3-16 PATIENTS DIAGNOSED WITH PULMONARY EMBOLUS AND ON ANTICOAGULANT THERAPY. Handoff report at 3:00 PM: “Mrs. L was admitted with signs and symptoms of having developed a pulmonary embolus. She just had a

baby 2 weeks ago. She has a heparin drip. The infusion pump is set at 20 mL/hr. You have 100 mL left. She

slept well. Respirations are unlabored at 22. The right lower lung has diminished breath sounds. She will be

started on Coumadin today. She is anxious to go home and be with her baby.”

Mrs. L’s current flowcharts contain the following information:

Integrated Learning Activity: With a partner, use the clinical situation and the flowcharts to:

Nursing Care Kardex

VS: q4h Diet: Regular

Bed rest with BRP I & O

O2 @ 3 L/min/NC prn SOB

IV: 500 mL D5W c-

20,000 units heparin

Infuse at 1000 units/hr

LFA #22 g angiocath


Daily PTT ! PT in AM

Routine Medications:

Coumadin 5 mg po today at 0900

Coumadin 2.5 mg po today at 1700

Coagulation Record

Date PTT Control Heparin dose

1st day 50 sec 25 sec 900 units/hr

2nd day 60 sec 25 sec 1000 units/hr

3rd day 90 sec 30 sec 1100 units/hr

Current 75 sec 30 sec 1000 units/hr

Copyright © 2014, 2010, 2006, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.


3-16 Patient Diagnosed With Pulmonary Embolus and on Anticoagulant Therapy 219

1. Identify the pertinent

patient information

made known to you in

the report.

2. Identify the pertinent

patient information

made known to you in

the flowcharts.

3. Review the data in

columns 1 and 2 and

identify information that

needs follow-up.

It is 3:30 PM; prioritize your plan of care for the next hour:

6:30 PM The nursing assistant informs you that the IV pump is beeping. You go into assess the pump and

you notice that the heparin bag is empty. You look at the infusion pump and it is set at 35 mL/hr instead of

25 mL/hr.

Critical reflection: To promote safe nursing practice, identify interventions that support the safe administration

of heparin therapy and professional competency:

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