The nurse determines that a patient with heparin-induced ...

[D2AR0N]

The nurse determines that a patient with heparin-induced thrombocytopenia is at risk for bleeding. Which intervention should the nurse include in this patient's plan of care?
 
  1. Avoid invasive procedures, such as rectal temperatures, urinary catheterizations, and parenteral injections.
  2. Apply pressure to puncture sites for 35 minutes for arterial blood gases aspiration.
  3. Give enemas to help the patient avoid straining during bowel movements.
  4. Encourage the patient to brush the teeth thoroughly and rinse with alcohol-based mouthwash after each meal.

Question 2

Upon analysis, a patient's red blood cells (RBCs) appear microcytic and hypochromic. The nurse recognizes that the patient likely has which condition?
 
  1. iron deficiency anemia
  2. acute blood loss anemia
  3. chronic blood loss anemia
  4. vitamin B12 deficiency anemia

[isabelt_18]

Answer to Question 1

Correct Answer: 1
With bleeding disorders, any trauma carries the risk of extensive bleeding from platelet agglutination, due to removal of platelets by phagocytosis. Arterial puncture sites require holding 1520 minutes, and venous punctures require 35 minutes to make sure a clot has formed in the patient with a prolonged clotting time. An enema is an invasive procedure, and the risk of bleeding from trauma is increased. The patient should be provided with stool softeners to avoid straining during a bowel movement. Brisk tooth-brushing and alcohol-based mouthwash are too strong for this patient, can lead to bleeding of the gums, and are not recommended.

Answer to Question 2

Correct Answer: 3
Chronic blood loss depletes iron stores as red blood cell (RBC) production attempts to maintain the RBC supply. The resulting RBCs are microcytic (small) and hypochromic (pale). Iron deficiency anemia results in a fewer number of RBCs being produced. With vitamin B12 deficiency anemia, the RBCs that are produced are macrocytic (large) and misshapen (oval rather than concave). Acute blood loss anemia would result in a low level of RBCs in circulation.