A nurse is providing discharge teaching to a client who has a new prescription for enoxaparin. Which of the following instructions should the nurse include?

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 thrombosis and 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.