Nursing 250, Spring 2022
Maria College, Department of Nursing
N250 Lab: Vascular Student Instructions
Preparation:
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Read Lewis: pp. 800-806, ATI Adult Med-Surg: pp. 223-231
Review lecture materials
Complete critical thinking questions prior to class
Review client chart for Fred Papa
Create a medication sheet for Mr. Papa’s ordered medications
Objectives: With attention to safety and asepsis, in a simulated clinical situation, the student
will:
1. Apply the nursing process in a caring manner to a client s/p vascular surgery.
2. Interpret assessment, lab and diagnostic data correctly, and prioritize care based upon
scientific principles.
3. Facilitate therapeutic communication techniques with client and family and utilize
evidence-based communication techniques such as SBAR-RN to communicate with other
members of the health-care team.
4. Utilize critical thinking to address challenges in caring for the client after a vascular
surgery.
5. Create an appropriate SBAR-RN according to rubric guidelines to convey important
information regarding the post-surgical client to the physician.
Activities:
In your learning teams you will perform a thorough assessment of your client, identify what you believe is
your client’s priority problem and complete a small group debrief to address your concerns. We will
debrief as a large group once all learning teams have had a chance to assess the simulated client.
Critical Thinking Questions:
1.
In the immediate post-op period after vascular surgery the client may be placed on both heparin and
warfarin for anti-coagulation. Explain why both medications may be utilized.
2.
Which nursing assessments and interventions are important when caring for the client after
revascularization surgery?
Revised 1/2021
Nursing 250, Spring 2022
Maria College, Department of Nursing
3.
Mr. Papa weighs 80kg and has been placed on a heparin weight based continuous infusion with the
below parameters, Available is Heparin drip 25,000 units in 250mL D5W and Heparin vials 5,000
units/ml. Calculate the volume to be given for bolus dosing, the initial flow rate and the change in
volumetric dosing according to aPTT
Weight- Based Heparin Orders
For Deep venous Thrombosis (DVT) and Pulmonary Embolism (PE)
Obtain PTT, INR, CBC prior to initiating heparin.
Notify physician if platelet count is less than 100 K, hemoglobin drops by more than 1 gram from
baseline, or other abnormal values.
Dosing Weight = Actual Body Weight = 80 kilograms
Initial heparin dosing:
(1) Give a bolus of 80 IU per kilogram =____________units = __________ mL bolus dose
(2) Start an infusion of 15 IU per kilogram per hour= ___________ units/ hr = _________mL/hr
(3) Order an aPTT 6 hours after heparin bolus given.
Adjusting Infusion based on aPTT
Revised 1/2021
Nursing 250, Spring 2022
Maria College, Department of Nursing
aPTT
(Seconds)
Bolus Dose IV
Hold
Infusion
(minutes)
80 units/ kg
< 35 s
(<1.2 X control)
=___________
0
Dose Change
Increase by 4
units/kg/hr
= ________units/hr
35 to 45 s
(1.2 to 1.5 X control)
46 to 70 s
(1.5 to 2.3 X control)
40 units/ kg
=_______ units/hr
=_________
0
No change
Decrease by 2 u/kg/hr
71 to 90 s
(2.3 to 3 X control)
0
> 90 s
(> 3 X control)
0
Increase flow rate
by
=_________ mL/hr
2 units/kg/hr
0
0
Rate Change
0
=________ units/hr
Decrease by 3 u/kg/hr
60
=________ units/ hr
Increase by
=_________ mL/hr
No change
Decrease flow rate
by
=_________ mL/hr
Decrease flow rate
by
=_________ mL/hr
Ongoing monitoring:
(1) Order an aPTT 6 hours after any dosage change.
(2) Once 2 consecutive aPTTs are within the therapeutic range, monitor the aPTT every 24 hours and
adjust infusion accordingly.
Revised 1/2021