Question

III. Case Study: Ms. J had right hip replacement surgery 3 days ago. She was on low-dose heparin therapy to prevent DVT. On initial assessment of the patient, the nurse finds her right calf to be tender to palpation with a red, warm vein on the posterior surface. The nurse reports this finding, and Ms. Jis diagnosed with DVT of the right calf. She is placed on IV heparin therapy and bed rest. 

1. What actions should the nurse take before administering the IV heparin? 

2. What medication should the nurse have on hand for a patient receiving IV heparin therapy? 

3. When evaluating Ms. J's daily blood test results, the nurse notes decreasing hematocrit and blood cell counts, an aPTT of 90 seconds, and a platelet count of 95,000. How does the nurse interpret these findings?

Answer 1

Deep vein Thrombosis ( DVT)

A potentially fatal condition in which one or more clot ( thrombi) form in the predominantly the leg or more unusually , arm . The clot may break free from the venous wall and travel via the circular system to heart or to the lungs.

1. Actions to be taken before IV Heparin administration

* Obtain laboratory values such as Prothrombin time ( PT), Activared partial thromboplastin time ( aPTT) and Complete blood count, platelet count and Haemoglobin level.

( a reduced platelet count is a contraindication for Heparin therapy )

* Set the anticoagulation target as per Instructions

* calculate the dose and administer the initial dose.

* Educate the patient regarding the increased risk of bleeding, signs of internal bleeding , how to manage bleeding ( if in case)etc.

* Monitor and evaluate lab values for ever 6 hours.

2. Medication should the nurse have in her hand during IV Heparin :

The medication, Protamine Sulphate , is the treatment medicine for Heparin overdose. It bind with Heparin xnd prevent its blood thinning effect.

3. Decreased Heamatocrit and Blood cell count: A decrease in packed Red cell volume ( Heamatocrit) and Blood cell count reduction

Decreased platelet count: Thrombocytopenia is one of the side effect of heparin administration . Platelet count Below 100,000/ mm ( cube) , is not desirable, report to physician xnd stop the infusion. Thrombocytopenia may lead to different complications such as pulmonary embolism, skin necrosis, gangrene etc.

aPTT: activated Partial Thromboplastin Time

A typical aPTT is 30 to 40 seconds. The patient in IV Heparin is having a time of 90 seconds ( aPTT). It indicates the effect of Heparin therapy and risk of bleeding tendencies.