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Difficulty: MediumPharmacological and Parenteral Therapies

A client is receiving a continuous intravenous (IV) infusion of unfractionated heparin for the treatment of a pulmonary embolism. Routine morning laboratory results reveal a sudden decrease in the client's platelet count from 180,000/mm³ (180 x 10^9/L) on admission to 60,000/mm³ (60 x 10^9/L) today. The client reports no active bleeding. Which action is the priority for the nurse to take?

  1. A
    Prepare to administer intravenous protamine sulfate to reverse the effects of the heparin.
  2. Stop the continuous heparin infusion and immediately alert the healthcare provider.Answer
  3. C
    Implement strict bleeding precautions while maintaining the current heparin infusion rate.
  4. D
    Request a prescription to administer a platelet transfusion to correct the thrombocytopenia.

Answer

The priority action is to immediately stop the heparin infusion and alert the healthcare provider due to the suspected development of Heparin-Induced Thrombocytopenia (HIT).
The correct action is to immediately stop the heparin infusion and notify the provider. A rapid drop in platelets by more than 50% from baseline in a client receiving heparin strongly indicates Heparin-Induced Thrombocytopenia (HIT). HIT is a paradoxical, immune-mediated adverse reaction that causes a hypercoagulable state, increasing the risk of life-threatening thrombosis. The absolute priority is to withdraw all heparin products immediately.

Step-by-Step Solution

1
Analyze the client's laboratory trends in the context of their current pharmacological therapy.
The client has experienced a dramatic drop in platelets (greater than 50% decrease) from 180,000/mm³ to 60,000/mm³ while receiving an intravenous heparin infusion.
Monitoring daily platelet counts is critical for clients on continuous heparin to detect early signs of adverse immune reactions.
2
Interpret the clinical significance of the severe platelet reduction.
The rapid depletion of platelets, even in the absence of active bleeding, strongly suggests Heparin-Induced Thrombocytopenia (HIT), a life-threatening, prothrombotic complication.
Recognizing HIT is essential because it paradoxically increases the risk of clotting despite the low platelet count.
3
Determine the immediate nursing priority based on the suspected complication.
The nurse must instantly stop the heparin infusion and notify the healthcare provider so a non-heparin anticoagulant can be prescribed.
Removing the offending pharmacological agent is the only way to halt the destructive immune cascade and prevent severe thrombotic events.

Key Concept

Recognition and Management of Heparin-Induced Thrombocytopenia (HIT)
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Topics

Pharmacological and Parenteral Therapies

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