Question

T.M., 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 given subQ q6h was prescribed. Other therapeutic means to decrease pain and alleviate swelling and redness were also prescribed.

How does heparin work and why was it prescribed?

What laboratory test(s) would be monitored for patients taking heparin? Explain your answer.

Explain the differences between heparin and enoxaparin. Are there advantages to either of these anticoagulants?

After 5 days of heparin therapy, T.M. was prescribed warfarin 5 mg PO daily.

Why was T.M changed to warfarin? What is the pharmacologic action of warfarin?

What laboratory test(s) would be monitored for patients taking warfarin? Explain your answer.

Explain the half-life and protein-binding for warfarin. What additional concerns do you have? How does this knowledge impact teaching for patient’s taking warfarin? Explain.

What assessments should be performed before starting anticoagulant therapy?

Explain the nursing considerations and patient teaching for anticoagulant (include rationale).

Answer 1

Heparin prevents thrombin from converting fibrinogen to fibrin and prevent further thrombus formation

Activated partial thrombiplastin time lab.test used to evaluate for requirement of iv heparin if longer then 90 second patient is at risk for bleeding

Iv heparin and enoxa heparin has same course of action but iv heparine have short half life and enoxa heparin have longer half life

From enoxaheparin patient shifted to warfarin therapy

Warfarin supress the coagulation by acting as agonist of vitamin K by inhibiting four dependent clotting factor x,ix,viiand ii

PT-INR lab test used for minitoring of effect of warfarin,If PT is more then 30 second patient is at risk of bleeding

Warferin is long term anticoagulant

Patient teaching

1 explain the client about hazards of anti coagulation therapy

2 recognise the sign of bleeding

3 elevate the legs for 10 minutes every hours

4 avoid smoking

5 use stocking as ordered

6 avoid any medications unless prescribed by physician

7 inform to physician if edema seen in legs

Take medication as ordered and take regular follow up and lab.tests