Enoxaparin (Lovenox) Nursing Implications Question

Enoxaparin (Lovenox) Nursing Implications Question

Before administering medications to a client hospitalized 3 days ago for acute asthma, the nurse compares the morning laboratory results with the admission data.  The nurse should confirm which prescription with the health care provider prior to administration?

1. Albuterol nebulization every 4 hours
2. Enoxaparin 40 mg subcutaneously every 24 hours
3. Methylprednisolone 20 mg intravenously every 6 hours
4. Potassium chloride 20 mEq/L every 24 hours

Enoxaparin (Lovenox) Nursing Implications Answer and explanation

The corect answer is 2- Enoxaparin 40 mg subcutaneously every 24 hours

Explanation:

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Enoxaparin (Lovenox) is a low-molecular-weight heparin anticoagulant administered for prophylaxis of deep venous thrombosis in hospitalized clients.  Bleeding and thrombocytopenia (platelet count <150,000/mm³ [150 x 10⁹/L]) are possible complications of anticoagulant therapy.  Heparin-induced thrombocytopenia (HIT) is a serious condition that often develops rapidly, requiring prompt recognition and treatment.  Unlike other drug-induced forms of thrombocytopenia, HIT can result in arterial or venous thrombosis(eg, stroke, extremity infarction), although the exact association is unknown.  This client’s platelet count (96,000/mm³ [96 x 10⁹/L]) has dramatically decreased since admission.  The nurse should note this drastic change and question the continuation of the prescription with the health care provider before administering the medication.

(Option 1)  Bronchodilators such as albuterol and ipratropium are indicated in acute asthma and chronic obstructive pulmonary disease exacerbations.

(Option 3)  Methylprednisolone (Solu-Medrol) is an anti-inflammatory corticosteroid drug indicated for treatment of lung inflammation associated with asthma; the route, dosage, and frequency are correct.  This client’s elevated white blood cell count is likely due to glucocorticoid administration and is an expected effect of corticosteroids.

(Option 4)  Potassium chloride is an electrolyte replacement drug and is indicated by the presence of hypokalemia (<3.5 mEq/L [3.5 mmol/L]); the route, dosage, and frequency are correct.  Frequent use of albuterol likely caused hypokalemia in this client.

Enoxaparin (Lovenox) Nursing Implications Educational objective:
Heparin-induced thrombocytopenia can result in arterial or venous thrombosis.  Platelet counts should be carefully monitored in any client receiving anticoagulant therapy.

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