A 71-year-old male client with moderate to late-stage Parkinson disease is admitted from home to the hospital with new-onset orthostatic hypotension and occasional dysphagia. According to his wife, he needs assistance with ADLs only on days when his rigidity is worse, and walks short distances in the house using a walker. Which of the following actions would the nurse take? Select all that apply.

Choice A reason: Asking the HCP to change the medication from heparin to enoxaparin (Lovenox) would not be the most appropriate action for a patient diagnosed with heparin-induced thrombocytopenia (HIT). Enoxaparin, like heparin, is a low molecular weight heparin and can still cause HIT. Therefore, this action does not address the immediate need to stop the heparin infusion to prevent further reduction in platelet levels and manage the HIT effectively.
Choice B reason: Discontinuing the heparin infusion is the correct action for a nurse to take first when a patient is diagnosed with heparin-induced thrombocytopenia (HIT). The primary step in managing HIT is to stop all forms of heparin to prevent further platelet activation and decrease in platelet count. Discontinuing heparin helps to prevent thromboembolic complications associated with HIT. Once heparin is discontinued, the healthcare provider can evaluate alternative anticoagulation therapies that do not cross-react with heparin, such as direct thrombin inhibitors.
Choice C reason: Administering prescribed warfarin (Coumadin) is not appropriate at this stage for a patient diagnosed with heparin-induced thrombocytopenia (HIT). Warfarin can initially lead to a hypercoagulable state, which increases the risk of thrombosis in patients with HIT. The immediate priority is to discontinue heparin, and warfarin should only be considered once platelet counts have recovered and the acute HIT has been managed.
Choice D reason: Preparing for platelet transfusion is not the first action to take for managing heparin-induced thrombocytopenia (HIT). Platelet transfusions are generally avoided in HIT as they can potentially worsen the thrombotic risk. The primary action should be to discontinue heparin and consider alternative anticoagulation therapies. Platelet transfusions may be reserved for cases where there is significant bleeding or invasive procedures are planned.

Choice A reason: Observing for signs of hypotension is not typically a primary concern for patients with Cushing syndrome. These patients are more likely to experience hypertension due to increased cortisol levels, which cause sodium and water retention, rather than hypotension. Therefore, while monitoring blood pressure is important, focusing specifically on hypotension is not relevant to the typical presentation of Cushing syndrome.
Choice B reason: Monitoring blood glucose levels is a crucial intervention for patients with Cushing syndrome. Increased cortisol levels lead to hyperglycemia and glucose intolerance. Patients may develop diabetes mellitus as a result of chronic hypercortisolism. Regular monitoring of blood glucose levels helps in managing and controlling hyperglycemia and adjusting medication as necessary to maintain stable glucose levels.
Choice C reason: Protecting the patient from exposure to infection is essential in caring for patients with Cushing syndrome. Elevated cortisol levels suppress the immune system, making patients more susceptible to infections. Implementing infection control measures, such as hand hygiene, using personal protective equipment, and monitoring for signs of infection, are vital to prevent complications and ensure patient safety.
Choice D reason: Restricting protein intake is not a recommended intervention for patients with Cushing syndrome. In fact, these patients often require a diet high in protein to counteract the muscle wasting and weakness caused by excessive cortisol levels. Adequate protein intake helps in maintaining muscle mass and overall health, making restriction counterproductive.