A nurse is reviewing the medical record of a client who has been taking lithium. Which of the following findings should the nurse notify the provider of immediately?

Enoxaparin is a low-molecular-weight heparin(LMWH) that exerts anticoagulant effects by accelerating the activity of antithrombin III, primarily inhibiting factor Xa. It is used for the prophylaxis and treatment of deep vein thrombosisand pulmonary embolism. Unlike unfractionated heparin, it has a more predictable pharmacological profile and typically does not require routine laboratory monitoring of clotting times.

Rationale:

A.Diarrhea is not a common or expected side effect of enoxaparin therapy, as the drug does not significantly affect the gastrointestinal microbiome. The most concerning side effects are related to bleeding or heparin-induced thrombocytopenia. If a patient experiences diarrhea, the nurse should investigate other causes such as dietary changes, infections, or different medications.

B.Monitoring the skin for bruising is a vital safety instruction because enoxaparin increases the risk of bleeding and hemorrhage. Bruising or ecchymosis can indicate that the medication is excessively thinning the blood or that the patient has experienced minor trauma. Early detection of bleeding allows for prompt medical intervention to adjust the dosage or manage complications.

C.Enoxaparin must be injected into the subcutaneous tissue, typically in the abdomen, and should never be injected into a muscle. Intramuscular injection of anticoagulants can cause the formation of painful and dangerous hematomas due to the high vascularity of muscle tissue. The nurse must ensure the client understands the correct technique for deep subcutaneous administration.

D.Weekly INR checks are required for patients taking warfarin, but they are not necessary for those on enoxaparin. Enoxaparin provides a very stable and predictable anticoagulant response that does not require the frequent dose adjustments associated with Vitamin K antagonists. This lack of required blood work is one of the primary benefits of LMWH therapy.

Desmopressin is a synthetic analogue of antidiuretic hormone(ADH) that increases water reabsorption in the collecting ductsof the kidney. It is the primary treatment for central diabetes insipidus, effectively concentrating urine and reducing excessive thirst and polyuria. Monitoring for water intoxication is the priority nursing intervention.

Rationale:

A.Bradycardia is not a direct adverse effect associated with desmopressin administration. While significant fluid overload could theoretically stress the cardiovascular system, a slow heart rate is not the specific parameter used to monitor for desmopressin toxicity. The nurse should focus instead on signs of volume expansion and electrolyte shifts, particularly those affecting the neurological system and sodium balance.

B.Fluid retention is a primary adverse effect of desmopressin because the drug effectively stops the kidneys from excreting water. If the client continues to drink large amounts of fluid while taking the drug, they are at risk for water intoxication and dilutional hyponatremia. The nurse must monitor for headache, confusion, and edema, which indicate that the body is retaining too much free water.

C.Blurred vision is not a common or direct side effect of desmopressin therapy. Visual changes are more often linked to medications that affect the autonomic nervous system or those with anticholinergic properties. However, if blurred vision occurs in the context of a severe headache while on desmopressin, it could be a sign of increased intracranial pressure from severe water intoxication.

D.Hypernatremia is the condition desmopressin is meant to treat in a patient with diabetes insipidus, not an adverse effect of the drug. Desmopressin causes water retention, which dilutes the blood and lowers the sodium concentration. Therefore, the nurse should monitor for the opposite effect, hyponatremia, which occurs if the medication works too effectively or if fluid intake is excessive.