| Course | NU142CL Medical-Surgical Nursing I Clinical |
|---|---|
| Unit | Unit 6 |
| Paper type | Patient workup |
| Length | About 560 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BSN (prelicensure) |
| Updated | October 2026 |
Free sample paper for NU142CL Unit 6
Platelets Halved by Day Five: A Patient Workup Rebuilt Partway Through the Shift for a Composite 66-Year-Old Woman on a Heparin Infusion for a Leg Clot, When a Morning Count Raised Concern for Heparin-Induced Thrombocytopenia
[Student Name]
Purdue University Global
NU142CL: Medical-Surgical Nursing I Clinical
Unit 6 Patient Workup
[Instructor Name]
[Date]
The patient is composite; values are bracketed where illustrative, and diagnostic and treatment decisions belong to the provider.
The Original Workup, Prepared Before the Shift
Patient AA, a composite 66-year-old retired teacher, was admitted five days ago with a deep vein thrombosis in her left thigh after a long car trip. She has been on an IV heparin infusion adjusted by protocol to her anti-Xa level. Plan for the shift as prepared: check the infusion rate against the latest level, watch for bleeding at IV sites, gums and in urine, assess the left leg for swelling and pain, encourage walking as allowed, and review the planned switch to an oral anticoagulant.
The Change at 1000
Her morning platelet count, drawn at [0600], resulted at [1000]: [112], down from [238] on admission and [205] two days ago. Her left calf was newly more swollen than the morning before, and a small area of skin at a previous injection site on her abdomen looked dusky.
A fall in platelets of more than half, five to ten days after heparin is started, is the typical pattern of heparin-induced thrombocytopenia, an immune reaction in which antibodies activate platelets and paradoxically cause new clots in veins and arteries (Greinacher, 2015). Bleeding is not the main danger; new clotting is.
The workup had been built around the risk of bleeding, and the morning count turned it toward the opposite risk, new clots.
The Rebuilt Workup
New priority one: risk for new thrombosis from possible heparin-induced thrombocytopenia. Actions: report the platelet trend and the new calf swelling and skin change to the provider immediately; expect heparin to be stopped, including flushes, and a non-heparin anticoagulant started, since stopping anticoagulation entirely would leave her clot untreated; record a suspected heparin reaction pending testing; label the chart so no heparin flushes are given. New priority two: monitoring for new clots. Actions: assess both legs, arms and skin for new swelling, color change or pain; check pulses in all four limbs; watch for chest pain or breathlessness that could signal a clot in the lung (Harding et al., 2023). New priority three: platelet and laboratory follow-up. Actions: platelet counts as ordered; antibody testing has been sent. Original priorities kept: bleeding precautions continue at a lower level of concern; walking held until the provider reviews the new swelling.
Medication Changes
Heparin infusion stopped at [1045] per order. Argatroban infusion started at [1130], a direct thrombin inhibitor that does not cross-react with heparin antibodies, adjusted to a clotting time (Burchum & Rosenthal, 2022). Heparin flushes removed from her IV orders. The oral anticoagulant switch is postponed until platelets recover. Because argatroban is cleared by the liver rather than the kidneys, the nurse also notes her liver tests from admission, which were normal, on the rebuilt page for the prescriber's reference.
Teaching
She is told plainly that her body may be reacting to heparin, that she will receive a different blood thinner, and that she must tell every future care team about this reaction so heparin is not given again.
References
Burchum, J. R., & Rosenthal, L. D. (2022). Lehne's pharmacology for nursing care (11th ed.). Elsevier.
Greinacher, A. (2015). Heparin-induced thrombocytopenia. The New England Journal of Medicine, 373(3), 252-261. https://doi.org/10.1056/NEJMcp1411910
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.
The Purdue Global NU142CL Unit 6 instructions
Unit 6 usually follows a patient who changed during the day and grades whether the workup was rebuilt around that change. Prompts commonly want the original plan, the new finding, its interpretation, the revised priorities and actions, medication changes and teaching. Instructors look for students who recognize that new information can reverse the main risk, as with heparin-induced thrombocytopenia, where clotting rather than bleeding becomes the danger. The original priorities should be moved, not erased, so the reasoning is visible. Actions should be immediate and specific, including stopping heparin in every form. Teaching that the patient must report the reaction in future protects her beyond this admission. Keep the timeline of the change visible on the page.
