Question

The physician has prescribed anticoagulation therapy with heparin for a client with a pulmonary embolus. The nurse should give priority to checking the client's: A. Fibrinogen level B. Prothrombin time C. Platelet count D. Partial thromboplastin time

Short answer

Answer: The priority test for a client undergoing anticoagulation therapy with heparin for a pulmonary embolus is Partial Thromboplastin Time (PTT).

Step-by-step solution

Understanding the choices

A. Fibrinogen level: Fibrinogen is a protein that plays a crucial role in blood clot formation. B. Prothrombin time: Prothrombin time (PT) is a test that measures how long it takes blood to clot. It is often used to monitor patients on anticoagulant medications not including heparin (such as warfarin). C. Platelet count: Platelets are cell fragments in the blood that help in blood clot formation. A platelet count refers to the number of platelets in the blood, and an abnormal count may indicate bleeding or clotting disorders. D. Partial thromboplastin time: Partial thromboplastin time (PTT) is another test used to measure blood clotting time. It is commonly used for monitoring patients on heparin therapy, as it measures the effectiveness of the intrinsic and common clotting pathways.

Comparing the choices

Since the patient is undergoing anticoagulation therapy with heparin, we need to choose the test that is specifically relevant to heparin therapy and the monitoring of its effectiveness. A. Fibrinogen level: Though fibrinogen is related to blood clot formation, it is not a specific test for monitoring heparin therapy. B. Prothrombin time: PT is used mainly for monitoring patients on warfarin therapy and is not specific to heparin therapy. C. Platelet count: Platelet count is a general test for blood clotting disorders but does not specifically monitor heparin therapy. D. Partial thromboplastin time: PTT is the most relevant test for monitoring the effectiveness of heparin therapy, as it measures the intrinsic and common clotting pathways which are affected by heparin.

Selecting the priority test

Based on the comparisons of the different choices, it is clear that Partial Thromboplastin Time (choice D) is the most relevant test to monitor the anticoagulation therapy with heparin for a client with a pulmonary embolus. Therefore, the nurse should give priority to checking the client's Partial Thromboplastin Time (PTT).

Key concepts

Partial Thromboplastin Time

Partial Thromboplastin Time (PTT) is an essential lab test used to assess the blood's ability to clot and to monitor anticoagulation therapy, such as heparin. Heparin is an anticoagulant medication that helps prevent the formation of blood clots. PTT measures the efficacy of both the intrinsic and common clotting pathways in the body.

For individuals on heparin therapy, PTT is used to ensure the medication is not causing the blood to be too thin, which could lead to excessive bleeding, or too thick, risking clot formation. The normal PTT range is typically between 60 to 70 seconds, but this can vary depending on the laboratory standards. When a patient receives heparin therapy, the goal is to maintain the PTT at 1.5 to 2.5 times the normal value. Regular monitoring through PTT ensures safe and effective treatment.

Pulmonary Embolus

A pulmonary embolus (PE) is a life-threatening condition where one or more arteries in the lungs becomes blocked by a blood clot. The clot usually originates in the deep veins of the legs—a condition known as deep vein thrombosis (DVT)- and travels to the lungs.

Symptoms of PE can include shortness of breath, chest pain, and coughing, which may produce blood. It's crucial for these symptoms to be recognized swiftly as PE requires immediate medical attention. Treatment often involves anticoagulation therapy to prevent further clotting. Understanding PE helps in realizing why it's essential to monitor anticoagulation therapy closely to avoid over-thinning of the blood, which could cause severe bleeding complications, or insufficient anticoagulation, which could lead to additional clot formation.

Anticoagulation Therapy

Anticoagulation therapy refers to the use of medications that prevent new blood clots from forming while allowing the body to break down existing ones. This therapy is crucial for conditions such as pulmonary embolus, atrial fibrillation, or after certain surgeries that may increase the risk of blood clots.

Heparin is a common anticoagulant often used for immediate anticoagulation due to its rapid onset of action. Another commonly used anticoagulant is warfarin, which requires monitoring the Prothrombin Time and International Normalized Ratio (PT/INR). Dosing for these medications is highly individualized, as many factors can alter the body's response to them, making monitoring through tests like PTT or PT/INR crucial to ensure patient safety and therapeutic efficacy. Maintaining the delicate balance of preventing clots while avoiding excessive bleeding is the key goal of anticoagulation therapy.

Nursing Prioritization

In nursing, prioritization is the process of determining the most important patient needs and which action to take first. When caring for a patient on heparin therapy for a pulmonary embolus, the nurse must focus on monitoring blood clotting times and watching for signs of bleeding or clotting. Prioritizing care involves initial and continual assessments, strict adherence to anticoagulant dosing schedules, and patient education.

For example, checking the PTT is essential for dosage adjustments and ensuring the patient remains within the therapeutic range. Additionally, nurses should educate patients about the importance of regular lab tests, potential side effects, and when to seek medical help. By effectively prioritizing care, nurses not only manage the immediate health concerns but also play an integral role in the prevention of complications.