Patient Info
Day 1: Tabbed Patient Info
Thomas Jameson, 69, with acute right leg pain for 2 days, mild SOB, etc. Venous Doppler → DVT, started on IV Heparin bridging to Warfarin.
What is a normal aPTT?
What is a therapeutic aPTT?
What precautions should be taken when drawing up Heparin?
What is the antidote for Heparin if the aPTT becomes too high?
What is an important detail to remember when administering a prefilled syringe of Enoxaparin?
Prioritize (1 to 4):
Match each lab to normal range:
Day 2: Scenario Update
Mr. Jameson’s aPTT is now 78 seconds, well within therapeutic range for IV heparin. He complains of mild gum bleeding when brushing teeth, occasional mild epistaxis. Vital signs remain stable, but the patient expresses concern about bleeding side effects.
Updated Provider Orders:
- Continue IV Heparin infusion at current rate
- Recheck CBC and aPTT in 4 hours
- Continue Warfarin (5 mg)
- Educate patient on bleeding precautions
Potential Nursing Notes:
- Gums bleeding triggered by soft brushing
- No active uncontrolled hemorrhage, mild only
- Patient anxious about “blood thinner side effects”
Evening of Day 2: You hear a call light and find Mr. Jameson in the bathroom. He’s bleeding from a cut on his forearm (he slipped and knocked into a towel rack). Gums bled heavily again after tooth brushing.
Vital signs now:
- BP: 130/85 mmHg
- HR: 98 bpm
- aPTT: 90 seconds (above target)
- INR: 2.3
New Provider Orders:
- Slightly decrease IV Heparin infusion per protocol (aPTT > 80)
- Monitor for further bleeding
- Continue Warfarin; recheck INR in AM
- Evaluate fall risk, ensure environment safety
Documentation (Day 2): in EpicHyperspace
Professor J Additional Questions:
1) If Mr. Jameson complains of a new severe headache, what is your immediate concern?
Day 3: Discharge
By Day 3, Mr. Jameson’s aPTT is stable at 65 seconds, and INR is 2.2. The provider discontinues IV Heparin and continues Warfarin therapy at home. Bleeding episodes have diminished, and he’s comfortable ambulating, discharge tomorrow with home health follow-up.
He’s relieved but still fearful of a major bleed, thankful for improved leg swelling, no SOB, asks about returning to normal activities.
Discharge Orders & Teaching Points
- Warfarin 5 mg PO daily
- Follow-up lab draws for INR every few days until stable
- Encourage consistent vitamin K intake (no sudden changes)
- Bleeding precautions (soft toothbrush, electric razor)
- Education on signs/symptoms of serious bleeding
- Avoid NSAIDs, watch for interactions with antibiotics
Which points should be emphasized for safety at home? (Select all that apply)
Review: Med Administration Game
Here’s a final interactive game to practice administering anticoagulants. The game will only load once you open this chapter.