Which statement about a postpartum client on heparin prophylaxis is appropriate to include in the plan?

• A. Apply pressure to the fundus with each contraction.
• B. Immediately discontinue anticoagulation if bleeding occurs.
• C. Encourage ambulation without monitoring labs.
• D. Monitor aPTT and platelet count.

Answer: (D)

When a postpartum client is receiving heparin prophylaxis, the plan must address balancing the risk of clotting with the risk of bleeding. Heparin affects the blood’s ability to clot, so you monitor how strongly it is anticoagulating the patient and watch for a drop in platelets that could indicate heparin-induced thrombocytopenia. Checking that the activated partial thromboplastin time (aPTT) reflects the desired level of anticoagulation helps guide dosing, and tracking the platelet count helps detect a serious adverse reaction early. This combination of labs ensures you can adjust therapy as needed and keep both mother and baby safe in a period of increased clotting risk.

Applying fundal pressure is not part of a plan for someone on anticoagulation and could cause harm. If bleeding occurs, the response is not to automatically discontinue anticoagulation; rather, assess the source and hold or adjust treatment as appropriate while monitoring the patient. Encouraging ambulation is important, but it does not replace the need for lab monitoring to ensure safe anticoagulation.