A nurse is teaching a client who has migraine headaches how to use biofeedback to reduce the need for pharmacological interventions. Which of the fallowing information should the nurse include in the teaching?

Rationale for correct choices

• heparin 30 units/kg IV bolus once: The diagnostic ultrasound confirms a thrombus in the right leg, indicating acute DVT. Anticoagulation with heparin is the first-line intervention to prevent clot extension and pulmonary embolism. The lab values (normal platelets, normal INR) show no contraindication to starting anticoagulation.

• acetaminophen 650 mg PO every 4 hr PRN: Acetaminophen is appropriate for managing the client’s pain (rated 6/10) without increasing bleeding risk. NSAIDs such as ibuprofen are avoided in DVT because they can impair platelet function and increase bleeding risk once anticoagulation is initiated.

Rationale for incorrect choices

• initiating fluid restriction: Fluid restriction is typically used in conditions like heart failure or hyponatremia, not DVT. Adequate hydration is beneficial in DVT because it helps maintain blood viscosity and supports circulation without affecting clot stability.

• maintaining the extremity below the level of the heart: Lowering the extremity increases venous pressure and can worsen swelling. For DVT, the extremity is usually elevated to promote venous return and reduce edema, so this option does not align with recommended care.

• administering cold packs to the extremity: Cold therapy can cause vasoconstriction and slow venous blood flow, which may worsen thrombosis. Warm compresses improve circulation but are used cautiously and only with provider guidance.

Rationale:

A. Magnesium sulfate: Magnesium sulfate does not have significant interactions with warfarin and is not contraindicated. It can be safely administered with appropriate monitoring, making it safe in this context.

B. Ibuprofen: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can increase the risk of bleeding when taken with warfarin. It inhibits platelet function and can potentiate anticoagulation, making it contraindicated.

C. Cetirizine: Cetirizine is an antihistamine that does not significantly affect coagulation or interact with warfarin. It can be safely used with warfarin under normal circumstances.

D. Gingko biloba: Gingko biloba can increase the risk of bleeding by inhibiting platelet aggregation. Clients on warfarin should avoid herbal supplements like gingko that can potentiate anticoagulation effects.

E. Aspirin: Aspirin has antiplatelet effects and can significantly increase the risk of bleeding when combined with warfarin. Concurrent use is generally contraindicated unless specifically approved and closely monitored by the provider.