Question

A 38 yo male with a right fractured femur, and knee, post op day 1. Orders are enoxaparin (Lovenox) 30 mg subcutaneous (SQ or Sub Cut) q 12 hours x 10 days. There are other orders but for now we will focus on this one.

1. What lab needs to be checked everyday prior to administration of this drug? Why?

2. Explain site rotation, and technique for administration of this drug.

He is 2 or 3 days to discharge to home:

3. This patient will not be in the hospital for 10 days, (unheard of anymore) so how are you the RN going to instruct him to give his own injection? (Thank goodness his arms aren't broken)

4. He rebels, and says to you "No way I'm going to stick myself with a needle." What are you going to do? 5. You have solved the problem of injections, but now there is another problem, he wants to just take an aspirin as prevention for his clotting issue. What will you say to him?

Answer 1

1)Lab test like PT (prothrombin time), which helps to detect bleeding and clotting disorders.

PT INR (international normalised ratio) is calculated from PT value and to monitor how well the blood thinner medicine act before the surgery

Post surgery C

CBC : to rule out the blood loss and any infections

Serum Electrolytes: because electrolyte imbalance occurs post surgery, usually hyponatremia

2)Site rotation for giving subcutaneous injection is important to prevent lipodystrophy,lipohypertophy, lipoatorpsy

The best place to administer this injection is both upper arm, both thighs and abdomen .The absorption range differs from one site to another, hence the rotational method to be followed.

Techniques to administer: hold the syringe upward and tap it to remove air bubbles, plunger could be pushed in to remove excess air if present.Pinch the skin and administer it at 90 degree angle as the medicine is preloaded

3)The RN could explain the technique to him for administering by self ,site rotation

4) Being a nurse explain the necessity of injections which prevents patients from major complications.To hire a nurse only for injection as he could hardly Walk

5)The action of injections lasts for 24 hours,oral medication acts nearly for 5 days. So after stopping the injection the patient has to be on blood thinner for few days until good mobilisation is done to prevent clotting.The complications should be explained eg., cardiac arrest due to clot, pulmonary embolism