Which nursing interventions are appropriate when administering ...

[Kthamas]

Which nursing interventions are appropriate when administering enoxaparin? Select all that apply.
 
  a. Monitor activated partial thromboplastin time (aPTT) levels.
  b. Administer via intramuscular (IM) injection into the deltoid muscle.
  c. The preferred site of injection is the lateral abdominal fatty tissue.
  d. Massage the area after the injection has been given.
  e. Hold extra pressure over the site after the injection.

Question 2

You know that sometimes the only needed action is to stop the warfarin (Coumadin) several days before the surgery.
 
  Other times, the provider initiates bridging therapy, or stops the warfarin and provides anticoagulation
  protection by initiating low-molecular-weight heparin. After reviewing all of his anticoagulation
  information, the provider decides that K.N. will need to stop the warfarin (Coumadin) 1 week before
  the surgery and in its place be started on enoxaparin (Lovenox) therapy.
 
  Compare the duration of action of warfarin (Coumadin) and enoxaparin (Lovenox) and explain the reason the provider switched to enoxaparin at this time.

[Bison]

Answer to Question 1

Answers: c, e
It is not necessary to monitor aPTT levels for enoxaparin therapy. This drug is given by deep
subcutaneous injection into the fatty tissue between the left and right anterolateral and left and
right posterolateral abdominal wall. The area should not be massaged after the injection because
excessive bruising might occur. Holding extra pressure over the injection site might be needed to
prevent excessive bleeding; K.N. has been on an anticoagulant up to this time.

Answer to Question 2

Warfarin has a duration of 2 to 5 days; enoxaparin has a duration of 12 hours. K.N. is still at risk for
thrombus formation because of the atrial fibrillation. Yet he needs to have the knee surgery, and it
would be risky to perform the knee surgery while K.N. is anticoagulated with warfarinthere would
be a risk of excessive bleeding during and after the surgery. Therefore, the warfarin is discontinued
in advance of the surgery because it will take several days for the anticoagulation effects to wear off.
However, the enoxaparin can still be given at this time to provide needed levels of anticoagulation.
It will be stopped just before the surgery because of its shorter duration. The goal is to have him off
oral anticoagulation for a minimum amount of time to prevent the possible risk of a clot formation
and potential stroke. His provider will monitor him closely before and after surgery.

[Kthamas]

Excellent

[atrochim]

TYSM