The nurse is caring for a client on IV heparin infusion and oral warfarin. Current laboratory values indicate that the client's aPTT is 5 times the control value and the PT/INR is 2 times the control value. What action does the nurse anticipate?

Question

The nurse is caring for a client on IV heparin infusion and oral warfarin.  Current laboratory values indicate that the client's aPTT is 5 times the control value and the PT/INR is 2 times the control value.  What action does the nurse anticipate?

Quizplus · Accepted Answer

The anticoagulant heparin has to be administered intravenously or subcutaneously. The duration is 2-6 hours intravenously and 8-12 hours subcutaneously. It is measured by the aPTT (activated partial thromboplastin time) laboratory value. Warfarin (Coumadin) is taken orally, with onset/therapeutic effects reached after 2-7 days. It is measured by prothrombin time (PT) or International Normalized Ratio (INR). The therapeutic range for aPTT or PT/INR is generally 1.5-2.0 times the control value (up to 3 times the control value at times). An aPTT value above the therapeutic range places the client at risk for excess bleeding. The heparin administration would need to be stopped or decreased. (Option A) Clients on warfarin must eat the same amount of dark green leafy vegetables because these foods contain vitamin K and will alter the effects of warfarin. The PT/INR is at therapeutic level so there is no concern related to this client's diet. (Option C) The warfarin dose has achieved the therapeutic range for PT/INR and does not need adjustment. (Option D) Vitamin K is the antidote for warfarin; the antidote for heparin is protamine sulfate. However, due to the short half-life of heparin, usually the dose is just held instead of administering an antidote when the values are too high. Educational objective: The therapeutic effect from heparin or warfarin (Coumadin) is 1.5-2.0 times the control value. Heparin is measured with aPTT and warfarin is measured with PT/INR. Vitamin K is the antidote for warfarin; protamine sulfate is the antidote for heparin.

The Nurse Is Caring for a Client on IV Heparin