A healthcare team is managing a 75-kg client who is on a continuous intravenous (IV) hepar… — NCLEX-RN

A healthcare team is managing a 75-kg client who is on a continuous intravenous (IV) heparin drip for a pulmonary embolism. The infusion pump is currently set to deliver $20 \text{ units/kg/hr}$ . Without warning, the client experiences profound hematemesis, epistaxis, and a sudden decline in consciousness. After stopping the heparin infusion, the nurse receives a stat prescription for intravenous protamine sulfate. The pharmacy dispenses protamine sulfate in vials with a concentration of $10 \text{ mg/mL}$ . According to the facility's standard reversal protocol, $1 \text{ mg}$ of protamine sulfate neutralizes $100 \text{ units}$ of heparin.

Based on the total amount of heparin the client received over the last hour, what is the exact volume in milliliters (mL) of protamine sulfate the nurse must administer (no rounding required), and what is a critical safety consideration during its administration?

1.5 mL; Administer the dose slowly over 1 to 3 minutes to minimize the risk of severe hypotension and bradycardia.Answer
B
1.5 mL; Administer as a rapid intravenous push to quickly arrest the life-threatening hemorrhage.
C
15 mL; Premedicate the client with intravenous diphenhydramine to prevent a delayed hypersensitivity reaction.
D
15 mL; Administer the medication via a dedicated central venous line to prevent severe tissue necrosis.

Answer

The correct volume is 1.5 mL, and the medication must be administered slowly over 1 to 3 minutes to prevent severe hypotension and bradycardia.

The client received

1,500 \text{ units}

of heparin in the last hour (

75 \text{ kg} \times 20 \text{ units/kg/hr}

). Since

1 \text{ mg}

of protamine sulfate neutralizes

100 \text{ units}

of heparin, the client requires

15 \text{ mg}

of protamine (

1,500 \div 100

). Using the dispensed concentration of

10 \text{ mg/mL}

, the required volume is

1.5 \text{ mL}

(

15 \text{ mg} \div 10 \text{ mg/mL}

). Furthermore, a critical pharmacological safety principle is that protamine sulfate must be administered slowly (no faster than 50 mg over 10 minutes) to prevent dangerous adverse effects, including sudden profound hypotension, bradycardia, and pulmonary hypertension.

Step-by-Step Solution

Calculate the total units of heparin administered in the last hour.

75 \text{ kg} \times 20 \text{ units/kg/hr} = 1,500 \text{ units/hr}

To determine the exact amount of circulating heparin that requires reversal.

Calculate the milligrams of protamine sulfate required.

1,500 \text{ units} \div 100 \text{ units/mg} = 15 \text{ mg}

The protocol states that 1 mg of protamine neutralizes 100 units of heparin.

Calculate the final volume of protamine sulfate to administer.

15 \text{ mg} \div 10 \text{ mg/mL} = 1.5 \text{ mL}

To determine the exact liquid volume to draw up from the dispensed vial.

Determine the safest rate of intravenous administration.

Administer slowly over 1 to 3 minutes.

Rapid IV push of protamine sulfate causes speed shock, which presents as severe hypotension, bradycardia, and anaphylactoid reactions.

Key Concept

Pharmacological and Parenteral Therapies - Antidote Administration and Medication Safety

Estimated Time:3m 0s

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