46-The nurse provides instructions to a client discharged on warfarin, after being treated for apulmonary embolism (PE) following surgery. Which statements made by the client indicate theneedfor further teaching?Select all that apply.1."I will need to take my blood thinner for about 3-6 months."2."I will place small rugs on my wood floors to cushion a fall."3."I will take a baby aspirin if I have mild chest pain."4."I will use a soft-bristled toothbrush to clean my teeth."5."I will wear a blood thinner MedicAlert tag."Explanation:Clients discharged onwarfarin(Coumadin) are taught interventions to prevent injury, such asremoving scatter rugsin the home to reduce the risk of tripping and falling (especially in elderly)(Option 2).Clients are educated toavoidaspirin, drugs containingaspirin, nonsteroidal anti-inflammatory drugs(NSAIDs), andalcoholwhen taking warfarin due to an increased risk for bleeding(Option 3)(Option 1)Warfarin is usually administered for 3-6 months following PE to prevent further thrombusformation. A longer duration (lifelong) of anticoagulation is recommended in clients with recurrentPE. Prothrombin time and INR must be monitored regularly to adjust the dose and maintain atherapeutic anticoagulant level.(Option 4)Clients should be taught to avoid trauma or injury to decrease the risk for bleeding.Preventive measures include gently brushing teeth with a soft-bristled toothbrush, avoiding use ofalcohol-based mouthwash, avoiding contact sports or rollerblading, and using a straight razor.Flossing should also be avoided in general, but waxed dental floss may be used with care in someclients.(Option 5)Clients are instructed to wear a MedicAlert tag (eg, necklace, bracelet) when takinganticoagulants (eg, warfarin, heparin).Educational objective:Clients on warfarin or heparin should avoid using aspirin or nonsteroidal anti-inflammatory drugs,wear a MedicAlert device, avoid activities that increase the risk for bleeding, and limit alcohol intake.. Show
47-An elderly client with depression is given trazodone. Which statement by the client indicates thatadditional teaching is needed? 3. "I will take this medication at night to avoid daytime drowsiness."4. "It is okay to drink 2 glasses of wine at night."Explanation:Trazodone(Oleptro), a serotonin modulator, is used to treat major depressive disorders. In additionto affecting serotonin levels, the drug blocks alpha and histamine (H1) receptors. Blockade ofalphareceptorscan causeorthostatic hypotensionsimilar to that from other alpha blockers (eg,terazosin, tamsulosin) used to treat benign prostatic hyperplasia. Blockade ofH1 receptorsleads tosedation. Therefore, this drug is particularly effective in treating insomnia associated withdepression. However, concurrent intake of other medications or substances that cause sedation canbe detrimental; these include benzodiazepines (eg, alprazolam, lorazepam, diazepam), sedating General High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. Genetic Implications: Pronunciation:
Trade Name(s)
Ther. Class. anticoagulants Pharm. Class. coumarins Indications
Action Interferes with hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, and X). Therapeutic Effect(s): Prevention of thromboembolic events. PharmacokineticsAbsorption: Well absorbed from the GI tract after oral administration. Distribution: Crosses the placenta but does not enter breast milk. Protein Binding: 99%. Metabolism and Excretion: Primarily metabolized by the liver via the CYP2C9 isoenzyme, with some metabolism via the CYP3A4 isoenzyme; the CYP2C9 isoenzyme exhibits genetic polymorphism (intermediate or poor metabolizers may have significantly ↑ (S)-warfarin concentrations and an ↑ risk of adverse reactions). Half-life: 42 hr. TIME/ACTION PROFILE (effects on coagulation tests)
Contraindication/PrecautionsContraindicated in:
Use Cautiously in:
Adverse Reactions/Side EffectsDerm: dermal necrosis GI: cramps, nausea GU: CALCIPHYLAXIS Hemat: BLEEDING Misc: fever * CAPITALS indicate life-threatening. InteractionsDrug-Drug
Drug-Natural Products:
