A client on a medical-surgical unit is receiving heparin therapy. Platelet levels decreased from 230,000/mm³ (230 × 10⁹/L) 2 days ago to 80,000/mm³ (80 × 10⁹/L) today. Which nursing actions are appropriate? Select all that apply.

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A significant reduction in platelets after initiation of heparin therapy can indicate heparin-induced thrombocytopenia (HIT), a severe, potentially lethal complication. HIT is an immune reaction to heparin that causes a drastic decrease of ≥50% in platelets and a paradoxical increase in arterial and venous thrombosis. The nurse should notify the health care provider immediately and anticipate stopping heparin therapy and initiating a non-heparin anticoagulant (eg, warfarin, rivaroxaban, argatroban) (Options B and C). Clients with HIT have increased risk for deep venous thrombosis (DVT) and pulmonary embolism. The nurse should perform a neurovascular assessment and report evidence of vascular clots (eg, DVT) to the health care provider. The nurse should also measure a full set of vital signs to assess for pulmonary embolism (eg, tachycardia, tachypnea, decreased oxygen saturation) (Option D). When large changes are noted in laboratory values, it is important to draw repeat samples to confirm those values, as errors in sampling or specimen handling could result in inappropriate intervention (Option A). (Option E) Clients who are suspected of having HIT or who have a history of HIT should never receive heparin or low-molecular-weight heparin (eg, enoxaparin). Only non-heparin anticoagulants may be given. Educational objective: The nurse should suspect heparin-induced thrombocytopenia in a client who is receiving or has recently received heparin and has a sudden reduction of ≥50% in platelet count. The nurse should stop heparin immediately, assess vital signs and neurovascular status, draw blood for repeat testing, and report findings to the health care provider.

A Client on a Medical-Surgical Unit Is Receiving Heparin Therapy