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 (NOTE: PT has now been replaced by or is reported, in most cases, with INR [International Normalized Ratio], an international value that allows for laboratory standardization.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
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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
The serum creatine levels, the BUN, the urinary potassium, the serum pH and sodium clacium are high.
Uncle Jake and Aunt Leah were playing golf last week. On the sixth hole, Jake told Leah that he was having unusual pain in his left arm and chest. All of a sudden he felt weak and complained that his shirt was much too tight. A dentist playing one hole behind them examined Jake and found he was short of breath, pale, and sweating. He called 911 on his cell phone and told Jake to lie down and wait for the ambulance. The paramedics rushed Jake to the hospital where he was evaluated by a cardiologist. The tests showed that he had four clogged arteries. He was scheduled for surgery the next day.
For instance, with early assessment, a patient with cellulitis may get oral anti-infection agents that could dodge hospitalization for intravenous anti-microbials. Additionally, a patient with ceaseless heart
Sometimes the patient’s condition can progress to where the need for infusions are required, an example of this is when their condition isn’t improving on the previous drugs. The child that I know receives infusions every 2 weeks of tocilizumab. Tocilizumab is a biologic response modifier, which works on blocking the production of the inflammatory protein IL-6 (one of the main factors of this disease), which helps to reduce the inflammation within the joints effected by arthritis.
medication within 24 hours were excluded from the study. Patients enrolled in the study were divided
Would you order any diagnostic testing for Mrs. S? If yes, what could normal/abnormal results indicate? Yes
The duration of the abovementioned effects usually lasts for five to six hours. For kratom capsules, the onset is a little delayed because of the time it takes for the dissolution of the capsule. Allow 30 to 40 minutes time after ingestion on an empty stomach before effects are felt, while it takes 60 to 90 minutes of absorption time when taken with
Helps to assess if the patient is maintaining appropriate BG level as directed by healthcare provider. She could be facing financial barriers to buy supplies that need to be addressed.
Patients are more likely to follow through with needed lab work if they can do it in at the time the of the appointment without missing more work,or having to get child care just to have labwork done.
• check the rate of infusion (I will talk more about this in a minute)
9. John, your boss, called and said that he wants to see you about the decrease in the quality of your product. YYY/ 1 day/ H
There is no consensus on the appropriate perioperative management of anticoagulation for patients who have been receiving long-term warfarin therapy. The most commonly used procedure is stopping the anticoagulant medication for a minimum of 4 days preoperatively and using bridging therapy with heparin
months ago he had a similar problem, but that the bleeding was much worse then
delayed return to activity (Gaine et al). Besides, it causes stress to the patient and the
Clarify the order with the Physician involved. Refer to the drug guide or any reliable source if necessary.