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Phytonadione/ Vitamin K1: Nursing Pharmacology

Notes

Notes

VITAMIN K1 (PHYTONADIONE)
DRUG NAME
Vitamin K1 (Phytonadione)
CLASS
Fat-soluble vitamin
MECHANISM OF ACTION
Cofactor for gamma-glutamyl carboxylase, which converts the inactive forms of coagulation factors II, VII, IX, and X into their active forms
INDICATIONS
Prevention of hemorrhage caused by vitamin K deficiency
ROUTE(S) OF ADMINISTRATION
IM
SIDE EFFECTS
  • Pain and erythema at the injection site
  • Skin rash or urticaria
  • Hypersensitivity reactions
  • Hyperbilirubinemia
CONTRAINDICATIONS AND CAUTIONS
None
NURSING CONSIDERATIONS
Administration
  • IM administration in vastus lateralis
  • Provide comfort measures, pain management

Assessment
  • Monitor for side effects: e.g., pain and erythema at the injection site, skin rash or urticaria, hypersensitivity reactions, hyperbilirubinemia
  • Therapeutic response: prevention of bleeding from vitamin K deficiency

Client education
  • Newborns are unable to produce the vitamin K needed for certain coagulation factors making them at risk for bleeding
  • Provide comfort during and after administration
Transcript

Vitamin K1, is a fat-soluble vitamin that helps regulate the process of blood coagulation. Vitamin K is found in abundance in green leafy food, like spinach, kale, and chard; and it’s also produced by the gastrointestinal microbial flora.

Neonates are particularly susceptible to vitamin K deficiency because breast milk is low in vitamin K.

In addition, there is an absence of gastrointestinal flora at birth that synthesize vitamin K. Moreover, the newborn's immature liver is less able to produce coagulation factors.

Now, vitamin K deficiency results in impaired coagulation cascade and blood clotting formation. This can potentially lead to hemorrhage, or vitamin K deficiency bleeding or VKDB for short, which is a condition previously known as hemorrhagic disease of newborn.

VKDB is most likely to occur between days 1 and 7 of life; by day 7, most healthy newborns start producing their own vitamin K.

Vitamin K deficiency in newborns can be prevented by giving phytonadione, also known as vitamin K1, which is the most active form of vitamin K.

Phytonadione is administered intramuscularly in the newborn setting, typically within one hour after birth.

Once administered, phytonadione acts as a cofactor to an enzyme found in the liver called gamma glutamyl-carboxylase, which converts the inactive forms of coagulation factors II, VII, IX, and X into their active forms.

Now, IM administration phytonadione to a newborn may have potential side effects. The most common ones include pain and erythema at the injection site, as well as a skin rash or urticaria.

Other potential side effects include hypersensitivity reactions, as well as hyperbilirubinemia, which is more likely to occur in premature infants.

Before administering phytonadione to a newborn, there are a number of nursing considerations to keep in mind.

First, educate the newborn’s family about why the medication is needed. Explain how during the first week of life, newborns are at risk for bleeding because their gastrointestinal tract hasn’t yet begun producing the vitamin K needed by the liver to make certain coagulation factors.

Be sure to address any questions or concerns they may have. During administration, stabilize the infant’s leg to prevent injury.

Sources
  1. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  2. "Focus on Nursing Pharmacology" LWW (2019)
  3. "Saunders Comprehensive Review for the NCLEX-RN® Examination - Elsevier eBook on VitalSource, 7th Edition" Elsevier Evolve (2017)
  4. "Pharmacology: A Patient-Centered Nursing Process Approach (8th edition)" Elsevier Health Sciences (2014)