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.

Rivaroxaban

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 is used preventatively, but it can also be used as a treatment in the cases of deep vein thrombosis and pulmonary embolism.

Considerations and Implications

Before Administering Rivaroxaban

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 breast feeding
  • prosthetic heart valve
  • epidural catheter placement or removal
  • recent surgery or surgery scheduled

If the patient falls under any one of these categories, rivaroxaban is not 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 should not 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 is 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.

During Administration of 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 10mg table can be taken with or without food, but 15mg and 20mg 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 in water, if it is a 10mg tablet that is sufficient, but if it is a 15mg and 20mg tabs it must be followed by food or tube feeding.

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