Drug-Food: Ingestion of large quantities of foods high in vitamin K content (see list in food sources for specific nutrients) may antagonize the anticoagulant effect of warfarin. Route/DosagePO (Adults): 2–5 mg/day for 2–4 days; then adjust daily dose by results of INR. Initiate therapy with lower doses in geriatric or debilitated patients or in Asian patients or those with CYP2C9*2 and/or CYP2C9*3 alleles or VKORC1 AA genotype. PO (Children >1 mo): Initial loading dose– 0.2 mg/kg (maximum dose: 10 mg) for 2–4 days then adjust daily dose by results of INR, use 0.1 mg/kg if liver dysfunction is present. Maintenance dose range– 0.05–0.34 mg/kg/day. Availability (generic available)Tablets: 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg Cost: Generic: 1 mg $10.83/100, 2 mg $10.83/100, 2.5 mg $10.83/100, 3 mg $10.83/100, 4 mg $10.83/100, 5 mg $8.52/100, 6 mg $10.64/100, 7.5 mg $10.83/100, 10 mg $10.83/100 Assessment
Lab Test Considerations: Monitor PT, INR, and other clotting factors frequently during therapy; monitor more frequently in patients with renal impairment. Therapeutic PT ranges 1.3–1.5 times greater than control; however, the INR, a standardized system that provides a common basis for communicating and interpreting PT results, is usually referenced. Normal INR (not on anticoagulants) is 0.8–1.2. An INR of 2.5–3.5 is recommended for patients at very high risk of embolization (for example, patients with mitral valve replacement and ventricular hypertrophy). Lower levels are acceptable when risk is lower. Heparin may affect the PT/INR; draw blood for PT/INR in patients receiving both heparin and warfarin at least 5 hr after the IV bolus dose, 4 hr after cessation of IV infusion, or 24 hr after subcut heparin injection. Asian patients and those who carry the CYP2C9*2 allele and/or the CYP2C9*3 allele, or those with VKORC1 AA genotype may require more frequent monitoring and lower doses.
Toxicity and Overdose: Withholding 1 or more doses of warfarin is usually sufficient if INR is excessively elevated or if minor bleeding occurs. If overdose occurs or anticoagulation needs to be immediately reversed, the antidote is vitamin K (phytonadione, Aquamephyton). Administration of whole blood or plasma also may be required in severe bleeding because of the delayed onset of vitamin K. Implementation
Patient/Family Teaching
Evaluation/Desired OutcomesProlonged PT (1.3–2.0 times the control; may vary with indication) or INR of 2–4.5 without signs of hemorrhage. warfarin is a sample topic from the Davis's Drug Guide. To view other topics, please log in or purchase a subscription. Nursing Central is an award-winning, complete mobile solution for nurses and students. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. Complete Product Information. What advice would you give to a patient taking warfarin?People on warfarin therapy should avoid drinking excessive amounts of alcohol over a short period of time (eg, with a single meal) because this can affect the INR and increase the risk of injury and serious bleeding. Warfarin and medications — A number of medications, herbs, and vitamins can interact with warfarin.
What are some important teaching points when administering warfarin?Other instructions for taking warfarin include:. Take your dose of warfarin as instructed once a day.. Take the dose at the same time each day. ... . Warfarin can be taken before or after eating.. If you forget to take your dose and remember within eight hours of the time you were supposed to take your dose, take the dose.. What are some things you would teach a patient on anticoagulant therapy?Patient Education
Patients on anticoagulant therapy must be educated about their increased risk for bleeding, monitoring for bleeding, managing bleeding if it occurs, and drug-specific information.
What health teaching should be done when a client is on an anticoagulant medication?Take your anticoagulant at the same time every day, as directed by your doctor or nurse. This is important because it makes the medication work more effectively. If you miss or skip a dose, contact your doctor or clinic. Do not take a double dose.
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