After receiving report, which client should the nurse assess first?

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Thrombocytopenia is a serious complication of heparin products (eg, unfractionated heparin and low-molecular-weight heparin [eg, enoxaparin]). Regardless of its cause, thrombocytopenia usually results in bleeding complications. However, in heparin-induced thrombocytopenia (HIT) this usually leads to paradoxical venous and/or arterial thrombosis and less commonly to bleeding. The mechanism for thrombosis is unclear. The danger of HIT is risk of organ damage from local thrombi and/or embolization, leading to stroke and/or pulmonary embolism. HIT occurs over several days. The nurse should monitor platelet levels of clients on heparin and report a decrease of ≥50% from baseline or a drop below 150,000/mm³ (150 x 10⁹/L) to the health care provider. If the client has HIT, all heparin products must be stopped immediately, and a different anticoagulant (eg, argatroban) should be started to prevent thrombosis risk. (Option B) This client with mildly elevated blood urea nitrogen (normal 6-20 mg/dL [2.1-7.1 mmol/L]) needs IV fluids. This is not the priority. (Option C) The client with myelodysplastic syndrome does not produce adequate blood cells. Low white blood cell count, platelets, and hemoglobin are expected. Although this client is at risk for infection, HIT has a higher priority. (Option D) Decreased hemoglobin and hematocrit are expected in sickle cell disease due to chronic/acute hemolysis. A packed red blood cell transfusion may be needed, but this is not the priority. Educational objective: Drug-induced thrombocytopenia may result in bleeding; however, heparin-induced thrombocytopenia has an added risk of thrombosis. The nurse should monitor platelet levels of clients on heparin and report a decrease of ≥50% from baseline or a drop below 150,000/mm³ (150 x 10⁹/L) to the health care provider.

After Receiving Report, Which Client Should the Nurse Assess first?