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Difficulty: Very hardPharmacological Therapies

A practical nurse (PN) is reviewing the morning clinical data for a client who is 22 days postoperative following a total hip arthroplasty. The client is scheduled to receive subcutaneous enoxaparin, oral celecoxib, and oral pantoprazole.

Morning clinical data:
- Blood pressure: 96/58 mmHg96/58\text{ mmHg}
- Heart rate: 112 beats/min112\text{ beats/min}
- Hemoglobin: 10.4 g/dL10.4\text{ g/dL}
- Platelet count: 85,000/mm385,000/\text{mm}^3

Which action should the PN take FIRST?

  1. Withhold the scheduled enoxaparin and celecoxib, and immediately notify the registered nurse.Answer
  2. B
    Withhold the enoxaparin due to the platelet count, but proceed with administering the celecoxib and pantoprazole.
  3. C
    Document the vital signs as expected postoperative fluid shifts and administer the scheduled medications.
  4. D
    Administer the celecoxib immediately to ensure adequate pain management before addressing the laboratory results.

Answer

Withhold the scheduled enoxaparin and celecoxib, and immediately notify the registered nurse.
The correct action demonstrates safe pharmacological practice and clinical judgment. The client has a critically low platelet count (85,000/mm385,000/\text{mm}^3) alongside early signs of shock (tachycardia and hypotension). Enoxaparin (an anticoagulant) and celecoxib (an NSAID) both impair the body's ability to clot. Administering them would place the client at extreme risk for severe hemorrhage. The practical nurse must withhold these medications and immediately escalate the situation to the registered nurse for prompt medical intervention.

Step-by-Step Solution

1
Analyze the laboratory results and recognize abnormalities.
The platelet count is 85,000/mm385,000/\text{mm}^3, which indicates critical thrombocytopenia (normal is 150,000−400,000/mm3150,000 - 400,000/\text{mm}^3).
Identifying thrombocytopenia is crucial because it significantly increases the client's risk for spontaneous or medication-induced hemorrhage.
2
Correlate laboratory findings with the current vital signs.
The client is exhibiting tachycardia (112 beats/min112\text{ beats/min}) and mild hypotension (96/58 mmHg96/58\text{ mmHg}).
These borderline vital signs, combined with low platelets in a postoperative client, are early physiological indicators of internal bleeding or shock.
3
Evaluate the scheduled pharmacological therapies against the clinical data.
Enoxaparin is an anticoagulant and celecoxib is an NSAID; both impair clotting and are contraindicated given the client's thrombocytopenia and signs of shock.
Administering either medication could precipitate or exacerbate a life-threatening hemorrhage.
4
Determine the most appropriate nursing action within the PN scope of practice.
The medications must be withheld and the registered nurse must be notified immediately.
The PN scope of practice requires safeguarding the client from contraindicated treatments and escalating critical clinical deterioration to the supervising RN for advanced assessment.

Key Concept

Recognizing early signs of shock and withholding anticoagulant and NSAID therapies in the presence of thrombocytopenia.
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Topics

Pharmacological Therapies

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