The emergency department nurse prepares a male client for surgery. The client was admitted with a traumatic open fracture of the femur, hematocrit of 36% (0.36), and hemoglobin of 12 g/dL (120 g/L). Which prescription should the nurse validate with the health care provider before administration?

Question

The emergency department nurse prepares a male client for surgery.  The client was admitted with a traumatic open fracture of the femur, hematocrit of 36% (0.36), and hemoglobin of 12 g/dL (120 g/L).  Which prescription should the nurse validate with the health care provider before administration?

Quizplus · Accepted Answer

The Joint Commission Surgical Improvement Project CORE measure set has shown that preventives (eg, heparin, enoxaparin, aspirin) in select surgical procedures, given 24 hours before and after surgery, reduce the risk of venous thromboembolism.  However, the estimated blood loss in a client with a fracture can be significant depending on the site (eg, 250-1200 mL).  Although this client's admission hematocrit (36% [0.36]) and hemoglobin (12 g/dL [120 g/L]) are only slightly low for an adult male (normal: 39%-50% [0.39-0.50], 13.2-17.3 g/dL [132-173 g/L]), the blood loss may not yet be evident.  Therefore, the nurse would validate the prescription for enoxaparin (Lovenox) with the health care provider before administration.
Medications commonly prescribed for a client with an open fracture include:
Cefazolin (Ancef), a bone-penetrating cephalosporin antibiotic that is active against skin flora (Staphylococcus aureus); it is given prophylactically before and after surgery to prevent infection (Option A)
Cyclobenzaprine (Flexeril), a central and peripheral muscle relaxant given to treat pain associated with muscle spasm; carisoprodol (Soma) or methocarbamol (Robaxin) can also be prescribed
Tetanus and diphtheria toxoid, an immunization given prophylactically to prevent infection (Clostridium tetani) if immunizations are not up to date (>10 years), unavailable, or unknown (Option D)
Ketorolac (Toradol), a nonsteroidal anti-inflammatory drug given to decrease inflammation and pain
Opioids (eg, morphine, hydrocodone [Vicodin]), given for analgesia (Option C)
Educational objective:
Medications commonly prescribed for a client with an open fracture to prevent infection and treat pain and muscle spasm include cefazolin (Ancef), tetanus toxoid, ketorolac (Toradol), opioids, and cyclobenzaprine (Flexeril)

The Emergency Department Nurse Prepares a Male Client for Surgery