A patient is being discharged to his home on enoxaparin (Lovenox) ...

[mia]

A patient is being discharged to his home on enoxaparin (Lovenox) injections for treatment of deep vein thrombosis (DVT). Which of the following statements made by the patient indicates a need for further discharge teaching by the nurse?
 
  a. I will inject the enoxaparin into the fatty tissue of my abdomen.
  b. I hate needles, but I know enoxaparin doesn't come in pill form.
  c. I will need to go to my doctor's office each day to have my blood drawn to see whether enoxaparin is working.
  d. I will call my physician immediately if I experience any uncontrollable bleeding while on enoxaparin.

Question 2

A patient applies a transdermal nitroglycerin patch at 0900. What additional instruction should be provided by the nurse regarding the patch?
 
  a. Leave the patch in place until the following morning, when a new patch will be applied.
  b. Apply an additional patch if breakthrough anginal pain occurs.
  c. Remove the patch at 9 PM.
  d. Note the location of the patch, so that it can be reapplied in the same location to enhance absorption.

[14vl19]

Answer to Question 1

ANS: C
The half-life of a low-molecular-weight (LMW) heparin, such as enoxaparin, is up to six times longer than that of unfractionated heparin. Less binding to macrophages and slower clearance by the liver are also factors. Because of enoxaparin's increased bioavailability, the plasma levels of the drug are highly predictable. As a result, it can be given on a fixed schedule with no need for routine monitoring of coagulation.
Enoxaparin is administered subcutaneously (into fatty tissue), and the abdomen is a correct injection site.
LMW heparins, such as enoxaparin, are available only for subcutaneous injection.
Bleeding is the major adverse effect and should be reported if it does not cease.

Answer to Question 2

ANS: C
A daily patch free interval of 10 to 12 hours is recommended. This can be accomplished by applying a new patch each morning, leaving it in place for 12 to14 hours, and then removing it in the evening.
A daily patch free interval of 10 to 12 hours is recommended. This can be accomplished by applying a new patch each morning, leaving it in place for 12 to14 hours, and then removing it in the evening.
An additional patch is never indicated, because hypotension may occur.
Patches should be rotated to different areas to prevent irritation and skin breakdown.

[mia]

TYSM

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