NRNP 6566 Week 5 Knowledge Check

NRNP 6566 Week 5 Knowledge Check QUESTION 1 1. A 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? This patient should be given fondaparinuc (Arixtra) subcutaneously. Dosing is weight- based: 1. 5 mg SQ once daily (for weight less than 50 kg 2. 7.5 mg SQ once daily (for weight ranges from 50-100 kg) 3. 10 mg SQ once daily (for weight exceeding 100 kg). QUESTION 2 1. A 64-year man is recovering from a transurethral resection of the prostate for treatment of benign prostate hyperplasia. The patient is receiving intravenous antibiotics for the urinary tract infection. The post-operative course has been smooth and the APRN is removing the 3-way Foley catheter when there is a sudden release of bright red blood with many blood clots in the Foley bag. The patient becomes hypotensive, tachycardic and the APRN notes new ecchymoses on the patient’s arms and legs. The patient was immediately transferred to the surgical intensive care unit (SICU) and a stat hematology consult was conducted. Stat CBC, d-dimer, peripheral blood smear, partial thromboplastin time, Prothrombin time/international normalization ratio (INR), and fibrinogen labs were drawn. Results were: CBC with markedly decreased platelet count, peripheral blood smear showed decreased number of platelets and presence of large platelets and fragmented red cells (schistocytes), prothrombin time prolonged as was the partial thromboplastin time. The d-dimer was markedly elevated, and fibrinogen level was low. Based on the clinical presentation and laboratory data provided, what is your working diagnosis? The working diagnosis for this patient is disseminated intravascular coagulation (DIC). It is an acquired coagulation disorder that is most commonly caused by infections (gram negative sepsis), malignant neoplasm, obstetric complication, liver disease, trauma, and burns. This patient is positive for urinary tract infection. Thrombocytopenia (decreased platelets), prolonged PT and aPTT, low fibrinogen levels, positive D-dimer, and schistocytes are all indicative of an acute uncompensated DIC (active hemorrhagic event). QUESTION 3 1. 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?