Question

Document2 - Word nferences Mailings Review View Help Tell me what you want to do Patients receiving anticoagulant therapy require a great deal of patient education regarding the medication's action, dosing, adverse effects, drug interactions, monitoring of INR, dietary and safety considerations. Document what you provide for patient education for a 34 year old female who was just placed on warfarin due to atrial fibrillation. This can be provided in bullet point but please include your reference(s) in APA format. (Ctrl) -

Answer 1

#. Health education for a 34year old female about warfarin :

Indications for warfarin :-

prevention/tx of venous thrombosis and PE, prevention of systemic embolism (MI, afib, prosthetic valves, valvular dz), mechanical heart valves-lifetime therapy, use for prevention after orthopedic surgery (6-8wks of anticoagulation recommendation)

Mechanism of action of warfarin :-

inhibition of vit K dependent clotting factors II (2), VII (7), IX (9), and X (10). Integers w/ hepatic synthesis of Vit K, extrinsic pathway, half life 2-60 hrs, onset of action 24-72 hrs, full protection after 5-7 d of therapy, tailor therapy to client, may not work for all its.

Monitoring warfarin :-

dose adjusted q 72h until INR stable, and then weekly, monitored by PT w/ INR (international normalization ratio), can be done by venous or finger stick, venous more accurate, patients followed in coumadin/anticoag clinics

INR levels :-

1: normal, 1-1.99: subtherapeutic, 2-3: therapeutic for most patients, 2.5-3.5: therapeutic for high risk patients, >3.5=potential toxicity (FDA warning), >6=high risk for bleeding, most people start holding warfarin around 4, vit K given for antidote will alter INR for one wk

Warfarin dosing :-

generic variation for dose, usual starting dose is 5-10 mg (less in elderly and liver dz), check in 72h, If INR < 2, increase dose 5-15%/wk, If INR 3-4, decrease dose 5-15%/wk, If INR 4-6, hold dose x2d, then decrease 5-15%/wk, If INR > 6, hold dose 2 d, decrease dose 5-15% & consider Vit K

Drug interactions w/ warfarin :-

multiple drug to drug, drug to herb & drug to food interactions, drug to ETOH, black box warning risk of major or fatal bleeding w/ intensity anticoagulation (INR >4), age >65y & other risk factors

Adverse effects w/ warfarin :-

AE-bleeding, hemorrhage, angina, CP, edema, hemorrhagic shock, hypotension, coma, dizziness, fatigue, fever, h/a, abdominal cramps and pain, alopecia, rash, urticaria, agranulocytosis, anemia, leukopenia, joint pain, muscle pain, osteoporosis w/ long term use

Patient education w/ warfarin :-

antidote is vit K, patient must make no radical changes in diet in regards to vit K foods (leafy greens, beef liver, pork, liver, green tea), pt education about bleeding risks, shaving, teeth, cuts, risk of falls (report if have one), report long-term bleeding excessive menstrual flow, red or dark brown urine, red or tarry stools, easy bruising, hemoptysis, patient to wear ID bracelet/necklace or info card, share history w/ dentist, podiatrist, manicurist, etc, high risk activities wear safety equipment (helmets, etc)