Question

MN, 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 subcutaneously every 6 hours was prescribed. An aPTT was ordered.

• Was MN's heparin within the safe daily dosage range?
• Why was an aPTT ordered?
• What is the pharmacologic action of warfarin?
• What serious adverse reactions could result with prolonged use or large doses of warfarin?
• What nursing diagnosis would you generate for this client?
• What patient teaching interventions should the nurse include?

Answer 1

• The patient is administered with the safest daily dosage form of heparin. The daily dosage range of heparin in an adult thrombophlebitis patient is,
• Initial or loading dosage : 5000 units by IV bolus
• Maintaining dosage : 5000 units subcutaneously q8 12hours or    7500 units SC q12hrs

Then we can reduce or adjust the dosage by checking the APTT result

ATTP diagnostic test :

• The APTT means Activated partial thromboplastin time ​​​​​. This is a laboratory diagnostic test use to find out the blood clotting time of a patient. The thrombophlebitis is the inflammation in the veins caused by the formation of clot in limbs resulting swelling and irrittation of the limbs caused by trauma . For this patient if we check the WBC count(the have normal WBC count) it would be normal so we want check the APTT test .By this test we can find the blood clotting time and thereby calculate the dosages of drug administration

Action of warfarin

• Warfarin is an oral anticoagulant , derivative of coumarin
• Ith blocks the vitamin K mediated blood coagulation
• Vitamin K is a main component of the normal blood clotting system. Normally it taken from the diet.
• The vitamin K reduced to vitamin KH2 by the enzyme vitamin K reductase.Then the vitamin KH2 undergo oxidation and give vitamin epoxide KO and leads to the carboxylation of glutamic acid on the clotting factors and triggers the clotting
• The Warfarin Inhibits or block the vitamin KO reductase enzyme and limit vitamin K availability in the cyclic reaction of blood clotting. This prevent the clotting

Adverse effects of Warfarin

• Bleeding disorders
• Brown or reddish urine
• Red cloured stool
• Blood coughing
• Eye or vision problem
• Weakness
• Tiredness
• Gum bleeding
• In major cases it may results cell or skin death (necrosis)
• Finally death in sever cases

Nursing diagnosis

• Swelling of tissues
• Reduced or slow peripheral pulse
• Color change of skin

These are the normal features of thrombophlebitis

Ith can be diagnosed by using

• Ultrasound scannig : To find out the swelling and type of disease whether it is in superficial vein or in Deep vein
• Blood test :To find out the APTT
• Venography : To locate any impaired blood flow
• Plethysmography : To find the change in blood volume

patient teaching nursing interventions

• Prevent the crossing of legs
• Wear smooth and loose cloths
• Examine the extremities mainly lower extremities to find edema
• Check the temperature
• Examine the skin coloration on lower limbs
• Mainly maintain the patient at bed
• Observe Homan sign