Question

PN 200 Fundamentals of Nursing II Pharmacology 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? Revised 1/2

Answer 1

1.Heparin can be administered only by two methods

• As a subcutaneous injection deep into the subcutaneous tissue
• Intravenous injection through infusion

2.The activated partial thromboplastin time is ordered to measure the coagulation time after a bleeding occurs.In simple the time taken to form a clot after a bleeding occurs.If heparin is taken the aPTT should range in between 60 to 80 seconds.If it is increased there is some bleeding disorder or liver problem.

3.When warfarin is taken it acts by stopping the production of the receptors from vitamin K.These receptors are essential for the formation of certain protein responsible for clotting mechanisms. The synthesis of factor 2 ,7,9,10 and protein C and protein S are inhibited because of the inhibition of production of Vitamin K .When Vitamin K is not present the other clotting factors can be synthesized.

It is in safe dose as the initial dose is always started from 2.5 to 5mg per day as a single dose

4.The half life of warfarin is about 20 to 60 hours and it is nearly 99% protein bound.In simple it can bring with the albumin.Therefore most of the excretion happens in the renal system.

When a diet has high protein binding nature it will increase the binding of warfarin as well.So normal amounts is required There are high of drug interactions when the amount of vitamin K from diet is increased with increased protein intake.The action of warfarin is to decrease the clotting so PT INR is done to check whether it is with in the expected normal range or not.

The normal range of PT is 11 to 13.5 and INR is 0.8 to 1.1 .If a patient takes warfarin it should lie on between 2.0 to 3.0.