A clinical protocol for unfractionated heparin is being used to manage a client with a rec… — NCLEX-RN

A clinical protocol for unfractionated heparin is being used to manage a client with a recent pulmonary embolism. The client's admission weight is $75 \text{ kg}$ . The intravenous (IV) medication bag contains $25,000 \text{ units}$ of heparin mixed in $250 \text{ mL}$ of 0.9% sodium chloride.

At 10:00, the client's activated partial thromboplastin time (aPTT) is reported as $42$ seconds. The client's heparin infusion is currently running at $15 \text{ units/kg/hr}$ .

The facility's heparin nomogram includes the following directives:

aPTT Result	IV Bolus Directive	Continuous Infusion Directive
$31$ to $45$ seconds	$40 \text{ units/kg}$	Increase by $2 \text{ units/kg/hr}$
$46$ to $70$ seconds	None	Continue current rate
$71$ to $90$ seconds	None	Decrease by $2 \text{ units/kg/hr}$

After administering the required IV bolus, what is the correct new rate for the continuous infusion pump in $\text{mL/hr}$ ? (Round to the nearest tenth).

$12.8 \text{ mL/hr}$ Cevap
B
$11.3 \text{ mL/hr}$
C
$13.3 \text{ mL/hr}$
D
$30.0 \text{ mL/hr}$

Cevap

The correct new rate for the continuous infusion pump is

12.8 \text{ mL/hr}

According to the protocol, an aPTT of

42

seconds requires increasing the infusion by

2 \text{ units/kg/hr}

. The new dose is

17 \text{ units/kg/hr}

. For a

75 \text{ kg}

client, this equals

1275 \text{ units/hr}

. Given a concentration of

100 \text{ units/mL}

(

25,000 \text{ units} / 250 \text{ mL}

), the pump rate is

1275 \div 100 = 12.75 \text{ mL/hr}

, which rounds to

12.8 \text{ mL/hr}

Adım Adım Çözüm

Identify the correct protocol directive based on the aPTT result.

The aPTT is

42

seconds, falling into the 31-45 seconds range. The directive is to increase the continuous infusion by

2 \text{ units/kg/hr}

Applying the correct protocol action is required before calculating the new dosage.

Calculate the new weight-based dosage rate.

Current dose (

15 \text{ units/kg/hr}

) + Increase (

2 \text{ units/kg/hr}

) =

17 \text{ units/kg/hr}

The continuous infusion must be adjusted based on the client's body weight to safely reach the therapeutic range.

Calculate the total units per hour required for this client.

17 \text{ units/kg/hr} \times 75 \text{ kg} = 1275 \text{ units/hr}

The pump requires a total volume per hour, so the weight-based dose must be converted to an absolute hourly dose.

Convert the hourly dose to a volume rate (

\text{mL/hr}

) based on the drug concentration.

Concentration is

25,000 \text{ units} / 250 \text{ mL} = 100 \text{ units/mL}

. New Rate =

1275 \text{ units/hr} \div 100 \text{ units/mL} = 12.75 \text{ mL/hr}

Electronic infusion pumps are programmed in

\text{mL/hr}

Round the final answer to the nearest tenth.

12.75

rounds to

12.8 \text{ mL/hr}

Following specific rounding instructions is critical for accurate medication administration.

Anahtar Kavram

Calculating weight-based continuous IV medication titrations according to a standardized protocol

Soru

Cevap

Adım Adım Çözüm

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