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limits the risk of calculus formation

Pharmacologic Highlights

Medication or

Drug Class Dosage Description Rationale

Warfarin sodium Maintenance: 2-10 mg Anticoagulant Assists in preventing clot formation (Coumadin) daily PO

Other Drugs: For symptom management—Increased serum uric acid levels can be treated with allopurinol or cyproheptadine, and pruritus can be managed with antihistamines or phenothiazines.

Independent

The patient's activity level is a primary concern. Allow for periods of rest because the patient may have both hypoxemia and a low hemoglobin count. At the same time, the patient needs to maintain mobility to prevent thrombosis because of increased blood viscosity. If rest and activity are balanced, the patient has the energy to be active for part of the day to limit complications. If the patient is bedridden, a program of active and passive range-of-motion exercises is essential. If the patient's appetite is dulled, encourage small, frequent feedings followed by a rest period to decrease nausea and vomiting. Fluid intake should be at least 3000 mL/day to decrease blood viscosity and limit uric acid calculus formation; work with the patient to determine the best method to prevent fluid volume deficit.

Monitor the patient carefully for signs of bleeding tendencies. Common bleeding sites include the nose, gingiva, and skin. Teach the patient to monitor these sites carefully after hospital discharge and to report any increased bleeding immediately. If the patient experiences minor trauma, teach him or her to apply pressure to the puncture site. In addition, encourage the patient to avoid razors or handling sharp objects. Make sure that the patient's environment is safe to limit the risk of falls or injury. If the patient develops pruritus, discourage scratching of the skin, use skin emollients, and work with the patient to determine a medication schedule that limits discomfort.

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