On day 7 of an unfractionated heparin infusion, a client's platelet count has fallen by 55% and the client develops a new painful swollen calf. Which action should the nurse take?
1Increase the heparin infusion and recheck the platelet count after the next scheduled laboratory draw.
2Continue the current heparin rate and apply a warm compress to the affected lower leg.
3Stop heparin exposure, notify the provider, and anticipate a non-heparin anticoagulant and HIT testing.✓ Correct answer
4Replace unfractionated heparin with therapeutic enoxaparin and monitor the platelet count daily.
Explanation
A platelet fall greater than 50% beginning 5 to 14 days after heparin exposure together with new thrombosis creates an intermediate or high probability of heparin-induced thrombocytopenia. The nurse should stop heparin exposure, notify the provider, and anticipate use of a non-heparin anticoagulant plus probability-based immunoassay and, when indicated, functional testing. Continuing or increasing heparin can worsen thrombosis. Enoxaparin is also a heparin product and is not an appropriate substitute when HIT is suspected.
Clinical reasoning summary Suspect HIT when platelets fall substantially several days after heparin and new thrombosis appears. Stop heparin exposure, calculate the 4Ts probability, notify the provider, and prepare for a non-heparin anticoagulant and appropriate antibody testing.