An adult client is being treated for a pulmonary embolism and is currently receiving a con… — NCLEX-RN

An adult client is being treated for a pulmonary embolism and is currently receiving a continuous intravenous heparin infusion at $15 \text{ units/kg/hr}$ . The client weighs $198 \text{ lbs}$ . The infusion bag supplied by the pharmacy contains $25,000 \text{ units}$ of heparin in $500 \text{ mL}$ of $5\%$ Dextrose in Water (D5W). The client's most recent activated partial thromboplastin time (aPTT) result is $41 \text{ seconds}$ .

The facility's heparin adjustment protocol states:

aPTT Result	Required Action
$< 35 \text{ seconds}$	Bolus $80 \text{ units/kg}$ , increase infusion by $4 \text{ units/kg/hr}$
$36 - 44 \text{ seconds}$	Bolus $40 \text{ units/kg}$ , increase infusion by $2 \text{ units/kg/hr}$
$45 - 75 \text{ seconds}$	No change to current infusion rate
$76 - 90 \text{ seconds}$	Decrease infusion by $2 \text{ units/kg/hr}$

Based on the protocol, at what rate in $\text{mL/hr}$ should the nurse set the infusion pump for the continuous maintenance drip? (Record your answer to the nearest tenth.)

Answer: 30.6 mL/hr

Answer

30.6

The correct pump rate is derived by first converting the client's weight to kilograms (

198 \text{ lbs} \div 2.2 = 90 \text{ kg}

). Based on the aPTT result of

41 \text{ seconds}

, the protocol requires increasing the current infusion rate (

15 \text{ units/kg/hr}

) by

2 \text{ units/kg/hr}

, making the new rate

17 \text{ units/kg/hr}

. Multiplying this by the client's weight yields a total hourly dose of

1530 \text{ units/hr}

. Dividing this hourly dose by the concentration of the IV solution (

50 \text{ units/mL}

) gives the required continuous pump rate of

30.6 \text{ mL/hr}

Step-by-Step Solution

Convert the client's weight from pounds to kilograms.

198 \text{ lbs} \div 2.2 \text{ lbs/kg} = 90 \text{ kg}

Heparin dosing is weight-based in kilograms, so an accurate conversion is the foundational step for safe medication administration.

Determine the required protocol action based on the aPTT result.

The aPTT is

41 \text{ seconds}

, which falls into the

36 - 44 \text{ seconds}

range. The protocol requires an increase of the continuous infusion by

2 \text{ units/kg/hr}

Protocols standardize medication titration based on objective laboratory data to achieve a therapeutic window.

Calculate the new total hourly heparin dose.

Current rate (

15 \text{ units/kg/hr}

) + Increase (

2 \text{ units/kg/hr}

) = New rate (

17 \text{ units/kg/hr}

). Total hourly dose =

17 \text{ units/kg/hr} \times 90 \text{ kg} = 1530 \text{ units/hr}

The adjustment must be added to the baseline rate before calculating the total weight-based hourly dose.

Calculate the concentration of the available heparin bag.

25,000 \text{ units} \div 500 \text{ mL} = 50 \text{ units/mL}

Establishing the exact concentration is necessary to convert the ordered dose (units) into a fluid volume (mL).

Calculate the new infusion pump rate in mL/hr.

1530 \text{ units/hr} \div 50 \text{ units/mL} = 30.6 \text{ mL/hr}

. (Already at the nearest tenth).

Dividing the desired hourly dose by the concentration yields the exact programming parameter for the intravenous pump.

Key Concept

Weight-based intravenous medication calculations and protocol-driven heparin titration.

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