Rivaroxaban Scenario

After graduating from nursing school and passing your boards, you accepted a position as an RN in the emergency center at Rasmussen General Hospital (RGH). In the weeks ahead, your emergency center plans to implement a new initiative where clients diagnosed with low-risk deep vein thrombosis (DVT) will be sent home on 3 months of oral anticoagulation therapy with rivaroxaban.

Historically, clients diagnosed with DVTs in the emergency center were admitted to the hospital’s observation unit. However, when surveyed about their experiences, many clients reported that this was costly, time-consuming, and inconvenient. Under RGH’s new program, emergency center nurses will be responsible for educating clients about their new medication and administering the first dose to the client before discharge.

As part of this new initiative, all emergency center nurses at RGH must be trained to properly educate these clients on all aspects of their new medication regimen. Because you have demonstrated a keen interest in pharmacology, your manager has asked you to develop the educational tools that will be used to train the nurses at RGH.

It’s worth noting that the standard dosing for all low-risk DVTs is as follows:

15 mg BID, 12 hours apart, for 21 days
After 21 days, use 20 mg once per day
After 90 days, the client will follow up in the thrombosis clinic to evaluate if they meet criteria for discontinuing the medication
Assignment Instructions

Your manager explained that all of the emergency center nurses at RGH will be educated in small groups through a short, in-service training session. You have been asked to develop a professional-looking PowerPoint presentation that the trainers will use to guide the in-service sessions. Your PowerPoint will need to:

Be professional-looking, have a title slide, and 10-15 content slides.
Use the Speaker Notes feature in PowerPoint to reduce the amount of text that appears on the content slides.
The Speaker Notes for each slide will contain the text that will guide what the trainer will say while presenting the slides during the in-service.
The content slides themselves should be clear and easy to understand; they serve as an outline so the audience can follow along with what is being presented.
Be written using proper spelling/grammar and at a level that would be appropriate for the audience.
Remember the purpose of the training is to help nurses learn to educate their clients about the use of a medication. With that in mind, it may be helpful to provide examples of how to explain the information to a client in an easy to understand way without complicated, technical terms.
Include APA formatted in-text citations for at least 3 scholarly references and present the sources in APA format on a References slide.
Contain content addressing the items below.
Pharmacotherapeutics
State the drug name and its therapeutic category.
Pharmacodynamics – how does this drug work to achieve its intended response?
Pharmacokinetics – how is this drug absorbed, distributed, metabolized, and excreted?
Discuss dosage, scheduling, route, and length of therapy.
Describe what clients can expect regarding their therapeutic response and when it should develop.
Introduce nondrug measures that clients can do to enhance their therapeutic response (e.g., specific diet to follow, exercise requirements, substances to avoid, special precautions to take, etc.).
Side Effects, Adverse Effects, and Interactions
Explain the symptoms of common side effects, and what clients can do to minimize any discomfort.
Explain the symptoms of any major adverse effects, and what clients should do if they experience them.
List the major adverse drug-drug interactions and drug-food interactions that clients need to be made aware of.
Follow-up Care

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Sample Answer

 

 

 

Rivaroxaban (Xarelto) for Low-Risk DVT: A Patient Education Guide for Nurses

Slide 1: Title Slide

  • Title: Rivaroxaban (Xarelto) for Low-Risk Deep Vein Thrombosis (DVT): A Patient Education Guide for Nurses
  • Rasmussen General Hospital Emergency Center
  • Your Name, RN

Slide 2: Introduction

  • Briefly introduce the new initiative at RGH for low-risk DVT patients receiving rivaroxaban for treatment.
  • Highlight the benefits for patients (avoiding hospitalization, cost-effective, etc.)

Full Answer Section

 

 

 

Speaker Notes:

In an effort to improve patient care and experience, Rasmussen General Hospital’s Emergency Center has implemented a new program for patients diagnosed with low-risk DVT. This program allows for discharge home with a prescription for rivaroxaban (Xarelto), an oral anticoagulation medication, instead of requiring hospitalization. This presentation will equip you, the nurses, with the knowledge to effectively educate patients about rivaroxaban and their new medication regimen.

Slide 3: What is Rivaroxaban (Xarelto)?

  • Briefly define rivaroxaban as an oral medication used to treat and prevent blood clots.
  • Mention its classification as a Factor Xa inhibitor (a type of blood thinner).

Speaker Notes:

Rivaroxaban is a medication you may be prescribing to some of your patients diagnosed with low-risk DVT. It belongs to a class of medications called Factor Xa inhibitors, which work by blocking a specific clotting factor in the blood, helping to prevent new blood clots from forming and existing clots from growing larger.

Slide 4: How Does Rivaroxaban Work?

  • Present a simple diagram illustrating the blood clotting cascade, highlighting the role of Factor Xa.
  • Briefly explain how rivaroxaban inhibits Factor Xa, preventing the formation of fibrin (a key component of blood clots).

Speaker Notes (Use the diagram to explain):

Blood clotting is a natural process that helps stop bleeding when you’re injured. During clotting, platelets and proteins in your blood work together to form a plug at the injury site. One of these proteins is Factor Xa, which plays a crucial role in the clotting cascade. Rivaroxaban works by inactivating Factor Xa, essentially interrupting this process and preventing the formation of fibrin, a substance that binds platelets together to form blood clots.

Slide 5: Dosage and Administration

  • State the standard DVT treatment regimen for rivaroxaban:
    • 15 mg twice daily (BID), 12 hours apart, for the first 21 days.
    • Followed by 20 mg once daily thereafter for a total of 3 months (90 days).

Speaker Notes:

The standard dosage for low-risk DVT treatment with rivaroxaban is 15 milligrams taken twice a day, spaced 12 hours apart, for the first 21 days. After that initial period, you will transition to taking a 20 milligram dose once daily for a total treatment duration of 3 months. It’s important to take rivaroxaban exactly as prescribed, at consistent times each day, with or without food.

Slide 6: Expected Therapeutic Effects

  • Explain that rivaroxaban works gradually to prevent new blood clots and may take some time to show its full effect.
  • Briefly mention potential improvements in symptoms like leg swelling or tenderness (if present).

Speaker Notes:

Rivaroxaban works by preventing new clots from forming, not by dissolving existing ones. Therefore, you may not experience any immediate changes in your symptoms. However, consistent use of rivaroxaban helps prevent further complications and promotes healing. If you were experiencing leg swelling or tenderness due to the DVT, these symptoms may gradually improve over time with treatment.

Slide 7: Nondrug Measures to Enhance Treatment

  • Advise patients on the importance of maintaining good hydration by drinking plenty of fluids.
  • Recommend continued leg elevation when resting or sitting for extended periods.
  • Encourage gentle leg exercises to promote circulation, as approved by their doctor.
  • Advise patients to avoid prolonged sitting or standing without movement.

Speaker Notes:

In addition to taking rivaroxaban as prescribed, there are some lifestyle habits that can help enhance the medication’s effectiveness and promote healing. These include staying well-hydrated by drinking plenty of fluids throughout the day. When resting or sitting for extended periods, elevating your affected leg above the level of your heart can also be beneficial. Gentle leg exercises, as recommended by your doctor, can improve circulation and reduce swelling. It’s also important to avoid prolonged periods of sitting or standing without movement to promote blood flow in your legs.

 

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