Question

Mrs. Jay, a 73 year old female, has been admitted to the hospital for treatment of a deep vein thrombosis in her right calf. Her PMH includes hypertension. She has been taking Capoten 12.5 mg BID with good control of her pressure.  She is ordered on bedrest with the following orders:

Heparin 5000units IV bolus, followed by a heparin drip of 25,000units in 250ml to infuse at 1000 units per hour. Follow heparin protocol that includes obtaining a stat aPTT 6 hours after initiation and 6 hours after any dose change.

How many mL per hour will you administer the heparin drip to deliver 1000 units per hour?

What is an aPTT? What is a therapeutic range?

How does heparin work? What precautions need to be taken?

What is the treatment for a heparin overdose?

After three days, the physician orders Warfarin (Coumadin) 2mg po daily.  Mrs. Jay asks why she needs to take Coumadin and the heparin.

How will you respond to her?

How does Coumadin work? What is the difference between Heparin and Coumadin?

What lab value will be monitored while on Coumadin? What is a therapeutic range?

What is the antidote for Coumadin overdose?

What are some nursing considerations for a patient taking anticoagulants?

Develop a detailed teaching plan for Mrs. Jay regarding taking Coumadin when she goes home.

Answer 1

# Stock required = 1000 unit

Stock in strength = 25000 unit

Quantity = 250 ml

How many ml per hour is 1000 ÷ 25000 × 250 = 10 ml / hour

# APTT is a blood coagulation test . It measures how long it takes blood to form a clot.

# Therapeutic range of the apTT is 30 to 40 seconds . In patients receiving anticoagulant therapy the range is 1.5 to 2.5 times the control value in seconds .

# Heparin reduces clotting in the blood by preventing cofactors namely thrombin and fibrin, from working correctly .

# Precautions need to be taken are there is chance of developing heparin induced thrombocytopenia , avoid injury or bruising , be careful when using sharp objects , consult doctor if you notice blood in urine or stool.

# Treatment for heparin overdose : discontinue heparin , administer protamine sulphate , address needs related to blood loss .

# Heparin works faster than warfarin , so it is usually given in situations where an immediate effect is desired. Usually patient switch to warfarin when long term anticoagulant treatment is recommended.

# Coumadin works by interfering with how the body uses vitamin k . Body needs vitamin k to make clotting factors in liver. These clotting factors help blood to clot and stop bleeding . Coumadin blocks vitamin k from making these clotting factors .

# Heparin works faster than coumadin so it is usually given in emergent situations . Coumadin takes longer to show therapeutic levels so it is used in more preventive and maintainence situations.

# PT ( prothrombin time ) is used to measure the effect of coumadin and INR ( International normalized ratio) testing should undergo every 4 weeks for coumadin recepients .

# An INR range of 2.0 to 3.0 is an effective therapeutic range for people taking coumadin.Therapeutic range of PT for coumadin is 2.0 to 3.0.

# Antidote is vitamin k ( phytonadione ,aquamephyton) .

# Daily monitoring of PT /INR and aPTT. , assess for evidence of increased thrombosis , assess for signs of bleeding and haemorrhage.

# Take coumadin as directed , Take it at the same time each day , If you miss a dose inform doctor to find out how much to take , never take a double dose, avoid drinking alchohol , don't make changes to warfarin dose , don't start any new medication without doctors order , do blood tests as per doctor's order.