Question

The patient receives heparin. During the morning assessment of the patient, the nurse notes that the patient's blood pressure and red blood cell (RBC) count are low. There is no evidence of bleeding on the bed linen or the patient's gown. What will the best assessment of this patient reveal?

1. The patient is dehydrated.
2. The patient may be bleeding internally.
3. The patient's activated partial thromboplastin time (aPTT) is too low.
4. The patient has probably formed some clots

Answer 1

The best assessment for a patient on heparin with low blood pressure and RBC count, without external bleeding, may reveal internal bleeding. It is important to monitor aPTT levels to ensure therapeutic anticoagulation but low aPTT does not correlate well with the symptoms presented.

Step-by-step explanation:

When a patient receives heparin and presents with low blood pressure and red blood cell (RBC) count, without visible bleeding, the best assessment might reveal that the patient may be bleeding internally. This is because heparin is an anticoagulant that can increase the risk of bleeding, including internal bleeding which may not be immediately apparent. A decrease in RBC count and blood pressure are potential indicators of this. The patient's activated partial thromboplastin time (aPTT) should be checked to ensure therapeutic levels of heparin; however, a low aPTT is not the best assessment in this scenario and does not typically correlate with internal bleeding or hypotension. The formation of clots is unlikely as heparin works to prevent clotting, and dehydration is less likely to be the cause given the presentation and the use of heparin.