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Zorluk: Çok zorAccident, Error, and Injury Prevention

A practical nurse (PN) is reviewing the morning laboratory results for an older adult client admitted the previous day with a concussive head injury following a mechanical fall. The client is prescribed a scheduled prophylactic dose of subcutaneous enoxaparin. The morning complete blood count (CBC) reveals a platelet count of 55,000/mm355,000/\text{mm}^3 (55×109/L55 \times 10^9/\text{L}). The client activates the call light and urgently requests assistance to walk to the bathroom. What is the PN's priority action to prevent client injury?

  1. A
    Administer the scheduled enoxaparin to prevent deep vein thrombosis, and carefully assist the client to the bathroom using a gait belt.
  2. Withhold the dose of enoxaparin, provide a bedside commode for elimination, and immediately report the laboratory findings to the registered nurse (RN).Cevap
  3. C
    Instruct the unlicensed assistive personnel (UAP) to walk the client to the bathroom while the PN pages the healthcare provider to discuss the laboratory results.
  4. D
    Apply bilateral soft wrist restraints to prevent the client from ambulating independently and risking a secondary head injury, then notify the provider.

Cevap

The priority action is to withhold the dose of enoxaparin, provide a bedside commode for elimination, and immediately report the laboratory findings to the registered nurse (RN).
The correct action prioritizes three critical safety domains. First, it prevents a catastrophic medication error by withholding an anticoagulant (enoxaparin) in the presence of significant thrombocytopenia (platelets at 55,000/mm355,000/\text{mm}^3). Second, it mitigates fall and bleeding risk by utilizing a bedside commode, which minimizes ambulation for a vulnerable client with a recent head injury. Third, it ensures appropriate escalation by immediately reporting the critical laboratory value to the registered nurse for further medical management.

Adım Adım Çözüm

1
Analyze the client's clinical profile and laboratory data.
The client has a recent concussive head injury and a low platelet count of 55,000/mm355,000/\text{mm}^3 (normal is 150,000150,000 - 400,000/mm3400,000/\text{mm}^3).
Identifying abnormal values is critical for determining the client's current risk level for hemorrhage.
2
Evaluate the safety of the prescribed medication.
Enoxaparin is an anticoagulant. Administering it to a client with severe thrombocytopenia and recent head trauma is strongly contraindicated.
Preventing medication errors involves recognizing when a prescribed medication poses a severe risk based on current lab values.
3
Determine the safest method to address the client's immediate physical need (elimination).
Providing a bedside commode minimizes the distance the client must travel.
A client with an acute bleeding risk and recent head injury is at extreme danger if a secondary fall occurs during ambulation to a distant bathroom.
4
Determine the appropriate escalation protocol.
The PN must immediately notify the RN of the critical lab value and the withheld medication.
The RN or healthcare provider must be informed promptly to adjust the medical plan of care and evaluate for potential internal bleeding.

Anahtar Kavram

In clients with severe thrombocytopenia and recent trauma, the practical nurse must prioritize injury prevention by withholding anticoagulants, implementing strict bleeding and fall precautions, and immediately escalating critical laboratory findings.
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Accident, Error, and Injury Prevention

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