PT INR critical level, not once, not twice

tvccrn, ASN, RN · May 5, 2005

Her family requested that only a nurse give her her coumadin.

As opposed to who?

Also, you mention that a nurse or doctor should be monitoring closely. Is this person in the hospital or at home? If in the hospital, I would assume (yes I know you should never assume) that they are being monitored. You don't say how high critical is, but if it's being reported as critical, I would also decline to administer the med until the level is more acceptable.

estrogen · May 5, 2005

Her family requested that only a nurse give her her coumadin. AND THE PROBLEM CONTINUES...In the last month her PT level had reached critical. She is currently on antibiotics and we believe that is the problem. The last time I was asked to give her her coumadin I refused, and I will continue to refuse as long as her PT level remains unstable. She could bleed to death at any time. I totally agree with her family. A nurse and her doctor should monitor her very closely at least for a while. Was I wrong?

Idon't get it eighther. why isn't the doctor holding her coumadin 'till her PT comes down?

barefootlady, ADN, RN · May 5, 2005

Make sure her PT/INR level is documented in your NN and that doctor is aware of levels. Holding medication at this stage is only good nursing judgement. Make CN and HN aware also. I have been questioned on this issue so many times, good thing I ALWAYS wrote a specific NN. Doctors do not like to be "questioned" on issues like this. :angryfire

GLORIAmunchkin72 · May 5, 2005

This is a long term care facility. I am a QMA. My question was: Was I wrong for insisting that only a nurse should administer her coumadin until her PT is stable over a reasonable course of time. This is a hot potato for me.

As opposed to who?
Also, you mention that a nurse or doctor should be monitoring closely. Is this person in the hospital or at home? If in the hospital, I would assume (yes I know you should never assume) that they are being monitored. You don't say how high critical is, but if it's being reported as critical, I would also decline to administer the med until the level is more acceptable.

SharonH, RN · May 5, 2005

My question was: Was I wrong for insisting that only a nurse should administer her coumadin until her PT is stable over a reasonable course of time.

Certainly not. You should be commended for being so conscientious and having good judgment in this matter.

tvccrn, ASN, RN · May 5, 2005

No, you weren't wrong in declining. Matter of fact, I think you were entirely correct in doing so. You are looking after her safety and well-being. Your facility should be commended for hiring someone who is willing to stand-up for the patients.

:yelclap:

lsyorke, RN · May 5, 2005

"My question was: Was I wrong for insisting that only a nurse should administer her coumadin until her PT is stable over a reasonable course of time. This is a hot potato for me."

My questions is why is ANYONE administering Coumadin when there's a documented critical PT?? It should be held and doctor notified.This sounds like a poor candidate for coumadin if her results are so unpredictable. Lovenox may be a better choice!

GLORIAmunchkin72 · May 5, 2005

"My question was: Was I wrong for insisting that only a nurse should administer her coumadin until her PT is stable over a reasonable course of time. This is a hot potato for me."
My questions is why is ANYONE administering Coumadin when there's a documented critical PT?? It should be held and doctor notified.This sounds like a poor candidate for coumadin if her results are so unpredictable. Lovenox may be a better choice!

The coumadin was withheld yesterday. I don't know about tomorrow or the day after. They have tried different dosages and she has been on vitamin K off and on. Just about the time they think it's safe again and she's back to critical. Her PT seems to be very hard to manage.

stidget99 · May 5, 2005

"She could bleed to death at any time." How high is high? Continue to hold coumadin. But also, maybe an order of Vit K would be in order??? Doc needs to order this.

Bird2 · May 5, 2005

You stated that she was on an antibiotic. Any chance she was on Diflucan? I've seen PT/INR skyrocket on it.

elFNP · May 5, 2005

I have few questions.

1. What is her INR when you refuse to give this Coumadin?

2. Does she have a DVT, valve replacement, s/p hip surgery?

3. What abx is she on? What is her albumin?