Nursing Prioritization Delegation Assignment Q 26
You are making a home visit to a 50-year old patient who was recently hospitalized with a right leg deep vein thrombosis and a pulmonary embolism. The patient’s only medication is enoxaparin (Lovenox) subcutaneously. Which assessment information will you need to communicate to the physician?
A. The patient says that her right leg aches all night
B. The right calf is warm to the touch and is larger than the left calf
C. The patient is unable to remember her husband's first name
D. There are multiple ecchymotic areas on the patient's arms
Correct Answer: C. The patient is unable to remember her husband’s first name
Confusion in a patient this age is unusual and may be an indication of intracerebral bleeding associated with enoxaparin use. Because of the reduced effectiveness of the antidote (e.g., protamine), bleeding complications can be severe and life-threatening.
Option A: The right leg symptoms are consistent with a resolving deep vein thrombosis. Around half of people who have had a DVT will experience some degree of chronic discomfort and around 15% of people will experience moderate to severe chronic pain and swelling. This is called post-thrombotic syndrome (PTS) and is caused partly by damage or leftover scar tissue inside the vein.
Option B: The patient may need teaching about keeping the right leg elevated above the heart to reduce swelling and pain. The client may also wear graduated compression stockings. These specially fitted stockings are tight at the feet and become gradually loosened up on the leg, creating gentle pressure that keeps blood from pooling and clotting.
Option D: The presence of ecchymoses may point to a need to do more patient teaching about avoiding injury while taking anticoagulants but does not indicate that the physician needs to be called.