You are administering heparin and following the protocol bel…

You are administering heparin and following the protocol below for a client weighing 189 lbs. The order is to administer an initial heparin bolus IV followed by a titrated IV infusion. Round to the tenths place. HEPARIN PROTOCOL Initial bolus- 50 units/kg Initial rate – 18 units/kg/h Obtain a PTT every 6 hours, and adjust dosage and rate as follows: If  PTT is less than 35 secs:      Repeat bolus with 80 units/kg and increase the rate by 4 units/kg/h If  PTT is 36 to 44 seconds:       Repeat bolus with 40 units/kg and increase the rate by 2 units/kg/h If  PTT is 45 to 75 seconds:       Continue current rate. If  PTT is 76 to 90 seconds:       If  PTT is 76 to 90 seconds: Decrease rate by 2 units/kg/h If  PTT is greater than 90 secs: Hold the heparin for 1 hour and decrease rate by 3 units/kg/h Available (for bolus)  – heparin 1,000 units/mLAvailable (for infusion) –  heparin 25,000 units in 250 mL D5W  6 hours later the PTT results from the lab are- PTT 100 secs for this patient. The client is currently receiving 20units/kg/h After HOLDING the infusion for 1 hour.  What rate will the nurse set the pump at for the titrated heparin IV infusion in response to the PTT of 100 secs?

A nurse is initiating a blood transfusion of PRBC to a clien…

A nurse is initiating a blood transfusion of PRBC to a client. Initial vital signs are: T 98.6°F, P 66 bpm, RR 16 bpm, B/P 115/72 mmHg, and Pulse Oximetry 98% on room air. After 15 minutes, the nurse rechecks the vital signs and notes the following changes: T 99.8°F, P 72 bpm, RR 18 bpm, B/P 118/76 mmHg, and Pulse Oximetry 98% on room air. Based on this assessment data, the nurse suspects a blood transfusion reaction is most likely occurring. Based on this condition which two interventions in priority order should the nurse take?   Which two priority parameters/manifestations should the nurse monitor ?