Nursing Student Asked:

A 52-year-old male patient with a history of atrial fibrillation (AF) is admitted for anticoagulation therapy initiation. The healthcare provider prescribes a continuous IV infusion of heparin to maintain a therapeutic activated partial thromboplastin time (aPTT). The initial bolus dose of heparin is 80 units/kg, followed by an infusion of 18 units/kg/hour. The patient weighs 78 kg.

Tasks:

1. Calculate the total bolus dose of heparin in units.

2. Determine the hourly infusion rate in units/hour.

3. Identify three nursing interventions to monitor for complications of anticoagulation therapy.

4. Explain the clinical significance of monitoring aPTT in patients receiving heparin therapy.

1. Total bolus dose calculation:

   • Formula: Bolus dose=weight (kg)×bolus dose (units/kg)

   • 78kg×80units/kg=6,240units. Answer: 6,240 units

2. Hourly infusion rate calculation:

   • Formula: Infusion rate=weight (kg)×infusion rate (units/kg/hour)

   • 78kg×18units/kg/hour=1,404units/hour. Answer: 1,404 units/hour

3. Three nursing interventions:

   • Monitor for signs of bleeding, such as bruising, hematuria, melena, or epistaxis.

   • Assess platelet count and monitor for signs of heparin-induced thrombocytopenia (HIT).

   • Ensure aPTT levels are monitored at regular intervals (e.g., every 6 hours) to maintain therapeutic levels.

4. Clinical significance of aPTT monitoring: Monitoring aPTT ensures that heparin therapy achieves therapeutic anticoagulation without causing excessive bleeding. Prolonged aPTT indicates an increased risk of bleeding, while subtherapeutic levels indicate inadequate anticoagulation, increasing the risk of thromboembolic events.