10 Questions
Match the following anticoagulant therapy assessments with their descriptions:
Assess for bleeding = Bruising, blood in urine or stools, vomiting blood Monitor CBC = Decreasing hemoglobin, signs of shock Client teaching = Education on anticoagulant therapy Heparin therapy = Monitoring aPTT values
Match the following lab values with their descriptions:
aPTT = Activated Partial Thromboplastin Time to monitor heparin ACT = Activated Clotting Time to monitor unfractionated heparin UA = Urinalysis to check for RBCs CBC = Complete Blood Count to monitor hemoglobin
Match the following heparin therapy values with their interpretations:
25-35 sec = aPTT normal value 46-70 sec = aPTT therapeutic value 1.5-2x normal = aPTT therapeutic value 70-120 sec = ACT normal value
Match the following anticoagulant therapy complications with their descriptions:
HIT = Heparin-induced thrombocytopenia Bleeding = Signs of bleeding from IV site, bruising, etc. Shock = Hypotension, tachycardia, and mental status changes Thrombosis = Paradoxical increase in venous or arterial thrombosis
Match the following anticoagulant therapy medications with their monitoring parameters:
Heparin = aPTT values Warfarin = INR values Hiruin derivatives = ACT values Synthetic thrombin inhibitors = ACT values
Match the following patient education topics with their descriptions:
Bleeding = Report any signs of bleeding Heparin therapy = Monitoring aPTT values Warfarin therapy = Monitoring INR values Anticoagulant therapy = Client education on all anticoagulants
Match the following laboratory tests with their descriptions:
CBC = Complete Blood Count to monitor hemoglobin UA = Urinalysis to check for RBCs aPTT = Activated Partial Thromboplastin Time to monitor heparin ACT = Activated Clotting Time to monitor unfractionated heparin
Match the following anticoagulant therapy nursing management topics with their descriptions:
Heparin therapy = Monitoring aPTT values and client education Warfarin therapy = Monitoring INR values and client education Anticoagulant therapy = Assessing for bleeding and shock HIT = Monitoring for heparin-induced thrombocytopenia
Match the following anticoagulant therapy values with their descriptions:
300 sec = ACT therapeutic value 25-35 sec = aPTT normal value 1.5-2x normal = aPTT therapeutic value 70-120 sec = ACT normal value
Match the following anticoagulant therapy complications with their descriptions:
Bleeding = Signs of bleeding from IV site, bruising, etc. HIT = Heparin-induced thrombocytopenia Shock = Hypotension, tachycardia, and mental status changes Thrombosis = Paradoxical increase in venous or arterial thrombosis
Study Notes
Anticoagulant Therapy: Bleeding Assessment
- Instruct patients to report any signs of bleeding, including bleeding from IV site, bruising, blood in urine or stools, vomiting blood, and bleeding gums.
- Monitor for petechiae, a sign of bleeding.
- Assess for signs of shock, including hypotension, tachycardia, and cold, blue, or painful feet.
Anticoagulant Therapy: Nursing Management
- Heparin and warfarin are two types of anticoagulant therapies.
Heparin: Therapeutic Lab Values
- aPTT (Activated Partial Thromboplastin Time) is used to monitor heparin use.
- Normal aPTT value is 25-35 seconds.
- Therapeutic aPTT value is 46-70 seconds, or 1.5-2 times the normal value.
- ACT (Activated Clotting Time) is used to monitor unfractionated heparin, hirudin derivatives, and synthetic thrombin inhibitors.
- Normal ACT value is 70-120 seconds, and therapeutic value is above 300 seconds.
Heparin-Induced Thrombocytopenia (HIT)
- HIT is an immune reaction to heparin, causing a severe reduction in platelet count and a paradoxical increase in venous or arterial thrombosis.
- HIT is diagnosed by measuring the presence of heparin antibodies in the blood.
Heparin Dosing and Evaluation
- Heparin dose is adjusted based on aPTT lab values.
- Heparin is administered through a continuous IV infusion, with a standardized scale based on patient weight.
- The initial dose is calculated based on patient weight and lab values (e.g., 15 Units/kg/hour).
Heparin Nomogram
- A nomogram is used to manage heparin therapy, with aPTT values guiding dosage adjustments.
- The nomogram provides information on bolus dose, infusion rate change, and repeat aPTT timing.
Heparin Calculations
- Heparin is measured in Units, with the nurse needing to recognize the units of heparin/mL of IV solution.
- The nurse calculates the mL/hour needed for a prescribed dose written in units/hour.
- The nurse may also calculate the units/hour being administered if the IV pump is set at a certain rate in mL/hour.
Learn how to manage heparin therapy using a standardized scale based on patient weight. Understand how to adjust the dosage of continuous IV infusion and IV push based on aPTT lab values. Evaluate the therapeutic effectiveness of heparin therapy.
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