What do you suspect is the cause of the thrombocytopenia?

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 of
breath for the last three months. Diagnostic work up confirmed a pulmonary
embolism. 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 2
of 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 80
mg subq daily. What labs should the APRN order to monitor this patient?

3. Renee is a 56-year-old female that fell about a
week ago and sprained her R ankle. She states she has been taking it easy
and 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 foot
and ankle were more swollen than they had been. She came to urgent care today
because 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 pounds
Heart S1S2 regular rate and rhythm,
Lungs clear, Abdomen soft
R ankle is swollen but not discolored. 1-2+ edema
noted Dorsiflexion causes some discomfort in the ankle and calf area.
Pedal pulses equal bilaterally
The APRN orders a duplex ultrasound of the right
leg. Radiology reports that the ultrasound is positive for a deep vein
thrombosis. How would you manage this patient (include labs and meds)?

4. A 25-year-old male is in the Surgical Intensive
Care Unit (SICU) following a motor vehicle crash (MVC) where he sustained
multiple 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 medications
and blood products, as well as total parenteral nutrition. Per hospital
protocol, he is receiving an unfractionated heparin 1:1000 flush after
administration of each of the triple antibiotics that have been ordered to
maintain patency of the lumens. Seven days post injury, the APRN in the SICU is
reviewing the patient’s morning labs and notes that his platelet count has
dropped precipitously to 50,000 /mm3 from 148,000/mm3 two days ago. Hemoglobin
and hematocrit are normal and there is no evidence of bleeding.

What do you suspect is the cause of the
thrombocytopenia? How would you treat it?

5. A 45-year-old male is evaluated for
complaints of severe low back and left leg pain. His MRI shows a herniated disk
at L4L5. He has been recommended for a lumbar laminectomy surgery to treat the
herniated disk. The patient had a cardiac stent placed 3 weeks ago and is
currently on Plavix post procedure. When will the patient be able to have the
lumbar surgery?

6. 54-year women is 3 days post abdominal
surgery for removal of a cancerous mass in her abdomen. She develops acute
shortness of breath associated with tachycardia and hypotension. CT Scan of the
chest is positive for multiple small pulmonary embolism. What medication and
dosing would you order initially to treat the pulmonary embolism?
7. A 26-year-old male was injured in a motorcycle crash 3
days ago. He sustained an acute subdural hematoma, acetabular fracture, and L2
fracture with spinal cord injury and resulting paralysis. He has a warm swollen
right lower leg. Duplex ultrasound of the right lower leg is positive. What is
the best treatment for this patient?

8. The APRN is prescribing treatment for a
44-year-old male with DVT. He is currently on enoxaparin 90 mg subq every 12
hours. Warfarin is going to be used for oral therapy. What does and duration
should be ordered for this patient?

9. A 44-year-old female with a mechanical mitral
heart valve is scheduled for elective abdominal surgery next week. The patient
currently takes warfarin 5 mg daily for prevention of thrombus. The patient is
high risk for blood clot formation and needs to be bridged once her warfarin is
stopped for surgery. How would you manage this patient’s anticoagulants during
the pre- and post-operative period?

10.
A 56-year-old
male is taking warfarin 3 mg daily for treatment of a DVT / PE. He has his INR
monitored every 4 weeks. His INR today is 3.1 and his last INR is 2.9. There
have been no changes in his medications or health.
What is his INR
goal? How would you manage his INR today?

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