A client with active GERD presents to clinic. Which statement by the client indicates they need additional education?

A) The client will remain free from visible bleeding, bruising, and signs of internal bleeding (tachycardia and hypotension) during this shift: This is the most appropriate outcome for the "Risk for bleeding" nursing diagnosis. Since both aspirin and warfarin are anticoagulants, they increase the client's risk of bleeding. The priority is to monitor for and prevent any signs of visible bleeding, bruising, or more serious internal bleeding, which could manifest as tachycardia or hypotension. This outcome directly addresses the client's safety by focusing on detecting and preventing bleeding complications.

B) The client will verbalize understanding of dietary restrictions while on warfarin and provide examples of foods that contain vitamin K during this shift: While this is an important goal for clients on warfarin (because vitamin K can interfere with the effectiveness of warfarin), it is not the most immediate concern in the context of the "Risk for bleeding" diagnosis. Dietary restrictions should be discussed but are not as time-sensitive or directly related to the prevention of bleeding in the short term, especially during this shift.

C) The client will state their pain level is less than 4 on a 0-10 pain scale during aspirin therapy: While managing pain is important, this outcome does not directly address the risk for bleeding associated with both aspirin and warfarin therapy. The priority nursing concern here is preventing bleeding, not pain management during aspirin therapy.

D) The client will remain free from any signs and symptoms of deep vein thrombosis (DVT): While preventing DVT is important for patients on anticoagulant therapy, the focus of this nursing diagnosis is on the risk of bleeding, not thrombosis. Therefore, this outcome is not as relevant to the immediate concerns related to the prescribed medications (aspirin and warfarin).

Identify the total units of heparin in the bag:

The IV bag contains 25,000 units of heparin in 250 mL.

Identify the desired hourly dose:

The client is ordered to receive 2,000 units of heparin per hour.

Calculate the mL containing 2,000 units:

We can set up a proportion:

(25,000 units) / (250 mL) = (2,000 units) / (x mL)

Solving for x, we get:

x = (2,000 units x 250 mL) / 25,000 units x = 20 mL