Every class, the same seven questions.

NCLEX safety alert: High-alert medication — independent double check before administration.

Mechanism of action

Potentiates antithrombin III, inactivating thrombin and factor Xa so new clot cannot form.

Indications

• DVT and PE treatment and prevention
• Acute coronary syndrome
• Line patency

Common adverse effects

• Bruising
• Minor bleeding at injection sites

Serious reactions

• Major hemorrhage
• Heparin-induced thrombocytopenia (HIT)

Contraindications

• Active major bleeding
• Known HIT
• Severe uncontrolled hypertension

Required assessments

• Baseline and ongoing bleeding assessment
• Neuro checks
• Injection sites

Laboratory monitoring

• aPTT (unfractionated)
• Platelet count
• Hemoglobin and hematocrit

Hold parameters

• Hold and notify for aPTT above the therapeutic range or platelets < 100,000

Antidote

Protamine sulfate

Nursing interventions

• Verify dose with a second nurse for high-alert infusions
• Use an infusion pump with guardrails
• Avoid IM injections and minimize invasive procedures

Client teaching

• Use a soft toothbrush and an electric razor
• Report black stools, bleeding gums or unusual bruising
• Do not take NSAIDs without provider approval