SQ dose is typically standard (5,000 units is common)
Heparin works by inactivating thrombin and factor X, so the lab value you are going to follow is the PTT (partial thromboplastin time). Anytime you start messing with the spine, you’ve got to be highly vigilant for hematomas…and having “thinned blood” would make a hematoma in this area more likely (and the result could be compression on the spinal nerves and paralysis…just don’t go there!) One of the things you want to be aware of is if your patient has an epidural, will have an epidural or any kind of spinal puncture. If your patient is on a heparin gtt, then they are needed some serious anticoagulation! This would be your patient who presented to the hospital with acute coronary syndrome, a PE or a DVT.
You will either be giving heparin as a SQ injection or an IV infusion. You’ll see it prescribed for patients who have a-fib, who need DVT/Pulmonary Embolism prevention, patients who have an arterial clot or need to prevent arterial clots (I see this a lot in the lower legs) and, lastly, patients in DIC (which deserves an entire post of its own!). Heparin: Heparin is an injectable/IV medication used a lot in the clinical setting for patients who are at risk for blood clots. Reversal is Vit K and FFP/clotting factors So, if they like to have spinach salad, they need to have the same amount of greens every day.ĭietary intake of leafy greens (Vit K) must be consistentĭose is adjusted based on INR (goal 2.0 – 3.0) What IS true, is that your patient’s intake of leafy greens (and essentially any food high in Vit K) must be consistent. One of the BIGGEST misconceptions about Coumadin is that your patient cannot ever ever ever have leafy greens ever again. So, who is going to take Coumadin? Coumadin is used for patients who have DVT, a history of DVT, pulmonary embolism, heart valves or stents, atrial fibrillation, and s/p myocardial infarction. What happens if your patient has taken TOO much Coumadin? The antidote for Coumadin is…VItamin K! You can also give FFP (fresh frozen plasma) or prothombin complex concentrate…these basically include those clotting factors that Coumadin exerts its effects on. How does Coumadin work? Coumadin is a PO drug that inhibits the synthesis of clotting factors, mainly the ones related to Vitamin K (Factors II, VII, IX and X and proteins C and S…but you probably don’t need that much detail!). But in general, if you go with 2.0-3.0, you’ll be in the right ballpark when it comes to your Med/Surg exams and NCLEX. Note that there are a few conditions which have a slightly higher range, so if you work in a cardiac unit some of your patients may have a goal of 2.5-3.5 (depending on the type of valve replacement).
When the INR is within this range, we say “the INR is therapeutic” meaning that the higher-than-normal INR is expected AND desired. The dose for Coumadin varies and is constantly adjusted by the pharmacy based on the INR with a target range typically 2.0-3.0). Warfarin/Coumadin: If you’ve heard some rumors about Coumadin being rat poison, you heard right! Not that it actually “poisons” rats, but the drug does cause the poor creatures to bleed out…it’s a very effective “blood thinner” in that regard! Note, however, that Coumadin doesn’t actually “thin” the blood….the term “blood thinner” is used as a broad term for meds that reduce blood clots, but what Coumadin actually does is lengthen the amount of time it takes for a blood clot to form. You’ll be using a fair amount of each of these, so it’s important to understand what they are and the nursing implications for each of them. The traditional anticoagulants are Warfarin/Coumadin, Heparin and Lovenox/Enoxaparin. Let’s break each of these down and talk about them in excruciating detail…ok just kidding…how about the highlights? Anticoagulants And if a blood clot is already formed, we go with clot-busting drugs (like TPA). In general, we tend to call these “blood thinners” even though, technically, they don’t actually “thin” the blood. To prevent blood clots, we have a two-pronged approach: anticoagulants (like Coumadin or Heparin) and anti-platelet drugs (like Plavix). In this article, we’ll talk about what you need to know about anticoagulants for nursing school. So, it makes perfect sense that we want to prevent blood clots AND treat them when they occur. They can restrict or even completely block blood flow to organs and extremities, causing things like pulmonary embolism, heart attack, stroke, ischemic bowel and even loss of limbs.
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