Question

Rachael Heidebrink Summary

I have taken care of the patient, Rachael Heidebrink, during the night and I would like to give you a report on her. Ms. Heidebrink suffered a pulmonary embolism 2 days ago and she is currently on IV heparin therapy.

Ms. Heidebrink is a 22-year-old white female who was admitted 4 days ago with a fractured right greater trochanter sustained in a motorcycle accident. A right hip hemiarthroplasty was performed 3 days ago. On post-op day 1 she started complaining of severe shortness of breath, and her SpO2 dropped to 88% on room air. A VQ scan revealed a pulmonary embolism in the left lung, and she was then started on a heparin drip.

Ms. Heidebrink’s SpO2 is 93% on 2 L of oxygen via nasal cannula. She has an IV line in her right arm with the heparin drip infusing at 14.2 mL/hr. She is rating her pain as 2 out of 10 right now. She had oral pain medication 3 hours ago. She has a urinary catheter draining clear yellow urine. Ultrasound scanning shows no sign of deep vein thrombosis (DVT), and her right hip dressing is dry and intact.

This morning Dr. Lindley wrote orders for anticoagulation bridge therapy. They are in the patient chart and will need to be initiated. Ms. Heidebrink also requires patient education about the change from IV to oral anticoagulant therapy. The aPPT results just came back, and you should check the orders to see if the heparin drip needs to be adjusted.

Why was patient Rachael put on an heparin drip?

Ms.Heidebrink's anticoagulant medication is being changed from IV to oral. What oral anticoagulant do you anticipate being ordered? What patient education do you want to give the patient regarding the oral medication?

Answer 1

1. Why was patient Rachel put on an heparin drip?

Patient was put on heparin therapy because patient suffered a pulmonary embolism, it is a condition in which one or more arteries in the lungs become blocked by clot, most times pulmonary embolism is caused by blood clots that travels from the legs, or artery, other parts of the body(Deep vein thrombosis). Heparin injection is an anticoagulant. It is used to decrease the clotting ability of the blood and help prevent harmful clots from forming in blood vessels. This medicine is sometimes called a blood thinner, although it does not actually thin the blood.

2. Warfarin is a oral anticoagulant medication used to prevent harmful blood clots from forming or growing larger.

Patient Education about care of while taking warfarin :-

-Instruct the patient excessive bleeding can occur in any area of the body, and patient taking warfarin should report any falls or accident ; as well as signs or symptoms of bleeding or unusual bruising, to their health care provider.

Signs of usual bleeding include :

• Bleeding from the gums
• Blood in the urine
• Bloody or dark stool
• A nose bleed
• Vomiting blood

- An unusual headache or a headache that is more severe than usual may signal intracerebral bleeding.

- lf you experiencing the following signs of bleeding, you should call 911 or your health care provider immediately ;

• Sever headache, weakness, confusion, or numbness
• Coughing up larger amounts of bright red blood
• Vomiting blood
• Bleeding that will not stop
• Bright red blood in stool
• Fall or injury to the head
• Headache that is sever or unusual

Some simple changes to decrease the risk of bleeding while taking warfarin include the following ;

• Use a soft bristle toothbrush
• Floss with, waxed floss, rather than untaxed floss
• Shave with an electric razor rather than a blade
• Take care when using sharp objects such as knives and scissors
• Avoid activities that have a risk of falling or injury (e. g., contact sports)

- If you are having surgery, dental works or other medical procedures, you need to stop taking warfarin. It is important to tell all your health care providers.

- Do not take double a doss because you missed a dose

-Don't start new medications, herbals, or supplements without talking to your health care provider.

- Do keep appointment for blood clots(PT, INR)

- Warfarin interacts with alcohol and certain foods :-Avoid alcohol and vitamin K contains food it is lower the PT and INR, making warfarin less effect potentially increasing blood clots.

Wear medical identification - it helps to get immediate medical care.