A nurse is preparing to administer enoxaparin sodium (Lovenox) subcutaneously to a client.
Which of the following is an appropriate action by the nurse?

Choice A rationale

An SpO2 of 97.

Choice B rationale

Low molecular weight heparin (LMWH), such as enoxaparin, primarily exerts its anticoagulant effect by inhibiting Factor Xa, and its effect is generally not monitored by the PTT (partial thromboplastin time). The PTT, which measures intrinsic and common pathway factors, is used to monitor unfractionated heparin. A value of 55 seconds is only slightly elevated from the normal range of 25 to 35 seconds but is not the standard monitoring parameter for LMWH.

Choice C rationale

A hematocrit of 45% falls within the normal range for an adult male (approximately 40% to 54%) and is a reassuring finding. Hematocrit is the percentage of red blood cells in the blood, and this normal value suggests the client does not have acute blood loss or significant anemia, which is a complication of anticoagulant therapy.

Choice D rationale

A decreased platelet count of 74,000/mm is a finding that must be reported immediately, as it indicates significant thrombocytopenia (normal range 150,000 to 450,000/mm). This could be due to Heparin-Induced Thrombocytopenia (HIT), a severe, immune-mediated adverse reaction to heparin (including LMWH) that paradoxically causes a high risk of life-threatening thrombosis and bleeding, necessitating immediate discontinuation.

Choice A rationale

While optimal nutrition and hydration are essential for bone matrix formation and overall cellular metabolism to support the healing process, involving components like calcium and Vitamin D, this physiological support is secondary to the immediate mechanical stability required for functional healing. Nutrition and hydration primarily provide the building blocks and medium.

Choice B rationale

Maintaining immobilization and alignment is the highest priority because bone healing fundamentally relies on minimizing movement at the fracture site to prevent displacement and shearing forces. Immobilization facilitates the stable formation of the fracture hematoma, which then differentiates into soft and hard callus, leading to bony union and functional restoration.

Choice C rationale

Pain relief, although crucial for patient comfort and compliance with the care plan, does not directly influence the physiological mechanism of bone union. Pain management focuses on symptom control by interrupting nociceptive signaling, which is supportive but not the primary driver for achieving a stable, healed fracture.

Choice D rationale

Promoting independence in activities of daily living is an important goal for rehabilitation and psychological well-being but is a long-term outcome dependent upon successful functional healing. Premature or excessive activity can disrupt the callus formation, hindering the primary biological repair process.