Question

A nurse is caring for a client who has a pulmonary embolism. The client is receiving heparin via continuous IV infusion at 1,200 units/hr and warfarin 5 mg PO daily. The morning laboratory values for the client are aPTT 98 seconds and INR 1.8. Which of the following actions should the nurse take?

a) Administer an additional dose of heparin
b) Withhold the next dose of warfarin
c) Increase the rate of heparin infusion
d) Administer vitamin K to reverse warfarin effect

Answer 1

The appropriate action for the nurse is to consult with the healthcare provider regarding the elevated aPTT due to heparin without altering the warfarin dosage, as the INR is slightly below the therapeutic range.

Step-by-step explanation:

The nurse caring for a client with a pulmonary embolism is managing two anticoagulant medications: intravenous heparin and oral warfarin. The morning lab values indicate an activated partial thromboplastin time (aPTT) of 98 seconds, which is above the normal range, suggesting that the heparin dose may potentially be too high. On the other hand, the international normalized ratio (INR) is 1.8, slightly below the therapeutic range for warfarin, which typically aims for 2.0-3.0 in treatment of most conditions. Considering these lab values, the nurse should not administer an additional dose of heparin, as the risk of bleeding is already high.

Moreover, withholding the next dose of warfarin is not indicated because its INR level is not above the therapeutic range. Increasing the heparin infusion rate would not be appropriate due to the elevated aPTT. Lastly, administering vitamin K, which reverses warfarin effect, is also not appropriate as the INR is not excessively high.

Thus, based on these values, the most appropriate action would be to consult with the healthcare provider regarding the heparin dosage, without making changes to the warfarin therapy.