A 70-year-old client receiving an unfractionated heparin inf… | MyMerci
Adverse Effects/Contraindications/InteractionsPA
Question
A 70-year-old client receiving an unfractionated heparin infusion for acute pulmonary embolism has the following labs and assessment: aPTT 90 seconds (institutional therapeutic range 60-80 seconds), no active bleeding, vital signs stable. Per the institutional weight-based heparin nomogram for an aPTT in this range, which order would the nurse anticipate?
1Hold the infusion for 0-30 minutes per nomogram, then resume at a reduced rate (typically 1-2 units/kg/h decrease), and recheck the aPTT in 6 hours.✓ Correct answer
2Continue the current infusion rate without adjustment, as the aPTT of 90 seconds remains within an acceptable range for a pulmonary embolism.
3Discontinue the heparin infusion permanently, and initiate warfarin therapy with enoxaparin bridging until the INR reaches 2-3.
4Administer a bolus dose of 5,000 units of unfractionated heparin IV and increase the infusion rate by 2 units/kg/h to achieve a therapeutic aPTT.
Explanation
Heparin nomogram interpretation Institutional heparin nomograms guide nurse-driven adjustments based on weight and aPTT (or anti-Xa). A common Raschke-type weight-based nomogram (target aPTT 60-80 s): • aPTT 90 (supratherapeutic): hold for 30-60 minutes, then decrease rate 3 units/kg/h. • Recheck aPTT 6 hours after every dose change.
Many institutions adapt these ranges; some use anti-Xa (target 0.3-0.7 IU/mL) instead of aPTT in patients with lupus anticoagulant or factor deficiencies.
Based on aPTT 90 (just at the upper edge of supratherapeutic depending on institution), a brief hold AND a rate decrease with re-check in 6 hours is the appropriate response. Independent bolus, permanent discontinuation with aspirin substitution, or no change all violate the protocol.
In-depth explanation
Clinical reasoning summary Heparin nomogram interpretation Institutional heparin nomograms guide nurse-driven adjustments based on weight and aPTT (or anti-Xa). A common Raschke-type weight-based nomogram (target aPTT 60-80 s): • aPTT 90 (supratherapeutic): hold for 30-60 minutes, then decrease rate 3 units/kg/h. • Recheck aPTT 6 hours after every dose change.
Many institutions adapt these ranges; some use anti-Xa (target 0.3-0.7 IU/mL) instead of aPTT in patients with lupus anticoagulant or factor deficiencies.
Based on aPTT 90 (just at the upper edge of supratherapeutic depending on institution), a brief hold AND a rate decrease with re-check in 6 hours is the appropriate response. Independent bolus, permanent discontinuation with aspirin substitution, or no change all violate the protocol.