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Zorluk: ZorPharmacological Therapies

A 68-year-old client is 3 days post-operative following a bowel resection. The practical nurse is reviewing the electronic health record before administering scheduled morning medications, which include subcutaneous heparin 5,000 units5,000\text{ units} and oral metoprolol 25 mg25\text{ mg}. The client's morning assessment data reveals the following:

AssessmentResult
Heart Rate92 beats/min92\text{ beats/min}
Blood Pressure98/58 mm Hg98/58\text{ mm Hg}
Respiratory Rate18 breaths/min18\text{ breaths/min}
Platelet Count75,000/mm375,000/\text{mm}^3
Hemoglobin11.2 g/dL11.2\text{ g/dL}

Which of the following actions is the most appropriate for the practical nurse to take?

  1. A
    Administer the heparin as prescribed to maintain deep vein thrombosis prophylaxis, but withhold the metoprolol due to the blood pressure.
  2. Withhold both the heparin and the metoprolol, and immediately report the findings to the registered nurse.Cevap
  3. C
    Administer the metoprolol because the heart rate is within expected limits, but withhold the heparin due to the laboratory results.
  4. D
    Accept a verbal directive from the registered nurse to administer the heparin via intravenous push and withhold the metoprolol.

Cevap

The most appropriate action is to withhold both the heparin and the metoprolol, and immediately report the assessment findings to the registered nurse.
The correct action is to withhold both medications and notify the registered nurse. The client's blood pressure of 98/58 mm Hg98/58\text{ mm Hg} is borderline hypotensive, which warrants withholding the beta-blocker (metoprolol) to prevent further cardiovascular depression. Furthermore, the platelet count of 75,000/mm375,000/\text{mm}^3 indicates significant thrombocytopenia (normal is 150,000150,000 to 400,000/mm3400,000/\text{mm}^3), placing the client at a high risk for bleeding; therefore, the anticoagulant (heparin) must also be withheld pending further medical evaluation.

Adım Adım Çözüm

1
Analyze the client's vital signs in relation to the prescribed metoprolol.
The blood pressure is borderline hypotensive at 98/58 mm Hg98/58\text{ mm Hg}.
Metoprolol is a beta-blocker that lowers both heart rate and blood pressure. It should typically be withheld if the systolic blood pressure is below 100 mm Hg100\text{ mm Hg} to prevent cardiovascular collapse.
2
Evaluate the laboratory results in relation to the prescribed heparin.
The platelet count is critically low at 75,000/mm375,000/\text{mm}^3 (thrombocytopenia).
A normal platelet count is 150,000150,000 to 400,000/mm3400,000/\text{mm}^3. Administering an anticoagulant to a client with significant thrombocytopenia drastically increases the risk of severe, life-threatening hemorrhage.
3
Determine the appropriate nursing intervention within the practical nurse scope of practice.
Both medications must be withheld and the findings immediately escalated to the registered nurse.
The practical nurse is responsible for recognizing abnormal pre-administration assessment data, preventing adverse drug events, and reporting critical findings to the supervising nurse or provider.

Anahtar Kavram

Medication Safety, Pre-administration Assessment, and LPN Scope of Practice
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Pharmacological Therapies

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