Anticoagulant Case Study (Pearl) - Day 1

Patient Story
Orders
Vital Signs
Medical History
Labs/Diagnostics
MAR

Patient Story (Day 1)

Pearl Anderson, age 79, is recovering from a subdural hematoma sustained six weeks ago. She has been largely immobilized ever since and, two weeks ago, developed a pulmonary embolism. She is now at a skilled nursing facility, where staff must balance preventing further clots while monitoring for bleeding complications. She is currently on subcutaneous unfractionated heparin to maintain prophylaxis against new clots.

Orders (Day 1)

  • Heparin 5,000 units subcut q8h
  • Vital signs q4h
  • Bedside PT/INR and aPTT daily
  • Fall precautions; bed alarm
  • CBC, PT/INR, aPTT in AM
  • Activity: Bed to chair with assistance
  • Diet: Regular

Vital Signs (Day 1)

  • BP: 138/84 mmHg
  • HR: 98 bpm (regular)
  • RR: 18 breaths/min
  • SpO₂: 97% on 2L NC
  • Temp: 37.2°C (99.0°F)

Medical History

  • Subdural Hematoma (6 weeks ago)
  • Pulmonary Embolism (2 weeks ago)
  • Hypertension
  • No known drug allergies

Labs & Diagnostics (Day 1)

Test Value Reference Range Indicator
aPTT 33 s 25–35 s NORMAL
PT/INR 12 s / 1.0 PT: 11–13.5 s; INR: 0.8–1.2 NORMAL
H/H (Hgb/Hct) 12 g/dL / 36% Hgb 12–15.5; Hct 36–46% LOW-NORM
Platelets 225,000/µL 150,000–400,000/µL NORMAL

Medication Administration Record (MAR)

Medication Time Status
Heparin 5,000 units SubQ 09:00 Given
Heparin 5,000 units SubQ 17:00 Scheduled
Lisinopril 10 mg PO daily 10:00 Scheduled

Day 1 Scenario Questions

1) What is a normal aPTT?

2) What is a therapeutic aPTT?

3) What is the antidote for heparin if the aPTT becomes too high?

4) If you give Pearl’s heparin in the morning, how soon will it take effect?

5) Where will you give the shot and what type of needle will you use?

6) What precautions will you take when drawing up the heparin?

7) What is an important detail to remember when administering a prefilled syringe of enoxaparin?

Arrange these steps for safe subcutaneous heparin administration in correct priority (1→4):

Verify dosage with another nurse
Inject subcut slowly at 90° angle
Check MAR and gather supplies
Locate and clean injection site
Priority #1
Priority #2
Priority #3
Priority #4

Match each lab to its normal or therapeutic range: