Question

A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results?

1. Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed.
2.Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed.
3.Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range.
4.Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate in place of warfarin sodium.

Answer 1

The nurse should collaborate with the healthcare provider to consider adjusting the warfarin dosage or discuss alternative medications such as dabigatran etexilate, due to the INR being below the therapeutic range.

Step-by-step explanation:

A client receiving a heparin infusion and warfarin for a clot in the right atrium has laboratory results including an activated partial thromboplastin time (aPTT) of 32 seconds and an international normalized ratio (INR) of 1.3. These levels suggest that the heparin infusion may be within a therapeutic range since standard aPTT levels are typically between 30 to 40 seconds.

However, the INR is below the therapeutic range for someone who is at high risk for clotting, as the therapeutic INR should be about 2.0 to 3.0 for most indications. Therefore, the nurse should consider collaborating with the healthcare provider (HCP) to adjust the warfarin dose or consider alternative medications such as dabigatran etexilate, which may provide a more stable anticoagulant effect than warfarin without the need for regular INR monitoring. It is important to act promptly to ensure the clot does not expand or lead to further complications.