Heparin is an anticoagulant that helps prevent and treat blood clots. This review is to prepare nursing students for the NCLEX exam.
Hey everyone it’s sarah thread sterner sorry encom and today we’re going to continue our pharmacology series by talking about the medication heparin and after you get done watching this youtube video don’t forget to access the free quiz that will test you on this medication so let’s get started as we’ve been studying these medications in this series we have been
Remembering the word nurse because this helps us remember those important questions we need to ask ourselves while studying these medications so we’re dealing with heparin and sometimes you may see it written as unfractionated heparin so the first thing we want to ask yourself is what name what family name does this drug fall into because that’s going to tell us
How this drug works well heparin is part of the in direct thrombin inhibitor family so it indirectly inhibits thrombin because it does this this makes this drug an anticoagulant which is going to alter the clotting process now how does heparin do this well it affects the intrinsic pathway of coagulation and this pathway is activated when there is internal trauma
To the vascular system compared to the extrinsic pathway which is activated when there’s external trauma which is how warfarin / coumadin really worked it affected the extrinsic pathway but heparin affects the intrinsic pathway now how it specifically does this is that heparin will bind with a naturally occurring substance in the body and when it does this it
Enhances the activity of this substance which we’re talking about antithrombin 3 and antithrombin 3 inhibits the enzymes that will play a role in the clotting process and it’s specifically going to prevent the activation of thrombin and if we prevent the activation of thrombin we’re going to alter claudine because we’re going to prevent the conversion of fibrinogen
To fibrin which is going to result in slower clotting times for our patient and this will help prevent clots and if they already have an existing clot prevent that clot from getting bigger and potentially breaking off and going into circulation now one thing heparin does not do is it does not lysis or break up an existing clot and when we’re talking about clots
One thing we’re talking about is like venous thromboembolism vtes and a lot of times we start out as small little clots in the vessel and we refer to those as deep vein thrombosis dvt and these clots can grow and they can break off and they can go into circulation when they do this it becomes an embolism and these clots can travel throughout the body and cause a
Lot of problems you can go to the lungs where we refer to that as like a pe a pulmonary embolism or these clots can go to the heart circulation where the heart muscle is fed by those arteries and can block the circulation to the heart muscle and a myocardial infarction can occur or these clots can go up through the brain circulation block blood flow to an area of
The brain and lead to a stroke so these clots can be very dangerous now let’s ask ourselves what is heparin used for why may our patient be on heparin well we’ve already established heparins and anticoagulant so it’s going to be used to prevent and treat blood clots and patients now what kind of conditions may a patient have that heparin can treat well patients
Who have those vtes those venous thromboembolism or a pulmonary embolism stroke help prevent a stroke where the clot can go and block the blood flow to the brain for atrial fibrillation whenever patients have this their heart really isn’t empty and like it should blood is pulling from those erratic impulses in the heart and a clot can form because anytime blood
Pulls together clots can form and we want to prevent like a clot being shot out of the heart and leading to a stroke or in certain cases of surgery like cardiac surgery or some types of orthopedic surgery like hip surgery where there’s an increased risk of clot development next let’s talk about the responsibilities of the nurse for a patient who is on heparin so
One thing you want to know is how is heparin administered well we can give it through an injection via the fatty sub-q tissue or the iv route intravenously through a continuous infusion so let’s talk about the continuous iv route first whenever a continuous heparin is ordered we will hang a bag of it and it’s referred to as a heparin drip and we will titrate this
Strip based on a protocol that has very specific guidelines that will be based on the patient’s a ptt result and a pt t stands for activated partial thromboplastin time and that is what we care about with heparin so remember that and here in a moment i’m gonna go in-depth about this result so based on this result either we will increase the drip give the patient a
Bolus or we will turn the drip off for an hour decrease the rate or there’ll be no change to the drip until the next a ptt result and the whole reason we’re doing that is because we’re trying to get this patient within this therapeutic range so we can prevent blood clots so it has to be therapeutic for it to actually work because we can cause them too much bleeding
Or we can actually cause them in where it’s not working at all and they’ll get blood clots so with this heparin drip this result will be drawled every like four to six hours i’ve mainly seen at six hours it depends on your hospital protocol and before you start heparin heparin is a weight based drug so you need to have an accurate current weight on that patient
So proper dosing can be administered so prior to giving this make sure you have an accurate weight so now let’s talk about that activated partial thromboplastin time that a ptt so what is the difference between a ptt vs. and a ptt well they both measure the same thing but the a ptt has an activator added to it to speed up the clotting time hence why it has that a
In front so it’s going to have a little bit more of a narrow range than your ptt but they measure the same thing so i wanted to quickly go over that because you may see those use interchangeably and i wanted you to know the difference so these lab results they measure those intrinsic and common pathways of the coagulation so it’s going to tell us how long those
Coagulation factors are working to form a clot and remember whenever we have a patient on heparin we want it to fall within a certain therapeutic range so we can prevent blood clots but we don’t cause them to excessively bleed so these results are measured in seconds now what is a normal a ptt a normal one is about 30 to 40 seconds depending on the lab that’s an
Approximate range so in order for a patient to be therapeutic we want them to have a reading of 1.5 to 2.5 times the normal range of what this normal should be so anywhere between 60 to 80 seconds they would be therapeutic so let’s look at that range if they’re a ptt was less than 60 what would that mean that would mean that they’re not therapeutics so we may with