How this NU142CL Unit 6 example is built
The workup opens with the original plan as prepared before the shift: infusion checks, bleeding precautions, leg assessment and the planned oral switch. The change at 1000 follows, with the platelet trend, calf swelling and skin change, and an explanation of the immune mechanism citing a clinical review, with the highlighted line on the reversed risk. The rebuilt workup sets three new priorities with actions, then keeps the original ones at lower rank, with a margin note. Medication changes record heparin stopped, flushes removed and argatroban started, with a note on its liver clearance. Teaching closes the page with plain language for the patient. The page shows the time of each change.
Where the points sit in the NU142CL Unit 6 rubric
Rebuilt workups in NU 142CL earn their points through recognition of the change, accuracy of interpretation, quality of revised priorities, and safe action. Recognition credit goes to noticing the trend, not only the single value. Interpretation is credited for correctly explaining why the main risk shifted from bleeding to clotting. Revised priorities should be ranked and specific, with the original ones visibly moved rather than deleted. Safe action rewards immediate reporting, stopping heparin including flushes, and monitoring for new clots in all limbs and the lungs. Sources cited in APA 7 support the mechanism and the drug choice. Graders reward a page that a reader can follow from the original plan to the new one without confusion. Showing when each step happened makes the response time visible.
NU142CL Unit 6 help from the desk
Workups in this unit often add the new finding at the bottom of the original page without changing priorities, which hides the most important development of the day. Another frequent error is treating a falling platelet count on heparin as a bleeding risk only, when the danger in this reaction is new clotting. Some plans stop the infusion but forget heparin flushes. Many leave anticoagulation stopped entirely. Rebuild the page around the change, explain the reversed risk, rank new priorities, keep the old ones lower, stop all heparin, expect a non-heparin anticoagulant, monitor every limb and teach the patient to report the reaction. Mark the time you noticed the change.
Get an NU142CL Unit 6 example written to your instructions
Changes of condition vary: a fall, a fever, a drop in pressure, sudden confusion. Outline the kind of change your Unit 6 patient went through, in general terms and without identifiers, and add the form and rubric. The model shows a composite version of that shift, both layers included. No fee for a first custom sample; 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
More NU142CL papers and BSN samples
- NU142CL Unit 1: Discussion Board Post
- NU142CL Unit 2: Patient Workup
- NU142CL Unit 3: Organization Sheet
- NU142CL Unit 4: Clinical Journal
- NU142CL Unit 5: Handoff Report
- NU142CL Unit 7: Procedure Note
- NU142CL Unit 8: Case Study Analysis
- NU142CL Unit 9: Post-conference Post
- NU142CL Unit 10: Final Case Study
- NU142 Unit 6: Handoff Report
- NU141CL Unit 6: Patient Education Handout
- NU141 Unit 6: Patient Education Handout
- NU140CL Unit 6: Post-Conference Post
NU142CL Unit 6 questions, answered
Where can I find a free NU142CL Unit 6 sample paper?
You can read the complete NU142CL Unit 6 rebuilt workup for suspected heparin-induced thrombocytopenia here, with the original plan, the change, revised priorities, medication changes and teaching, citing three sources. We can rebuild a workup around a change in your own patient.
What is heparin-induced thrombocytopenia?
An immune reaction in which antibodies activate platelets, causing the count to fall, typically by more than half within five to ten days of starting heparin, and paradoxically causing new clots in veins and arteries.
Why is clotting the main risk in NU142CL Unit 6?
Activated platelets form new clots even as the count falls. Bleeding is not the main danger in this reaction, so priorities shift to watching for new clots in limbs and lungs.
Should anticoagulation be stopped in heparin-induced thrombocytopenia?
Heparin is stopped in every form, including flushes, but anticoagulation continues with a non-heparin drug such as argatroban, since her original clot still needs treatment.
What should the patient be taught?
That her body may be reacting to heparin, that a different blood thinner is being used, and that she must tell every future care team about the reaction so heparin is not given again.