2. Heparin can be given IV, SQ, or PO.
3. It is used to detect deficiencies of certain clotting factors and is used to monitor heparin therapy. According to emedicine.medscape.com, the reference range for aPTT is 30-40 seconds. Test results fall between are more than 70 seconds it signifies spontaneous bleeding according to emedicine.medscape.com
4. Coumadin is used to treat blood clots. It depresses hepatic synthesis of vitamin K clotting factors (II [prothrombin], VII, IX and X. The dosage ordered is safe because according to Kee, Hayes, & McCuistion (2012), p. 675, client’s can receive 5 to 10 mg per day
5. The half life of Coumadin is 0.5 to 3 days. Because Coumadin has a long half-life and is highly protein bound, the drug can have cumulative effects. Bleeding can occur, especially if another highly protein-bound drug is administered together with Coumadin.
6. INR is done to monitor the therapeutic effects of Coumadin. The normal range of the medication is 2 to 3.
7. Hemorrhaging could result from prolonged used or large doses of Coumadin.
8. Monitor vital signs because an increased pulse rate and decreased systolic BP can indicate fluid volume deficit resulting from bleeding, monitor PT / INR and platelet count, monitor client for nose bleed, hematuria, bruising, advise client to use a soft tooth brush, instruct client to shave with an electric razor, teach client to control external hemorrhage from accidents or injuries by applying firm, direct pressure for at least 5 to 10 minutes
9. The nurse should check the client’s PT/INR and notify M.D. of results so that medication can be adjusted