Question

A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for:

a. a repeat aPTT to be drawn immediately.
b. analgesic medication.
c. changing heparin to aspirin.
d. protamine sulfate.

Answer 1

The nurse should request protamine sulfate to reverse the effects of heparin due to signs of over-anticoagulation and potential bleeding, as evidenced by low blood pressure, increased heart rate, prolonged aPTT, and lumbar pain.

Step-by-step explanation:

The nurse will request an order for protamine sulfate. The patient’s symptoms, including low blood pressure (90/50 mm Hg), increased heart rate (98 beats per minute), an aPTT greater than 90 seconds, and lumbar pain, indicate possible heparin over-anticoagulation and potential heparin-induced bleeding.

Protamine sulfate is an antagonist to heparin that can reverse its effects quickly and is indicated in cases of suspected heparin overdose or adverse reactions. The request for a repeat aPTT or analgesic medication could be considered later, but prompt treatment with protamine sulfate is critical in this clinical scenario to prevent further complications from excessive anticoagulation.