Question

The patient is admitted to the hospital with a diagnosis of right calf DVT. Below are the orders:

• Bed rest with bathroom privileges
• CBC, UA, PT, PTT stat
• Guiac stool daily X 3 days
• Heparin 5,000 units bolus IV X 1
• Heparin 25,000 units in 250ml D5W to infuse at 1000 units/hour
  • ****Have students do the math to determine: What do you set the pump at:
    • mL/hr = 250 ml X 1000 units = 10mL
      • 25,000 units hr hr
• Adjust heparin infusion per protocol
• Daily PT/INR
• Warfarin 10mg by mouth X1 tonight
• Call for daily warfarin dose

5. Why was bed rest with BRP ordered for the patient?

6. Why was a bolus of heparin given before starting a continuous heparin infusion?

7. Why was warfarin started simultaneously with the heparin?

PART II:

8. When can the heparin infusion be discontinued?

9. Name the drug that antagonizes the effect of heparin:

10. Name the drug that is an antidote to warfarin:

11. List at least 4 bleeding prevention precautions the nurse would discuss with the patient:

12. What discharge instructions will the patient need regarding:

1. Diet:
2. Medications:
3. Out-patient lab tests:

13. What is the major risk of DVT?

14. If the patient were not a candidate for anticoagulation therapy, what surgical intervention could be done to minimize this risk?

15. What chronic complication is the patient at risk for as a result of having a DVT?

16. List interventions for the patient to prevent or minimize this complication. (Select all that apply)

   Avoid sitting for long periods

BP Control

Apply Compression stockings in the evening

Regular Exercise

Weight reduction

Encourage dependent leg positioning

Answer 1

To reduce the risk of pulmonary embolism

Bolus acts as a loading dose and after that the maintainence dose is administered by infusion

7) Because the late prothrombin suppresion hiparin and warfarin are administered simultaneously

8) prior to any surgery the heparin is discontinued

9) Protamine sulfate

10) protamine sulphate acts as antidote

11) soft bristle brushing , preventing any injury , don't take sharp things in hand always wear shoe when going to any rough floor

12) take balanced diet which are rich in vitamins, take medicines regularly don't stop taking drugs by your own, regular do blood test to know about blood profile

13) pulmonary embolism is the major and serious risk of dvt

14) thrombolysis is a sugical procedure which directly dissolves the clot in Supperfical veins in deep veins the thrombectomy is done surgically removing clot

15) chronic venous insufficiency, and post-thrombotic syndrome are the chronic complications of dvt

16) Avoid sitting for long periods

Apply Compression stockings in the evening

Weight reduction

Encourage dependent leg positioning