NUR 146 CL - Heparin Flashcards
Why is heparin used?
Heparin is used to prevent and manage blood clots (thromboembolism), treat embolism and prevent clotting during surgeries
Can heparin administration and/or monitoring of coagulation tests be delegated to assistive healthcare personnel?
No. These action can only be conducted by qualified nurses
What is the antidote for heparin?
When is it administered?
Protamine Sulfate, given via IV
- It is administered (as ordered) for heparin toxicity or overdose
(Do we immediately get an order for protamine sulfate whenever heparin is being administered?)
When is heparin contraindicated?
- Hx of heparin-induced thrombocytopenia (“low platelet count”)
- Hx of heparin-induced thrombocytopenia and thrombosis (a clot)
- Hypersensitivity to pork products or heparin
- Pre-existing conditions: any condition where a risk for hemorrhage exists; cerebrovascular hemorrhage, cerebral aneurysm, aortic aneurysm, hypertension
Any condition where a risk for hemorrhage exists: GI ulcers, liver disease, renal disease, recent childbirth, severe thrombocytopenia
List drug interactions with potential complications
- Oral anticoagulants
- NSAIDs: Ibuprofen, salicylic acid
- Herbal supplements: Ginger, garlic, ginkgo, primrose oil, horse chestnut
- Meds that can counteract: Digitalis, antihistamines, nicotine, nitroglycerin, penicillin, aspirin!
Patient Teaching / What would you educate your patient on heparin for?
- Use a soft toothbrush & Electric Razor
- Report epistaxis (nosebleeds), bleeding gums, petechiae
- Report s/s of hypersensitivity to heparin: fever, rash, chills
- Monitor for bleeding: Urine, dark and cloudy; stool, black/tarry; gums; skin
- Remind patient to request assistance if OOB
- Do not take aspirin (it can thin the blood); Check with PCP prior to taking OTC meds
As a nurse, what would you monitor for your patient on heparin?
- Bleeding gums, epistaxis (nosebleed)
- Hypotension, tachycardia (potential hemorrhage)
- Elevated temperature
- Decrease in Hematocrit
- If female: monitor pad count and CBC
What lab values do we monitor for heparin?
When do we check aPTT?
- Monitor PTT (Partial Thromboplastin Time): therapeutic value = should be at 1.5-2.5x control
- Monitor aPTT (Activated Partial Thromboplastin Time): should be 1.5x-2.5x control ; aPTT is checked before administration, then at 6 hour intervals until dose stabilized, then daily
- Hemoglobin & Hematocrit
- INR (International normalized ratio)
- ACT (Activated Clotting Time)
Notify the PCP if results are outside of proper range
What are some adverse effects of heparin?
- Hemorrhage: most common
- Heparin-induced thrombocytopenia (HIT) = “Low platelet count”
- Heparin-Induced thrombocytopenia and Thrombosis (HITT)
Complications of HITT:
DVT, Stroke, pulmonary embolism, myocardial infarction, limb ischemia, renal arterial thrombosis
- Fever, chills, skin rash, pruritis (severe itching)
How would you determine if therapeutic anticoagulation as been attained?
You would check the patient’s aPTT (activated partial thromboplastin time)
- Patient’s aPTT should be 1.5-2.5x the control
- Check prior to administering, 6 hours later, then at 6 hour intervals and after each dose until stabilized. aPTT it is checked daily once stabilized
