DVT - DVT case study with answers and explanations PDF

Preview

Summary

DVT case study with answers and explanations...

Description

Case Study – DVT Larry Melaney, age 65 years came into the clinic complaining of left calf pain and difficulty walking following a long ride in a vehicle. The nurse practitioner notes that the leg is red and swollen, warm to touch and it measures 40 cm on the left calf (34 on the right). Deep vein thrombosis is confirmed by doppler. Larry was started on IV heparin to prevent the clot from getting any bigger. 1. Which of the following parameters should you monitor for in regard to determining if a therapeutic dose is being administered? a. INR, 2 to 3 times the patient’s baseline b. PTT, 2 to 3 times the patient’s baseline c. Platelet count of 100,000 mm3 d. PT 11-12.5 sec 2. All of the following are true about heparin therapy except: (select all that are incorrect) a. it has a rapid onset to prevent DVT and PE. b. it doesn’t cross the placenta so it can be used in pregnancy. c. it can cause minor bleeding but no major bleeding. d. it can cause heparin-induced neutropenia. 3. Which of the following drugs should you have ready in case of heparin overdose? a. aminocaproic acid (Amicar) b. deferoxamine (Desferal) c. vitamin K d. protamine sulfate 4. While the patient is still receiving continuous IV heparin, the provider prescribes oral warfarin (Coumadin). This is because a. warfarin takes 3 to 5 days to achieve therapeutic effects. b. IV heparin alone becomes ineffective after the first 1 to 2 days. c. abrupt cessation of heparin therapy increases the risk for thrombocytopenia d. warfarin reduces the risk for hemorrhage 5. The provider discharges the patient to home with a prescription for warfarin (Coumadin). You should advise the patient to do which of the following? (Select all that apply) a. Avoid taking NSAIDS b. Use a disposable razor c. Brush his teeth with a soft toothbrush d. Increase intake of dark green, leafy vegetables. e. Check bowel movements for signs of bleeding. f. Ask the provider before taking over-the-counter drugs.

6. Several months later, Mr. Melaney’s doctor decides that Larry should be changed from warfarin to apixaban. Which of the following is NOT an advantage for Mr. Melaney in switching to the new drug? a. no coagulation labs (INR) need to be monitored due to a predictable dose being prescribed. b. Vitamin K is no longer a concern with daily dietary intake. c. studies have shown that there is less major bleeding and fewer drug interactions. d. the antidote for apixaban is protamine sulfate.

7. Match the drug in the left column to the action in the right column. ____C__1. Clopidogrel (Plavix) a. injectable med that dissolves blood clots _____A____2. Alteplase (Activase) b. injection given to prevent/treat DVT or pulmonary embolus __B___3. Enoxaparin (Lovenox) c. oral med inhibits platelet aggregation...