1. The nurse is caring for a patient on an intravenous heparin infusion. Which action is most appropriate in the care of this patient?
1. high dosing hepain used if patient has a KNOWN clot; give them bolus of 5,000 units, then followed by IV drip to give X units/hour
2. low dosing heparin NO CLOT YET used for prolonged bedrest people, knee/hip replacement patients
3. DON’T take Heparin with aspirin/NSAIDS will INCREASE bleeding
4. Get BASELINE lab values to know hemoglobin/hematocrit to see if bleeding more from heparin
5. NON INVASIVE PROCEDURES no IV sticks, cuts, NG tubes(anything that can make the patient bleed)
6. ROUTESQ or IV
7. ONSETimmediate, duration 4-6 hours
8. Lab tests APTT or PTT
9. ANTIDOTE Protamine sulfate (will stop the bleeding from Heparin)
10. If on a heparin IV drip DECREASE the drip and put the client on Coumadin as you continue to decrease heparin dosing(don’t just take patient of Heparin abruptly) CBC every 3 days
Periodical blood tests
Double check dose w/ other nurse
1. The nurse reports laboratory result as indicating an adverse reaction to heparin therapy
2. CBC lab test-> is done EVERY OTHER DAY for IV heparin therapy
3. NORMAL aPTT of 90-180 seconds
Low platelet ct. (HITT)-platelets used up in clots.
Circulating count low
4. Ptt>100=critical, before 50-70 can develop more clots
2. Which of the patients listed below would be excluded from thrombolytic therapy?
1. pregnant women
2. head trauma
3. active bleeding
4. recent brain/intracranial surgery
5. uncontrolled blood pressure ex. B.P. is 200 mm/Hg give this it can cause shock
6. >>>75 years old
7. broken down by liver, so if have liver issues don’t give thrombolytic
8. if on anticoaguluant, because all of them dissolve/prevent clots
1. In which instance does the nurse demonstrate appropriate technique when administering subcutaneous heparin?
2. DON’T aspirate or rub heparin
3. Given 2 inches away from umbilicus (belly button) and in LOWER ABDOMEN; 2 INCHES BELOW UMBILLICUS AND ABOVE ILLIAC CRESTS
4. Can be given in arm/legs but not normally if so 45 degree angle
5. 25 or 28 gauge needle (SMALL GAUGE) GO IN AT A 90 DEGREE ANGLE
3. The nurse evaluates heparin therapy as therapeutic when the PTT/apt is: (LOOK UP WHAT THESE STAND FOR IN THE BOOK)
1. PTT=90-180 seconds (prothrombin time)
2. aPTT- 50-70 seconds (activated partial thromboplastin time)
aptt prolongation of 1.5 – 2.5 times the mean normal reference interval. example: aptt mean normal = 30 seconds (10/16/06 to present) therapeutic range = 45 – 75 seconds (1.5 – 2.5 x mean normal)
look at pt-coumadin look at ptt-heparin
**** pt and ptt or aptt are lab tests which measure how long it takes a patient's blood to clot. since this time varies from person to person a lab might be drawn to determine the normal clotting time for a patient. or the mean normal value may be used as explained below.
4. Which drug does the nurse keep on hand to stop bleeding associated with a heparin overdose?
1. Protamine Sulfategiven IV or PUMP
1. A nurse hears in report that a patient has a cholesterol microemboli. This prompts the nurse to investigate which patient variable?
2. PURPLE TOE SYNDROME associated with Coumadin therapy and is emboli composed of CHOLESTEROL
3. anticoagulant or thrombolytic meds
Abnormal lab
Hypotension
Bleeding
4. Purple toe syndrome (cholesterol microemboli)
5. Which assessment finding(s) prompts the nurse to hold a scheduled dose of warfarin (Coumadin) and contact the physician? (PICK 1)
1. Coumadin is only given PO so if patient is NPO hold the Coumadin
2. If patient has blood in urine/gums are bleeding means PT & INR are HIGH and need to DECREASE COUMADIN
3. If patient is on NSAIDS/aspirin because can INCREASE bleeding
4. If patient is scheduled for surgery could bleed bad, so stop Coumadin usually 5 days before surgery
5. Check to see if patient is using garlic
