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2 Minute EBP Challenge

Monday, March 08, 2010

Restoring Hemoglobin

One of the goals for a patient who has a large blood loss is the restoration of normal hemoglobin levels. This is partially done by blood transfusions, usually to a hemoglobin level of about 10g/dL. A hemoglobin level that low will leave the patient feeling fatigued, but should be high enough to protect the heart from anemic ischemia.

Sunday, February 28, 2010

Renal Dysfunction

Mrs. Mersa is admitted with sepsis and hypotension. Her labs indicate:
BUN 58 mg/dl
Serum creatinine 2.1 mg/dl
Urine sodium 70 mEq/L
Urine specific gravity 1.010, with cellular casts and RBCs in the urine.
Based on these findings you would consider:

Friday, February 12, 2010

Which action first?

Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse?

More 2 Minute EBP Challenge

Heparin-induced Thrombocytopenia

Monday, January 25, 2010

Stay up-to-date the easy way!

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How would you answer this question?

Your patient Mr. Kellogg is diagnosed with heparin-induced thrombocytopenia (HIT). As his nurse you should anticipate that his physician will treat HIT with:

a. Platelet transfusions
b. Warfarin
c. Argatroban
d. Enoxaparin

The correct answer is "c" argatroban.

Thrombocytopenias are a collection of conditions that cause the platelet count to decrease. There are many ways that platelets can become activated and depleted in the clotting process. The most common reasons for drops in platelet counts are depletion from pre-existing conditions such as sepsis, trauma, or surgery. Approximately 5% of patients that receive heparin will develop an immune response that activates platelets causing life-threatening clotting and occasional bleeding. This condition is called heparin-induced thrombocytopenia.

Heparin is a drug that inhibits platelets from forming clots by inactivating thrombin and depressing platelet function directly. The result is a decrease in clot formation and increased bleeding. Preventing clot formation is beneficial in your patient with a pulmonary embolism or myocardial infarction, but adverse effects can occur such as intracranial hemorrhage with the use of heparin.

A small percentage of the population will develop an immune response to heparin that leads to activation of platelets, rather than inhibition. This condition is referred to as heparin-induced thrombocytopenia (HIT), and results in the activation and depletion of platelets in the presence of therapeutic doses of heparin.

The most effective way to treat HIT is to discontinue all forms of heparin, including IV flushes. Administering platelets to this patient can cause more clotting and increase the severity of symptoms. Enoxaparin is a low-molecular weight heparin that can cause HIT, and warfarin can cause tissue necrosis in HIT. Argatroban is an anticoagulant that will not worsen HIT. Argatroban works by directly inhibiting thrombin and not by stimulating heparin antibodies, and is therefore safe in treating HIT.

From: Woodruff, D.W. (2006). HIT: Now you see 'em , now you don't. Nursing Made Incredibly Easy, 4(1); 53-55.

Congratulations to Toronda Jones-Hickson who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly. Congratulations Toronda!

Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.

(c) 2010 Ed4Nurses, Inc. Feel free to print this e-mail and share it with your colleagues. Other forms of digital or print reproduction are prohibited without prior written consent from Ed4Nurses, Inc.

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2 Minute EBP Challenge

Heparin-induced Thrombocytopenia