A nurse is caring for a client who has a pulmonary embolism and has been on a heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

Choice A reason: Hematemesis Hematemesis, or vomiting blood, is a serious symptom that usually indicates bleeding in the upper gastrointestinal tract. This could be due to a severe peptic ulcer, among other conditions1. The blood may appear red or black, and the condition can cause a person to go into hypovolemic shock, which can lead to organ failure and death if not treated immediately. Therefore, hematemesis should be identified as the priority symptom in this case. While all these symptoms can be associated with peptic ulcer disease, hematemesis is the most serious and should be prioritized due to the risk of significant blood loss and potential for hypovolemic shock.

Choice B reason: Abdominal bloating Abdominal bloating is a symptom that can be caused by various conditions, including indigestion, overeating, and certain medical conditions. While it can be uncomfortable, it is generally not as immediately life-threatening as hematemesis.

Choice C reason: Epigastric discomfort Epigastric discomfort refers to pain or discomfort in the upper abdomen, below the ribs. It can be caused by conditions such as acid reflux, GERD, overeating, lactose intolerance, and others. While it can be a symptom of a peptic ulcer, it is not typically as urgent as hematemesis.

Choice D reason: Dyspepsia Dyspepsia, also known as indigestion, can cause symptoms such as bloating, heartburn, and feeling full too quickly8910. It can be caused by a variety of factors, including certain foods, overeating, and medical conditions like GERD. While it can be a symptom of a peptic ulcer, it is generally not as immediately life-threatening as hematemesis.

Choice A: Lactated Ringer’s

Lactated Ringer’s solution is an isotonic crystalloid that contains electrolytes similar to those found in blood plasma. While it is commonly used for fluid resuscitation, it does not provide a significant source of calories and therefore is not the best option to temporarily replace TPN.

Choice B: 0.9% sodium chloride

0.9% sodium chloride, also known as normal saline, is an isotonic solution that is used to expand volume and correct electrolyte imbalances. Like Lactated Ringer’s, it does not contain a significant amount of calories and is not suitable as a temporary replacement for TPN.

Choice C: 3% sodium chloride

3% sodium chloride is a hypertonic saline solution used in controlled settings to treat specific conditions such as hyponatremia. Due to its high concentration of sodium, it is not appropriate for routine fluid replacement and does not provide calories.

Choice D: Dextrose 10% in water

D10W is the preferred choice in this scenario because it provides a source of glucose, which can help maintain blood glucose levels when TPN is not available. It is important to monitor the patient’s blood glucose levels while infusing D10W to ensure they remain within a safe range. When a TPN container is delayed, Dextrose 10% in water is the most appropriate temporary solution to infuse until the next container becomes available, as it provides necessary calories in the form of glucose to the patient.