Their drip have to possibly give them a bolus or increase their rate because they’re not where we want them and they could develop blood clots now if they were higher on the higher spectrum like greater than 80 were that risk for bleeding because they’re clotting time is really pro wrong so we may according to protocol have to turn them drip off for an hour or
Decrease their rea so with heparin one thing i really want you to remember is about this a ptt it needs to be 1.5 to 2.5 times the normal range for that patient to be therapeutic now let’s look at some more responsibilities especially with the injectable heparin through the sub-q tissue as a nurse we want to know where how to get it so remember these points we
Want to of course an insert in the fatty tissue in the abdomen but we want to stay at least two inches away from the belly button and one inch away from scars because if you inject there it’s not really going to absorb because you have that scar tissue also rotate sites so look in the chart where did the previous nurse administer it ask the patient and always go
On the opposite side and whenever you give it don’t massage or a spray or rub the injection side another thing we want to do is monitor for bleeding any type of patients on any anticoagulant they’re at risk for bleeding and it’s usually going to be in the most subtle places so you want to look after urine are they losing blood in their urine does it look yellow
Or does it look like a pinkish reddish tint to it that could indicate hematuria in how does their stool look is it dark and tari that could be blood that’s referred to as malena how does it look around their gums do they have using of blood that can indicate we have some bleeding issues and are they vomiting if so what does it look like does it look like coffee
Ground emesis that could indicate blood and how does their vital signs look is their heart rate really high and their blood pressure low we talked about this with our hypovolemic shock when a patient can hamrick that can indicate that or are they all of a sudden complaining of the severe sudden headache to mean that we have some brain bleeding in our brain and
Look at their labs have they haven’t had a significant drop in their hemoglobin hematocrit level that’s looking at our red blood cells and how do their platelets look do they have a drop in their platelets which can indicate heparin induced thrombocytopenia so we want to be watching out for those things as well now let’s quickly talk about this heparin induced
Thrombocytopenia because it can happen to your patient who is on heparin and you want to be on the lookout for it so what is it well it’s when antibodies are created against the heparin because it is bind with platelet factor 4 so when the heparin and platelet factor 4 have fine these antibodies are created and they will go and attach to this complex once it
Attaches to this complex it will activate the platelets whenever that happens you’re gonna have problems you’re gonna have small clots to form and it’s going to deplete our platelet count hence thrombocytopenia so that is really why we want to be looking at that cbc those platelets and see if they’ve dropped drastically because if they have patient could be going
Into this some other things you want to be looking out for other than that low platelet count is look do they have any worsening or new clots that are developing and depending on where that clot is we’ll just herrmann the sign and symptom for instance if they’re gonna get a new dvt it can be a warm harden swollen area they have in the lungs it can be a chest pain
Shortness of breath the heart things like that even going to the brain they can have mental status changes so you want to be always assessing those areas now how about if this develops what happens well as a nurse you can expect the heparin drip to be discontinued it will be documented in the patient’s health history that they have this and to never put them on
Heparin again and they can be started on another anticoagulant the family of the direct thrombin inhibitors like al gatchaman or by valor rudin which is angio mac’s to help with their anticoagulation some other things you want to remember what the responsibility part of heparin is the antidote always remember the antidotes for these medications in the antidote for
Heparin is protamine sulfate and whenever you give medications always avoid the i m route because these patients are at risk for bleeding it takes them a while to clot so we want to avoid i m injections and when drawing blood we want to make sure that we hold firm direct pressure after drawing the blood because they can bleed for a while and we want to prevent a
Hematoma from forming and also teach the patient about that as well especially the get injure they’ll need to hold pressure for a while this medication can be used during pregnancy warfarin could not be used during pregnancy and speaking of warfarin this medication heparin can be used as a bridge while a patient is being switched warfarin because warfarin takes
About three to five days for the patient to become therapeutic where the inr is between two to three so they’ll be on heparin during that bridging time then the heparin will be discontinued because you know heparin has a short half-life now let’s talk about some side-effects other than they can have the excessive bleeding and the heparin induced thrombocytopenia
You want to watch out for osteoporosis this can occur in patients who take heparin long term and in high doses because it can stimulate the osteoclast activity and inhibit osteoblast activity which will alter the strength of the bone so watch for bone fractures things like that and other side effects could be hair loss and rashes and lastly the education pieces
For the patient taking heparin you’ll want to teach them how to monitor for signs and symptoms of that excessive bleeding like looking in the urine the stool the gums if they vomit what does it look like things like that that they would need to report to their doctor also using a soft bristle toothbrush so they don’t cut the gums and cause it to bleed and electric
Razors rather than the straight razors because they may cut themselves avoiding contact sports that they can become injured have some type of trauma that because they’re susceptible to bleeding that they could really have a major injury also avoiding taking aspirin any type of nsaids or over-the-counter health vitamins because this can interfere with heparin and
Increase bleeding and always talk to your healthcare provider before taking any new medications and how to administer the sub-q heparin you’ll want to demonstrate to the patient show them make them demonstrate back to you to make sure that they’re doing it right and to always let other health care providers know that they’re taking heparin especially prior to any
Type of invasive procedure okay so that wraps up this review over heparin thank you so much for watching don’t forget to take the free quiz and to subscribe to our channel for more videos
Transcribed from video
Heparin (Anticoagulant) Nursing NCLEX Review: Pharmacology, Intervention, Patient Teaching By RegisteredNurseRN
