Answer Happy

JE You are assigned to care for Larry, a 70-year-old retired bus driver who has just been admitted to your medical floor with R leg deep vein thrombosis (DVT). Larry has a 48 pack-year smoking history, although he states he quit 2 years ago. He has had pneumonia several times and frequent episodes of atrial fibrillation (A fib). He has had 2 previous episodes of DVT. Two weeks ago, he noticed swelling of his R foreleg that became progressively worse until it also involved his thigh to the groin. His wife brought him to the hospital when he complained of increasingly severe pain in his leg. A doppler study indicated a probable thrombus of the external iliac vein extending distally to the lower leg, he was admitted to the hospital for initiation of heparin therapy. Significant admission lab values are PT 12.4 sec, INR 1.11, PTT 25 sec, Hgb 13.3 g/dL, Het 38.9%, cholesterol 206 mg/dL. Basic metabolic panel is normal. Your assessment of Larry reveals normal heart sounds; BP 138/88; pulse 104; 3+ pitting edema R lower extremity; mild erythema of R foot and calf; and severe R calf pain. He is alert and oriented (AAO) but a little restless. He denies SOB and chest pain.

1 4. List 8 assessments you should complete and/or monitor closely for development this life- threatening complication. Larry is started on anticoagulation. The medical team is considering two options. Option one: 5. Enoxaparin 80 mg every 12 hours is prescribed for systemic anticoagulation. Larry is 5'6" and weighs 176 lb. What kind of drug is enoxaparin? Is this dose appropriate? How would it be administered? Option two: 6. Heparin infusion. Based on weight of 176 lb. The heparin drip is started at 12 units/kg/hour Concentration of Heparin bag is 25.000 unit 1000 ml of D-W Calculate the rate the Heparin infusion in mL/hr Note, I pump can run to the 10th of a mL Six hours later the PTT is 43 seconds. Using the Heparin protocol below, calculate what two actions the nurse should do. I would first administer this amount of heparin and then I would adjust the heparin infusion to mL per hour Repeat PTT Adjust heparin infusion based on sliding scale below: Stop Bolus PTT Infusion Rate Change Dose For minutes $5 sec 80 units kg 0 4 units kg har 36-45 sec 40 units kg 0 2 units kg bir 46-70 0 O no change) 71-90 0 0 12 units kg hi > 90 sec 0 60 units kg bur 6 burs 6 bis 0 next AM 6 hrs. 6 hrs *Note: Some hospitals are starting to switch to lab test Anti-Xa in place of PTT for unfractionated heparin. However, the idea for adjusting heparin dosing based on a lab test