Must post first. Bob, a 65-year-old man with atrial fibrillation, has been using warfarin for the past 12 months after he presented to the local emergency department with signs of a TIA. A head CT scan and trans-esophageal echocardiogram done at the time were normal. He has been well since. Bob has came  it the clinical today as the INR taken this morning was 4.6. Up until now, his INR results (which have been measured every 2 weeks) have been stable and in the range of 2.0√3.0. He has not started any new prescribed medications recently. Bob also has hypertension and osteoarthritis (for which he had a left total hip replacement 6 months ago). Current medications: Atenolol 50 mg once daily, Lisinopril 10 mg once daily and warfarin 6 mg at night. On examination: BP 140/80 mmHg; pulse rate 65, irregular. The remainder of the physical examination is normal with no evidence of bruising, epistaxis, or gastrointestinal bleeding.   List potential drug interaction(s) with warfarin, which may increase the INR. Foods/beverages Over the counter medications Complimentary medicines Is the INR level therapeutic?  Is it too high or too low?  What do you as the nurse need to do? Explain the rationale behind monitoring the INR.  What other measures, if any, would you take to manage the raised INR? What education would you provide for the patient? List three factors, apart from drug interactions, associated with an increased risk of major bleeding while on warfarin.

Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
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Must post first.

Bob, a 65-year-old man with atrial fibrillation, has been using warfarin for the past 12 months after he presented to the local emergency department with signs of a TIA. A head CT scan and trans-esophageal echocardiogram done at the time were normal. He has been well since.

Bob has came  it the clinical today as the INR taken this morning was 4.6. Up until now, his INR results (which have been measured every 2 weeks) have been stable and in the range of 2.0√3.0. He has not started any new prescribed medications recently.

Bob also has hypertension and osteoarthritis (for which he had a left total hip replacement 6 months ago). Current medications: Atenolol 50 mg once daily, Lisinopril 10 mg once daily and warfarin 6 mg at night.

On examination: BP 140/80 mmHg; pulse rate 65, irregular. The remainder of the physical examination is normal with no evidence of bruising, epistaxis, or gastrointestinal bleeding.

 

  1. List potential drug interaction(s) with warfarin, which may increase the INR. Foods/beverages

Over the counter medications

Complimentary medicines

  1. Is the INR level therapeutic?  Is it too high or too low?  What do you as the nurse need to do? Explain the rationale behind monitoring the INR. 
  2. What other measures, if any, would you take to manage the raised INR? What education would you provide for the patient?
  3. List three factors, apart from drug interactions, associated with an increased risk of major bleeding while on warfarin.
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