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Cardiovascular Case Study Examples

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Cardiovascular Case Study: Atrial Fibrillation and Oral Anticoagulation

Scenario
You are the nurse working in an anticoagulation clinic. K.N. is a patient who has a longstanding irregularly irregular heartbeat (atrial fi brillation, or A-fi b) for which he takes the oral anticoagulant warfarin (Coumadin). Recently, K.N. had his mitral heart valve replaced with a mechanical valve. You know that there are different PT/INR (prothrombin time/International Normalized Ratio) goal recommendations based on the indication for anticoagulation. (NOTE: PT has now been replaced by or is reported, in most cases, with INR [International Normalized Ratio], an international value that allows for laboratory standardization. PTT is more properly written …show more content…

Because you are at risk for bleeding, bruising, hemorrhaging. We need to give you vitamin K to reverse the effects of the Coumadin and it takes 12- 24 hr before the vitamin K starts to work. We need to know what your levels are once it kicks in.

6. K.N.’s INR the next day is 3.7. Although the INR is a little elevated, the provider made no further medication changes. K.N. is instructed to fi nish the remaining 2 days of antibiotics and return again in 7 days to have another PT/INR drawn. Why should the
INR be checked again so soon instead of the usual monthly follow-up?

Because the effects of vitamin K last for 1 week and the patient will not respond normally to Coumadin for the entire week. We need to know where his INR is after the vit. K wears off.

7. K.N. grumbles about all the lab tests but agrees to follow through. The next INR is 2.8.
What patient education needs to be stressed at this visit? Identify two education needs.

You need to explain to him the s/s of blood clotting (since he may have too low an INR d/t treatment and he needs to know this). Explain that his a-fib puts him at risk for blood clots.

Explain that he is also at risk for bleeding, so only use a soft tooth brush, electric razor, and tell the doctor if he has black, tarry stools.

8. Six months later, K.N. informs you that he is going to have a knee replacement next month. What should you do with this information?

Make sure you contact his knee surgeon to

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