A nurse is reviewing the medical record of a client who is to undergo open heart surgery. Which of the following findings should the nurse report to the provider as a contraindication to receiving heparin?

Thalassemia

Rheumatoid arthritis

Thrombocytopenia

COPD

Answer and Explanation

The Correct Answer is C

A. Thalassemia: A genetic blood disorder affecting hemoglobin production. While patients with severe anemia may have an increased bleeding risk, thalassemia itself is not a contraindication to heparin. Caution is needed if the patient has splenomegaly or significant anemia.

B. Rheumatoid arthritis: An autoimmune condition that can increase bleeding risk due to chronic inflammation and medication use, such as NSAIDs or corticosteroids. However, heparin is not contraindicated unless there is an associated bleeding disorder or severe thrombocytopenia.

C. Thrombocytopenia: A condition characterized by a low platelet count, significantly increasing the risk of bleeding. Heparin use can worsen this condition, especially in cases of heparin-induced thrombocytopenia (HIT), which can lead to both bleeding and thrombosis.

D. COPD: A chronic lung disease that does not directly contraindicate heparin therapy. While COPD patients may be at risk for deep vein thrombosis due to immobility, heparin remains a standard prophylactic treatment unless there are other bleeding risks.

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Correct Answer is D

Explanation

A. Place pillows under the client's knees: Placing pillows under the knees can lead to venous stasis, increasing the risk of deep vein thrombosis (DVT). Prolonged knee flexion can also reduce circulation and contribute to joint stiffness. Instead, the client should be encouraged to keep their legs extended and change positions frequently to promote blood flow.

B. Avoid use of anticoagulants: Anticoagulants are commonly prescribed after surgery to prevent thromboembolic complications such as DVT and pulmonary embolism. Avoiding them may increase the client's risk of clot formation, especially if they have limited mobility. The decision to withhold anticoagulation should be based on specific contraindications rather than routine avoidance.

C. Discourage leg exercises while in bed: Leg exercises help prevent blood pooling in the lower extremities, reducing the risk of DVT. Discouraging movement can lead to complications such as impaired circulation, muscle stiffness, and clot formation. Encouraging active and passive range-of-motion exercises supports recovery and decreases the likelihood of postoperative complications.

D. Apply compression stockings to the lower extremities: Compression stockings help improve venous return and reduce the risk of clot formation by preventing blood from pooling in the lower extremities. They are particularly beneficial for clients with limited mobility after surgery. Using them in combination with early ambulation and anticoagulation therapy further decreases the risk of thromboembolic events.

A. Metoprolol 5 mg every 2 to 3 min up to three doses B. Oxygen at 2 L/min via nasal cannula C. Draw electrolytes along with Hgb and Hct D. Morphine 6 mg IV bolus every 3 hr as needed for pain E. Nitroglycerin 0.4 mg SL now may repeat every 5 min up to 3 doses F. Obtain daily weight G. Atropine 0.5 mg IV bolus every 5 min up to 2 mg

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"B"},"G":{"answers":"C"}}

Explanation

Anticipated:

Metoprolol 5 mg every 2 to 3 min up to three doses
Oxygen at 2 L/min via nasal cannula
Draw electrolytes along with Hgb and Hct
Morphine 6 mg IV bolus every 3 hr as needed for pain
Nitroglycerin 0.4 mg SL now may repeat every 5 min up to 3 doses

Nonessential:

Obtain daily weight

Contraindicated:

Atropine 0.5 mg IV bolus every 5 min up to 2 mg

Rationale:

Metoprolol 5 mg every 2 to 3 min up to three doses: Beta-blockers reduce myocardial oxygen demand by decreasing heart rate and blood pressure, making them beneficial in acute coronary syndrome. They should be used cautiously in patients with signs of heart failure or bradycardia.
Oxygen at 2 L/min via nasal cannula: Supplemental oxygen is recommended for clients with acute coronary syndrome when oxygen saturation is below 94% to optimize myocardial oxygen supply and prevent ischemia.
Draw electrolytes along with Hgb and Hct: Electrolytes are critical in evaluating myocardial function, and hemoglobin/hematocrit levels help assess perfusion and oxygen-carrying capacity.
Morphine 6 mg IV bolus every 3 hr as needed for pain: Morphine is used to relieve severe chest pain in myocardial infarction and reduce myocardial oxygen demand by decreasing anxiety and preload.
Nitroglycerin 0.4 mg SL now may repeat every 5 min up to 3 doses: Nitroglycerin dilates coronary arteries, improving oxygen delivery to the myocardium, and reduces preload and afterload, alleviating chest pain. It is a first-line treatment for angina and myocardial infarction but should be avoided in cases of hypotension.
Obtain daily weight: Daily weight monitoring is primarily used for fluid balance assessment in conditions like heart failure rather than for acute myocardial infarction management.
Atropine 0.5 mg IV bolus every 5 min up to 2 mg: Atropine is used to treat bradycardia. However, the client is tachycardic, so atropine would worsen the condition and is contraindicated.

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A nurse is reviewing the medical record of a client who is to undergo open heart surgery. Which of the following findings should the nurse report to the provider as a contraindication to receiving heparin?

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Explanation

The nurse is reviewing the client's medical record. For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"B"},"G":{"answers":"C"}}

Explanation

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