Examkin

Question

Difficulty: HardPharmacological and Parenteral Therapies

A nurse is assessing a client who has been receiving a continuous intravenous infusion of unfractionated heparin for four days to treat a deep vein thrombosis. The client's most recent laboratory results reveal a platelet count that has decreased from an admission baseline of 240,000/mm3240,000/\text{mm}^3 to 95,000/mm395,000/\text{mm}^3. The nurse suspects the client is developing heparin-induced thrombocytopenia (HIT). Based on this clinical presentation, which of the following actions should the nurse take? Select all that apply.

  1. Stop the continuous intravenous heparin infusion immediately.Answer
  2. Assess the client closely for signs of neurovascular compromise or new venous thrombosis.Answer
  3. C
    Prepare to administer a prophylactic platelet transfusion to correct the low platelet count.
  4. D
    Anticipate transitioning the client's anticoagulation therapy to subcutaneous enoxaparin.
  5. E
    Administer intravenous protamine sulfate to reverse the medication's therapeutic effects.
  6. Prepare to initiate an infusion of a direct thrombin inhibitor such as argatroban.Answer

Answer

The correct actions are to stop the continuous intravenous heparin infusion immediately, assess the client closely for signs of neurovascular compromise or new venous thrombosis, and prepare to initiate an infusion of a direct thrombin inhibitor such as argatroban.
Heparin-induced thrombocytopenia (HIT) is a severe, immune-mediated complication characterized by a sudden, unexplained drop in platelet count (typically greater than 50% from baseline) and a paradoxical increase in the risk for arterial and venous thrombosis. The immediate priority is to stop all sources of heparin exposure. Because the client remains at a high risk for thrombosis, an alternative non-heparin anticoagulant, such as a direct thrombin inhibitor (e.g., argatroban or bivalirudin), must be initiated. Additionally, due to the prothrombotic state, the nurse must closely monitor the client for signs of new blood clots, such as neurovascular changes or changes in extremity perfusion.

Step-by-Step Solution

1
Analyze the client's clinical presentation and laboratory trends.
The platelet count has dropped by more than 50% from the baseline of 240,000/mm3240,000/\text{mm}^3 to 95,000/mm395,000/\text{mm}^3 over four days of continuous heparin therapy.
A significant and sudden drop in platelets during heparin therapy is a hallmark indicator of heparin-induced thrombocytopenia (HIT).
2
Determine the priority pharmacological intervention for suspected HIT.
The immediate action is to discontinue the unfractionated heparin infusion and avoid all other heparin products.
Continued exposure to any form of heparin will worsen the immune-mediated destruction of platelets and increase the risk of thrombosis.
3
Identify appropriate ongoing management and monitoring strategies.
Prepare to administer a non-heparin direct thrombin inhibitor (e.g., argatroban) and assess for new thrombotic events.
Despite the low platelet count, HIT causes a highly prothrombotic state. The client requires alternative anticoagulation and vigilant monitoring for new clots.

Key Concept

Recognition and acute pharmacological management of Heparin-Induced Thrombocytopenia (HIT).
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic