Week 12 Case Study

Question 1

Ms J is a 29-year-old woman who presented to the emergency department with calf pain in her left leg on walking. On inspection, a red, swollen area was identified. This was later diagnosed as a deep vein thrombosis. Ms J had recently been prescribed an oral contraceptive pill. She was commenced on an intravenous infusion of heparin and transferred to your ward

Answer 1

Questions and answers follow

Question 2

What are the intended actions of the heparin infusion?

Answer 2

The indications of heparin infusion is to prevent and treat all types of venous thromboembolism in high risk patients. It is also used as a prophylaxis to prevent clotting during particular surgeries or medical conditions, example cardiac or blood vessel surgery, during blood transfusion, individuals with disseminated intravascular coagulation and haemodiaysis

Question 3

What specific observations would you undertake on Ms J with regard to the heparin?

Answer 3

Temperature (febrile), constipation, chills, nausea, vomiting, epistaxis, bruising, slight haematuria, skin necrosis, alopecia

Hypersensitivity reactions; Anaphylaxis, conjunctivitis, rhinitis, asthma, urticaria and angioedema

Question 4

What early signs might indicate that she is receiving too much heparin?

Answer 4

Sudden numbness or weakness especially on one side
Sudden severe headache, confusion, problems with vision, speech, or balance
Chest pain, sudden cough, wheezing, tachypnea, tachycardia

Question 5

What drug would you ensure is available in case of heparin overdose?

Answer 5

Protamine sulfate

Question 6

Describe the education you would provide Ms J about heparin

Answer 6

Educate on safety precautions - need to use an electric razor, avoid contact sports

Ensure appropriate patient education - include warning signs of medication, need for periodic monitoring and evaluation, need to wear a medic-alert bracelet, ensure knowledge about drug/ therapy regime