Question

PN 105 Fundamentals of Nursing I 

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 prescribed. Other therapeutic means to decrease pain and alleviate swelling every 6 hours was 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 1est 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? 

Answer 1

Thrombophlebitis

It is the inflammation of the vein due to any blood clot or thrombus, especially in the lower legs.

1. Various methods for administering Heparin

As the digestive system can't absorb Heparin, it administers parenterally, beyond the gut. Commonly, Heparin administer through IV( intravenous) and Subcutaneous. To prevent the risk of hematoma, Heparin is used not to give through the intramuscular site.

2. aPTT test

Activated Partial thromboplastin time indicates the time taken for a coagulation process to happen or a blood clot to form. The physician ordered a PTT test to Mr. Tom Moore to monitor the heparin therapy and Identify his risk of the bleeding problem as the aPTT become high with the use of Heparin. Overdose of Heparin may cause Stroke, heart attack because of severe bleeding.

Normal range of aPTT is 30 - 40 seconds. For a patient, who is under heparin therapy, the aPTT time range is between 70- 100 seconds.

If the aPTT time increases beyond the normal range indicates the chances of bleeding in turn results in a heart attack or stroke.

3. Warfarin

Warfarin is an anticoagulant. Its main pharmacological action is to prevent coagulation by inhibiting Vitamin K( by inhibiting Vitamin K epoxide reductase.) Vitamin K is essential for the formation of a blood clot by making the coagulation factors.

Warfarin : normal dose is 2- 5 mg. Mr. Moore is taking a safe dose. 5mg is recommended as the initial dose for thrombophlebitis.

4. The half-life of Warfarin is 40 hours. It may vary from 20- 60 hours. 99% Protein Binding is there for Warfarin. it mainly binds to plasma proteins, and the action lasts up to 4 days.

As Warfarin is highly protein bound, there are chances for various drug interactions. Close monitoring is necessary, and precautions should be taken to avoid all herbal products and vitamins. Nonsteroidal anti-inflammatory drugs, antibiotics, and other antiplatelet drugs should use only with clear instruction from physician.

PT/ INR

prothrombin time : 12 sec

international normalized ratio: to monitor the ability to form clots.