This assignment requires short-sentence answers to 10 questions involving the care of patients with venous thromboembolism and clotting disorders, which are listed below or see attached file. Also, the questions do not have to be included in the paper on the number of the question 1-10 to its answer, you do not have to use all 3 pages only provided just in case needed.
Knowledge Check Questions
1. A 66-year-old man was evaluated for shortness ofbreath for the last three months. Diagnostic work up confirmed a pulmonaryembolism. He is alert and oriented. Vital signs are stable. He is ambulatory.He has a stable home environment and good support from his wife. He is on day 2of treatment with Lovenox 90 mg every 12 hours. The patient wants to go home.Would you discharge him? How would you manage his medications?
2. A 26-year-old female is currently on Lovenox 80mg subq daily. What labs should the APRN order to monitor this patient?
3. Renee is a 56-year-old female that fell about aweek ago and sprained her R ankle. She states she has been taking it easyand laying around her home for most of the last week so it would heal.Yesterday she noticed that her calf was sorer than it had been, and her R footand ankle were more swollen than they had been. She came to urgent care todaybecause she was afraid that the injury was worse than she thought it was.T 99.2 BP 128/77 HR 88 RR 18 Wt 126 poundsHeart S1S2 regular rate and rhythm,Lungs clear, Abdomen softR ankle is swollen but not discolored. 1-2+ edemanoted Dorsiflexion causes some discomfort in the ankle and calf area.Pedal pulses equal bilaterallyThe APRN orders a duplex ultrasound of the rightleg. Radiology reports that the ultrasound is positive for a deep veinthrombosis. How would you manage this patient (include labs and meds)?
4. A 25-year-old male is in the Surgical IntensiveCare Unit (SICU) following a motor vehicle crash (MVC) where he sustainedmultiple life-threatening injuries including a ruptured spleen, chest trauma,and bilateral femur fractures. He has a triple lumen central venous catheter(CVC) for monitoring his central venous pressure, administration of medicationsand blood products, as well as total parenteral nutrition. Per hospitalprotocol, he is receiving an unfractionated heparin 1:1000 flush afteradministration of each of the triple antibiotics that have been ordered tomaintain patency of the lumens. Seven days post injury, the APRN in the SICU isreviewing the patient’s morning labs and notes that his platelet count hasdropped precipitously to 50,000 /mm3 from 148,000/mm3 two days ago. Hemoglobinand hematocrit are normal and there is no evidence of bleeding.
What do you suspect is the cause of thethrombocytopenia? How would you treat it?
5. A 45-year-old male is evaluated forcomplaints of severe low back and left leg pain. His MRI shows a herniated diskat L4L5. He has been recommended for a lumbar laminectomy surgery to treat theherniated disk. The patient had a cardiac stent placed 3 weeks ago and iscurrently on Plavix post procedure. When will the patient be able to have thelumbar surgery?
6. 54-year women is 3 days post abdominalsurgery for removal of a cancerous mass in her abdomen. She develops acuteshortness of breath associated with tachycardia and hypotension. CT Scan of thechest is positive for multiple small pulmonary embolism. What medication anddosing would you order initially to treat the pulmonary embolism?7. A 26-year-old male was injured in a motorcycle crash 3days ago. He sustained an acute subdural hematoma, acetabular fracture, and L2fracture with spinal cord injury and resulting paralysis. He has a warm swollenright lower leg. Duplex ultrasound of the right lower leg is positive. What isthe best treatment for this patient?
8. The APRN is prescribing treatment for a44-year-old male with DVT. He is currently on enoxaparin 90 mg subq every 12hours. Warfarin is going to be used for oral therapy. What does and durationshould be ordered for this patient?
9. A 44-year-old female with a mechanical mitralheart valve is scheduled for elective abdominal surgery next week. The patientcurrently takes warfarin 5 mg daily for prevention of thrombus. The patient ishigh risk for blood clot formation and needs to be bridged once her warfarin isstopped for surgery. How would you manage this patient’s anticoagulants duringthe pre- and post-operative period?
10.A 56-year-oldmale is taking warfarin 3 mg daily for treatment of a DVT / PE. He has his INRmonitored every 4 weeks. His INR today is 3.1 and his last INR is 2.9. Therehave been no changes in his medications or health.What is his INRgoal? How would you manage his INR today?
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