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Difficulty: HardPharmacological Therapies

A practical nurse is caring for a client who is two days post-operative following a total hip arthroplasty. The client is prescribed subcutaneous enoxaparin 40 mg40\text{ mg} once daily. While reviewing the client's electronic health record prior to the morning medication administration, the nurse notes the following data:

- Hemoglobin: 11.5 g/dL11.5\text{ g/dL}
- Hematocrit: 34%34\%
- Platelet count: 78,000/mm378,000/\text{mm}^3 (baseline on admission: 225,000/mm3225,000/\text{mm}^3)

Which action should the practical nurse take first?

  1. A
    Administer the enoxaparin as prescribed and implement standard bleeding precautions.
  2. B
    Assess the surgical dressing and wound drains for excessive sanguineous output.
  3. Withhold the scheduled dose of enoxaparin and immediately notify the registered nurse.Answer
  4. D
    Evaluate the client's lower extremities for unilateral swelling before deciding to administer the medication.

Answer

The correct action is to withhold the scheduled dose of enoxaparin and immediately notify the registered nurse.
The client has developed severe thrombocytopenia, a potential sign of heparin-induced thrombocytopenia (HIT). Administering enoxaparin is strictly contraindicated. The practical nurse must prioritize safety by immediately withholding the medication and reporting the critical laboratory finding to the registered nurse.

Step-by-Step Solution

1
Analyze the morning laboratory results.
The platelet count is 78,000/mm378,000/\text{mm}^3, representing a severe drop from the baseline.
Identifying critical abnormalities is required before medication administration.
2
Correlate the findings with the prescribed medication.
Enoxaparin can cause heparin-induced thrombocytopenia, making administration dangerous.
Nurses must recognize adverse effects to ensure safe pharmacological therapy.
3
Determine the priority action within the practical nursing scope.
The medication must be withheld and the registered nurse notified immediately.
Preventing harm takes precedence over routine administration or secondary assessments.

Key Concept

Heparin-Induced Thrombocytopenia (HIT) and Practical Nurse Scope
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Topics

Pharmacological Therapies

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