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Difficulty: MediumReduction of Risk Potential

A licensed practical nurse (LPN) is reviewing the morning laboratory results for a client who is receiving a continuous intravenous heparin infusion for a deep vein thrombosis. The client's results are as follows:

* Hemoglobin: 13.8 g/dL
* Platelets: 82,000/mm³ (admission baseline: 250,000/mm³)
* Activated partial thromboplastin time (aPTT): 68 seconds (control: 30 seconds)

Based on these findings, which action should the LPN take next?

  1. A
    Document the activated partial thromboplastin time as therapeutic and proceed with routine care.
  2. B
    Discontinue the continuous intravenous heparin infusion to prevent further platelet destruction.
  3. Notify the registered nurse immediately regarding the significant decrease in the platelet count.Answer
  4. D
    Administer the client's scheduled medications after checking the name and room number.

Answer

The correct action is to notify the registered nurse immediately regarding the significant decrease in the platelet count.
The client's platelet count has dropped by more than 50% from the baseline, which is a strong clinical indicator of heparin-induced thrombocytopenia (HIT). While the aPTT is therapeutic, the critical drop in platelets requires immediate escalation to the registered nurse or healthcare provider. HIT is a life-threatening complication that necessitates stopping the heparin and starting an alternative anticoagulant, an intervention that must be coordinated by the registered nurse and provider.

Step-by-Step Solution

1
Analyze the provided laboratory results.
The hemoglobin is normal, and the aPTT is within the therapeutic range for a heparin infusion (1.5 to 2.5 times the control). However, the platelet count has dropped significantly from the admission baseline.
Identifying abnormal or critical laboratory values is a fundamental step in risk reduction.
2
Identify the potential clinical complication.
A sudden, drastic drop in platelets (more than 50% from baseline) in a client receiving heparin indicates a high probability of heparin-induced thrombocytopenia (HIT), a life-threatening complication.
Recognizing early signs of life-threatening trends is essential for client safety.
3
Determine the appropriate nursing action within the practical nurse scope of practice.
The LPN must immediately report this critical laboratory finding to the registered nurse (RN) or healthcare provider for further intervention, as the heparin infusion will likely need to be discontinued.
Practical nurses are responsible for data collection and the prompt escalation of critical findings to the directing RN.

Key Concept

Escalating Critical Laboratory Values and Recognizing Heparin-Induced Thrombocytopenia
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Topics

Reduction of Risk Potential

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