A nurse is reviewing the laboratory results of a client who received a dose of sodium polystyrene sulfonate. Which of the following labs should the nurse monitor to evaluate if the medication has been effective?

A medication error is an adverse eventthat necessitates immediate clinical and administrative action to ensure patient safety. The primary goal following an error is to assess the client for physiological instabilityand implement corrective treatments. Transparent communicationwith the healthcare team is essential for mitigating harm and documenting the event for future quality improvement initiatives.

Rationale:

A.The nursing supervisor should be notified as part of the facility's internal administrative process, but this is not the most immediate priority. While the supervisor oversees the unit's safety protocols, they cannot provide the medical orders necessary to treat a potential adverse reaction. Administrative notification should follow the clinical notification of the primary healthcare provider to ensure the patient's immediate health.

B.Agency administration is typically notified through the formal filing of an incident report once the patient is stable and immediate care has been coordinated. The administration uses this data for risk management and system-wide improvements rather than direct clinical intervention. Therefore, reporting to this department first would inappropriately delay the necessary medical assessment of the affected client.

C.The client's provider must be notified first so they can evaluate the clinical impact of the error and prescribe any necessary antidotes or monitoring. Immediate medical assessment is the highest priority to ensure the patient does not suffer from toxic effects or therapeutic failure. The provider is responsible for determining the next steps in the client's medical management plan.

Enoxaparin is a low-molecular-weight heparin(LMWH) that exerts anticoagulant effects by accelerating the activity of antithrombin III, primarily inhibiting factor Xa. It is used for the prophylaxis and treatment of deep vein thrombosisand pulmonary embolism. Unlike unfractionated heparin, it has a more predictable pharmacological profile and typically does not require routine laboratory monitoring of clotting times.

Rationale:

A.Diarrhea is not a common or expected side effect of enoxaparin therapy, as the drug does not significantly affect the gastrointestinal microbiome. The most concerning side effects are related to bleeding or heparin-induced thrombocytopenia. If a patient experiences diarrhea, the nurse should investigate other causes such as dietary changes, infections, or different medications.

B.Monitoring the skin for bruising is a vital safety instruction because enoxaparin increases the risk of bleeding and hemorrhage. Bruising or ecchymosis can indicate that the medication is excessively thinning the blood or that the patient has experienced minor trauma. Early detection of bleeding allows for prompt medical intervention to adjust the dosage or manage complications.

C.Enoxaparin must be injected into the subcutaneous tissue, typically in the abdomen, and should never be injected into a muscle. Intramuscular injection of anticoagulants can cause the formation of painful and dangerous hematomas due to the high vascularity of muscle tissue. The nurse must ensure the client understands the correct technique for deep subcutaneous administration.

D.Weekly INR checks are required for patients taking warfarin, but they are not necessary for those on enoxaparin. Enoxaparin provides a very stable and predictable anticoagulant response that does not require the frequent dose adjustments associated with Vitamin K antagonists. This lack of required blood work is one of the primary benefits of LMWH therapy.