Question

PN 105 Fundamentals of Nursing I Case Study- Thrombophlebitis- Heparin Tom Moore, a 57 year-old man, has thrombophlebitis in the right lower leg. IV Heparin, 5000 units by bolus, was given. Following the IV bolus, Heparin 5000 units was given subcutaneously every 6 hours was prescribed. Other therapeutic means to decrease pain and alleviate swelling and redness were also prescribed. An aPTT test was ordered. 1. What are the various methods for the administering Heparin 2. Why was an aPTT test ordered? How would you determine whether Mr. Moore is within the desired range? Explain your answer After 5 days of Heparin therapy, Mr. Moore was prescriber warfarin (Coumadin) 5 mg, by mouth daily. A PT/INR test was ordered. 3. What is the pharmacologic action of warfarin? Is the wasfarin dose within the safe daily dose range? Explain your answer. 4. What are the half-life and protein binding for warfarin'? If a patient takes a drug that is highly protein bound, would there be a drug interaction? Explain your answer. Why is a PT/INR ordered for Mr. Moore? What is the desired range? 5. What serious adverse reactions could result with prolonged use of large doses of warfarin? 6. What patient teaching interventions should the nurse include? List three (3) interventions you, as the nurse, would employ 7. Months later, Mr. Moore has hematemesis. What nursing actions should be taken? 11/17

Answer 1

1. Various methods of heparin administration are :-

- subcutaneous (SC)

- intravenous (IV)

- IA

2. The activated partial thromboplastin time (aPTT or PTT) is a functional measure of the intrinsic and common pathways of the coagulation cascade. The aPTT test measures the length of time (in seconds) that it takes for clotting to occur . The normal range of aptt is 30-40secs . If the patient has the value between this then her range is normal .

3. The pharmacological action of warfarin - depresses the hepatic synthesis of vitamin K clotting factors II ( prothrombin ) , VII, IX and X . The dosage is safe because in a venous thrombosis patients initial dose is 2-5mg PO/IV q day.

4. The half life of warfarin ranges from 20-60 hours . The mean plasma half life is approximately 40 hours and the duration of effect is two to five days . Thus the maximum affect occurs after 48hours of administration . 99% of the drug bi ds with human albumin .

PT and INR values are monitored to evaluate the length of time needed for clotting . Normal PT is 12- 15secs and INR is 2-3 secs . If the patient has values within this means the patient has normal desired range .