Pharmacology - Heparin and Warfarin 2
A patient asks if it is safe to take heparin while pregnant. How should the nurse respond?
"Heparin can be administered safely during pregnancy because it does not cross the placenta."
For which patients is warfarin contraindicated?
1. Patients who are pregnant 2. Patients scheduled for brain surgery 3. Patients with vitamin K deficiency
Which teaching is appropriate for a patient taking warfarin?
1. Use an electric razor. 2. Use a soft-bristled toothbrush. 3. Notify your dentist you are taking warfarin
Which teaching is important for a patient taking warfarin?
1. Avoid herbal products. 2. Wear support hose. 3. Avoid smoking.
A patient is overheard telling a family member, "I am receiving heparin intravenously to dissolve the blood clot in my lung." What would be an appropriate response to this patient's statement?
"Heparin does not dissolve clots, but prevents new clots from forming."
Which discharge teaching is appropriate to give a patient who has been prescribed warfarin?
1. Notify the health care provider for excessive bruising, abdominal pain, or tar-colored stools. 2. Check with the health care provider prior before taking any new medications. 3. Obtain emergency care for profuse bleeding. 4. Wear a medical alert ID that states you are taking warfarin.
The nurse is giving discharge teaching regarding warfarin to a Chinese patient. The patient uses coining (rubbing a coin vigorously along the back) to help decrease fever. Which teaching will be especially important for this patient?
"Warfarin causes an increased risk for bruising, so coining can lead to bruising and would not be advised."
A 30-year-old woman taking warfarin has a hematocrit of 22. Which questions would be important for the nurse to ask?
1. "How heavy is your menstrual bleeding?" 2. "Do you have tar-colored stools?" 3. "Are you taking any over-the-counter medications?"
Which statement would indicate a patient needs more discharge teaching related to warfarin?
1. "This medication will break up blood clots I have in my legs." 2. "I'll take this medication whenever I don't take my baby aspirin." 3. "I'll increase my intake of green leafy vegetables."
A patient is started on a continuous infusion of heparin at 0900. What time should an aPTT be checked?
1300-1500
A patient is admitted with an acute pulmonary embolism (PE). Heparin intravenous (IV) is prescribed. Why is the prescription for IV rather than subcutaneous heparin?
Immediate onset of action.
Warfarin binds with which molecule in the body?
Albumin
For which patient would warfarin be contraindicated?
An alcoholic patient with liver disease.
A patient is receiving a continuous heparin infusion. What is the appropriate aPTT response?
An increase of 1.5-2.5 times above baseline aPTT.
Heparin combines with which factor to inhibit thrombus formation?
Antithrombin III
What is the initial intervention for a patient on an anticoagulant who cuts himself?
Apply direct pressure with a clean cloth to the cut for 5-10 minutes.
What is important to teach Ms. Wang about nutrition while she is taking warfarin?
Avoid broccoli.
A patient who only speaks Spanish is being discharged home on an anticoagulant. How can the nurse best ensure the patient understands discharge instructions?
By providing discharge teaching instructions in the patient's preferred language
The nurse is hanging a new bag of intravenous heparin and sees the dose is prescribed in milligrams. What is the nurse's next action?
Contact the prescriber for a change in prescription.
During the patient interview, the nurse finds that the patient taking warfarin eats a salad for lunch every day. What is a concern for this patient?
Decrease in warfarin's effectiveness
A patient taking warfarin states she is having trouble falling asleep at night. Which advice would be contraindicated in this patient?
Drink a cup of chamomile tea before bedtime.
Why is heparin administered parenterally rather than orally?
Heparin is destroyed by gastric secretions.
A patient with recurrent blood clots is taking warfarin at home. During an office visit, which lab work would indicate a high risk for thrombus formation?
INR of 1.5
A patient is taking an anticoagulant at home. In which situation should the health care provider be contacted immediately?
If the patient develop dark, tarry stools
Which result is possible if a patient takes St. John's wort and heparin simultaneously?
Increased bleeding
A patient taking warfarin is profusely bleeding. He received vitamin K 2 hours ago but continues to bleed. Which prescription should the nurse anticipate?
Infusion of fresh frozen plasma
What is a critical nursing assessment in a patient receiving a continuous heparin infusion?
Monitoring the aPTT and notifying the provider of the need to make changes
A hospitalized patient has been receiving subcutaneous heparin every twelve hours. The patient is scheduled to have a lumbar puncture at 0900. What is the nurse's priority action?
Notifying the health care provider the patient is receiving heparin.
Why should patients inform their dentist if they are taking an anticoagulant?
Patients are at an increased risk for bleeding.
When assessing a patient who is taking warfarin, which manifestation could indicate bleeding?
Petechiae on arms
A patient is receiving heparin infusions for several days after major surgery. In reviewing lab data, the nurse finds that the platelet count is 130,000/microL, when previously it had been 300,000/microL. What might this decrease in platelets signify?
Possible heparin induced thrombocytopenia (HIT)
What is the primary use for subcutaneous heparin therapy?
Preventing thrombosis
What is the antidote to heparin overdose?
Protamine sulfate
Which laboratory value should the nurse monitor related to warfarin therapy?
Prothrombin time reported in international normalized ratio (INR)
A patient is administering subcutaneous heparin at home. Which teaching point is appropriate for this patient?
Shave with an electric razor.
Which laboratory value should the nurse monitor related to intravenous (IV) heparin therapy?
aPTT
