A patient has been receiving heparin while in the hospital to ...

[Coya19@aol.com]

A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin (Lovenox).
 
  The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching?
  a. Enoxaparin does not require coagulation monitoring.
  b. Enoxaparin has greater bioavailability than heparin.
  c. Enoxaparin is more cost-effective than heparin.
  d. Enoxaparin may be given using a fixed dosage.

Question 2

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.

[Amiracle]

Answer to Question 1

ANS: C
Low-molecular-weight (LMW) heparins have higher bioavailability and longer half-lives, so routine coagulation monitoring is not necessary and fixed dosing is possible. LMW heparins are more expensive, however, so this statement indicates a need for further teaching.

Answer to Question 2

ANS: D
Heparin overdose may cause hemorrhage, which can be characterized by low blood pressure, tachycardia, and lumbar pain. Protamine sulfate should be given, and the heparin should be discontinued. An aPTT may be drawn later to monitor the effectiveness of protamine sulfate. Analgesics are not indicated because the lumbar pain is likely caused by adrenal hemorrhage. Aspirin will only increase the risk of hemorrhage.