Author Question: The nurse is providing care for a patient who developed heparin-induced thrombocytopenia (HIT) ... (Read 64 times)

Bernana · **on:** Jul 23, 2018

The nurse is providing care for a patient who developed heparin-induced thrombocytopenia (HIT) during heparin therapy. The nurse is aware that lepirudin (Refludan) is often given to patients with this condition.

Which assessment findings should the nurse report to the medical team?
1. The most recent aPTT is 2.8.
2. The patient's last stool tested positive for blood.
3. The patient is allergic to eggs.
4. The patient's spleen was removed after a motor vehicle accident 3 years ago.
5. The patient drinks 5?6 cups of coffee daily.

Question 2

The nurse is planning care for a patient receiving enoxaparin (Lovenox). Which interventions should be included?

1. Teach the patient or family to give subcutaneous injections at home.
2. Monitor for development of deep vein thrombosis.
3. Monitor multiple lab tests.
4. Teach the patient signs of excessive bleeding.
5. Schedule administration times right before breakfast and the evening meal.

bhavsar · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

Correct Answer: 1,2
Rationale 1: Lepirudin is contraindicated if the aPTT is above 2.5.
Rationale 2: Lepirudin is contraindicated in patients who are actively bleeding.
Rationale 3: There is no contraindication to the use of lepirudin in patients with egg allergy.
Rationale 4: A surgery 3 years ago is not a contraindication to the use of lepirudin, nor is absence of the spleen.
Rationale 5: There is no contraindication to the use of lepirudin in those who drink coffee.

Answer to Question 2

Correct Answer: 1,2,4
Rationale 1: Family and patients can be taught to give subcutaneous injections at home.
Rationale 2: Lovenox is used to prevent DVTs. The nurse should observe for the development of DVTs.
Rationale 3: Lovenox is a low-molecular-weight heparin (LMWH), and does not require multiple lab tests.
Rationale 4: Although Lovenox is more predictable than are other anticoagulants and has fewer adverse effects, bleeding is still a possibility.
Rationale 5: Lovenox is generally administered once daily, and administration time is not tied to mealtimes.