Question

Mr. Tani was admitted today with unilateral swelling of his legs, you noticed that he has a positive homan's sign, You complete your assessment on hm and have discovered that his right lower extremity is swollen, red and tender to touch, Mr. Tani stated that he had surgery about two weeks ago, and he didn't receive consistent physical therapy due to staff shortages, 1> The physician orders bilateral lower extremity Doppler flow studies and bilateral duplex sonography. What would these tests reveal? 2> The physician orders IV heparin standard weight protocol. Mr. Tani weighs 44.9 kg. You have been ordered to administer heparin IV units kg and to start the heparin drip at 16 units /kg/hr. Available is heparinIV 2.500 units/mI. How many units will you administer prior to starting the infusion? How many mils) is this? 3> Six hours after the infusion the heparin assay level (aPTT) has posted and is 29 seconds, based on the heparin protocol what is your next action? What will your new infusion rate be? Does this require a co-signature? Your next heparin assay level has been ordered in 6 hours. 4> What lab levels would you check for when your patient is on coumadin and heparin? What are the reversal agents?

Answer 1

Bilateral lower extremity Doppler flow studies and duplex sonography would reveal the condition of Mr. Tani's legs. Prior to starting the heparin infusion, 808 units of heparin would be administered to Mr. Tani. A heparin assay level of 29 seconds would require adjusting the heparin infusion rate. For patients on both coumadin and heparin, lab levels to check include INR for coumadin and aPTT for heparin. The reversal agents are vitamin K and protamine sulfate, respectively.

Step-by-step explanation:

The bilateral lower extremity Doppler flow studies and duplex sonography would reveal the condition of the blood vessels in Mr. Tani's legs. These tests can detect any blood clots or blockages that may be causing the swelling and redness.

Prior to starting the heparin infusion, you would administer 808 units of heparin to Mr. Tani. This is equivalent to 0.32 mL of heparin.

Based on the heparin protocol, a heparin assay level of 29 seconds would indicate that the heparin dose needs to be adjusted. The new infusion rate would depend on the specific guidelines of the protocol. It is advisable to consult the physician or a senior nurse to determine the appropriate next action and infusion rate.

The lab levels to check for when a patient is on both coumadin and heparin include the international normalized ratio (INR) for coumadin and the activated partial thromboplastin time (aPTT) for heparin. The reversal agent for coumadin is vitamin K, while the reversal agent for heparin is protamine sulfate.