Anticoagulant Medications

ESSAY

1. Ordered: Coumadin 2.5 mg PO daily at bedtime.

Available:

a. What is the primary danger of Coumadin overdose?

b. Which test result needs to be monitored: aPTT or INR?

c. Which antidote needs to be available: vitamin K or protamine sulfate?

ANS:

a. Excessive bleeding and hemorrhage

b. INR

c. Vitamin K

2. Ordered: heparin 8000 units subcut q6h.

Available:

How many milliliters should the nurse prepare?

a. Estimated dose:

b. DA equation:

c. Evaluation:

Indicate the nearest measurable dose on the syringe.

ANS:

a. Estimate: Less than 1 mL. More than 0.5 mL.

b.

c. Equation is balanced. Estimate supports answer.

3. Ordered: dalteparin sodium 4000 units subcut daily.

Available:

How many milliliters should the nurse prepare?

a. Estimated dose (more or less than drug concentration volume on hand):

b. DA equation:

c. Evaluation:

Indicate the nearest measurable dose on the syringe.

ANS:

a. Estimate: Less than 0.2 mL

b.

c. Equation is balanced. Estimate supports answer.

4. Ordered: heparin 3500 units subcut q6h.

Available:

How many milliliters should the nurse prepare?

a. Estimated dose:

b. DA equation:

c. Evaluation:

Indicate the nearest measurable dose on the syringe.

ANS:

a. Estimate: Less than 1 mL

b.

c. Equation is balanced. Estimate supports answer.

5. Ordered: enoxaparin sodium 35 mg subcut, for a patient following knee surgery.

Available:

How many milliliters should the nurse prepare?

a. Estimated dose:

b. DA equation:

c. Evaluation:

Indicate the nearest measurable dose on the syringe.

ANS:

a. Estimate: 0.35 mL (less than 0.4 mL)

b.

c. Equation is balanced. Estimate supports answer.

6. Ordered: heparin infusion 1000 units per hour

Available: heparin 20,000 units in 1000 mL 0.9 NaCl solution

Agency policy requires that heparin be administered with an infusion pump.

IV flow rate the nurse should set on infusion pump:

a. DA equation:

b. Evaluation:

c. Which antidote is used for heparin overdose: vitamin K or protamine sulfate?

d. What are the general SDR guidelines, in units per 24 hours, for IV heparin?

ANS:

a.

b. Equation is balanced. Only mL per hour remains.

c. Protamine sulfate

d. 1000 units per hr; 20,000 to 40,000 units per 24 hrs. Exceptions are made based on patient need.

7. Ordered: heparin infusion 1200 units per hour

Available: heparin 25,000 units in 1000 mL NS solution

How many hours and minutes will the infusion last?

a. DA equation:

b. Evaluation:

IV flow rate the nurse should set on the infusion pump:

c. DA equation:

d. Evaluation:

ANS:

a.

b. Equation is balanced. Only hours and minutes remain.

c.

d. Equation is balanced. Only mL per hour remain.

8. Ordered: heparin infusion 1500 units per hour

Available: heparin 20,000 units in 1000 mL Ringer’s solution

When the nurse arrives on duty, the IV is flowing at 125 mL per hour.

How many units per hour are being infused?

a. DA equation:

b. Evaluation:

IV flow rate the nurse should have set on the infusion pump based on the order:

c. DA equation:

d. Evaluation of math and flow rate:

ANS:

a.

b. Equation is balanced. Flow rate is excessive.

c.

d. Equation is balanced. Flow rate needs to be lowered to 75 mL per hour. Notify prescriber promptly. Monitor aPTT levels; monitor patient for bleeding. Document per agency policy.

9. Ordered: heparin infusion 200 units per kg to be infused over 4 hours, for a surgical patient

Patient’s weight: 90 kg

Available: heparin 25,000 units per 250 mL NS

a. Total dose ordered:

IV flow rate the nurse should set on the infusion pump:

b. DA equation:

c. Evaluation:

ANS:

a. 18,000 units (200 units × 90 kg)

b.

c. Equation is balanced. Only mL per hour remains.

10. Ordered: heparin infusion 1000 units per hour, for a patient with thrombophlebitis

Available: heparin 25,000 units in 500 mL NS

Infusing: heparin solution at 40 mL per hour

How many units per hour are being infused?

a. DA equation:

b. Evaluation:

IV flow rate the nurse should set on the infusion pump, in milliliters per hour:

c. DA equation:

d. Evaluation of math and flow rate:

ANS:

a.

b. Equation is balanced. Only units per hour remain. Flow rate is twice the rate it should be.

c.

d. Equation is balanced. Only mL per hour remains. Flow rate must be reduced to 20 mL per hour. Notify prescriber. Monitor aPTT levels. Monitor patient for bleeding. Document per agency policy.