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Bugaloo, RN 11,922 Views

Joined: Jun 30, '07; Posts: 172 (58% Liked) ; Likes: 753

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  • Apr 2

    This is an informational guide that I created for patients who are presently on Coumadin or expected to be on Coumadin upon discharge. It is in article form because it was a freelance article that I wrote. As we all know, it is up to nurses to do patient teaching, not the doctors! It is written in simple terminology that all patients can understand. When I was a home health nurse, it seemed that I was always doing research on diseases and conditions so that I could make up my own patient teaching guides. Not all hospitals have teaching resources on hand for nurses to use. Feel free to use this for teaching purposes if you wish.

    The medication Coumadin is classified as an anticoagulant. It is also known by its generic name, warfarin. Coumadin is, simply put, a "blood thinner". It thins your blood to prevent blood clots from forming. There are several medical conditions that warrant the use of Coumadin. Here, we will discuss just a few.

    Pulmonary Emboli (PE)

    A pulmonary emboli is a blood clot in the lung. When you are hospitalized with a pumonary emboli, anticoagulants will be administered in either injection form (Heparin or Lovenox) or as an IV drip (Heparin drip). After the blood clot has resolved and you are discharged from the hospital, you will probably be given a prescription for Coumadin to take at home.

    Deep Vein Thrombosis (DVT)

    A deep vein thrombosis is a blood clot deep in the vein. These usually develop in the legs. If the clot is serious enough to require hospitalization, you would be treated with either Heparin or Lovenox injections or a Heparin drip. Again, Coumadin is usually prescribed after hospitalization to prevent another blood clot from forming.

    Atrial Fibrillation (A-Fib)

    Atrial fibrillation is an irregular heart rhythm. For some, this is a chronic condition, which means that their heartbeats irregularly all the time. Patients with atrial fibrillation usually take Coumadin for the rest of their lives to prevent blood clots. With atrial fibrillation, blood clots can occur because the heart is pumping blood out at irregular intervals, so the volume of blood in the circulatory system is not consistent.

    After Hip and Leg Surgery

    Surgery of the hips and legs requires some bedrest after surgery. This period of immobility can cause blood clots to form because your range of motion is compromised. Although precautions are taken to prevent blood clots after surgery, Heparin or Lovenox injections are usually used as well. Physical therapy is usually started in the hospital and then continued at home. When you are discharged home, you will usually be on Coumadin short term.

    What are the risks of taking Coumadin? The main risk is that your blood may become too thin. This is why your doctor will want you to have your blood drawn regularly to check the PT/INR. The PT/INR results will tell your doctor how long it takes for your blood to clot and adjust your Coumadin dosage accordingly. It is very important to follow your doctor's orders concerning the blood work and dosage changes. Signs and symptoms of abnormally thinned blood are bleeding from the gums, excessive bruising, black, tarry stools (very dark or black bowel movements the consistency of tar) and blood in your urine.

    As with most medications, Coumadin should be taken every day at the same time. Ask your doctor what time he wants you to take it. Usually, it is in the evening hours. If you miss a dose, you will need to contact your doctor so he can advise you what to do.

    When you are taking Coumadin, there are some important things to remember. You should avoid an excessive diet of foods that are high in Vitamin K, such as green leafy vegetables, broccoli, green onions, asparagus and olive oil. Coumadin and Vitamin K work against each other. Vitamin K actually helps thicken the blood. It is given in injection form when someone's blood is dangerously thin. You should also avoid dangerous or hazardous activities which could result in bleeding or fractures. You should use a soft bristle toothbrush when brushing your teeth. Carry a card with you at all times that states that you are on Coumadin. Be aware of any signs of abnormal bleeding and report them to your doctor immediately. Let all of your physicians know that you are on Coumadin.

    Coumadin, when taken as prescribed, works very well. By knowing a little bit more about this medication and following these tips, you become an active participant in your medical care.

    Some information in this article provided by Mosby's Nursing Drug Reference, 2007

    More about Warfarin Therapy: Guidelines

  • Feb 16

    What are the advantages of being a Med-Surg nurse?

    Med-Surg nurses develop a broad knowledge base of many different medical diseases and conditions. They are able to execute excellent patient teaching based on this knowledge. They are often highly skilled in assessing small changes in a patient's condition that can prevent more serious problems from developing.

    What are the disadvantages of being a Med-Surg nurse?

    The Med-Surg floor is sometimes insanely busy. The floor is often short-staffed and the turn-over rate is high. Long hours, high acuity patients and hospital politics can lead to burn out if you do not pace yourself.

    What qualities should a Med-Surg nurse have?

    The ability to leap tall buildings in a single bound!!! OOPS, Sorry! That is SuperNurse, 'er...umm...Superman. Seriously though, the most important quality a Med-Surg nurse should have is a sense of humor. You will face things that will be much easier to stomach if you can laugh about it. Secondly, a sense of confidence can put your patients at ease and let them feel as if they are in excellent hands (which they are, of course!). The ability to prioritize and manage your time wisely is also important. Remaining professional and courteous even in times of high stress is a must for any nurse, but especially in Med-Surg.

    What types of patients are admitted to Med-Surg units?

    Your patient load can vary from simple 23-hour observations to chronic (frequent flyer) patients with multiple medical issues. Common medical conditions that patients are admitted with are the following:

    • CHF
    • COPD
    • Diabetes
    • Pneumonia
    • UTI
    • Pancreatitis
    • Mental status changes
    • Abdominal pain
    • Fever
    • CVA/TIA
    • Cellulitis
    • Falls/Fractures
    • Drug overdose
    • Alcohol Withdrawal
    • Chest pain
    • MVA's
    • Cancer

    What essential supplies should a Med-Surg nurse have in her pocket at all times?

    • Black ink pens
    • Something to write on
    • Scissors
    • Tape
    • Pen light
    • Chapstick
    • Alcohol wipes
    • A lucky charm

    How can a Med-Surg nurse stay focused and organized throughout their shift?

    I find that the acronym ADPIE helps me stay on top of everything I need to do.
    • A: Assess my patients
    • D: Determine what I need to do for each patient to keep them safe, comfortable and content while they are in my care.
    • P: Plan HOW I will do this for each patient.
    • I: Implement my plan for each patient, and share with each patient what the plan will be.
    • E: Evaluate that plan periodically throughout the shift.

    A lot of times, things will not go according to plan, but at least if I am dealing with a critical issue with one patient that takes a lot of time, I know that I can get back on track quickly with the rest of them when the crisis is over.

    What are the signs of burnout in a Med-Surg nurse?

    Burnout is always a risk when you are dealing with both acute and chronically ill patients. Recognizing the signs of burnout are very important. If you start to experience any of these symptoms, deal with them right away by scheduling vacation time, avoiding overtime shifts and getting adequate rest.
    • An overwhelming sense of anxiety
    • Uncharacteristic negativity
    • Nausea, diarrhea and stomach cramps
    • Exhaustion and fatigue
    • Lack of motivation and focus
    • Being short-tempered
    • Being sarcastic and critical
    • Having trouble sleeping
    • Dreading coming back to work on your days off
    • Obsessing over work even on your days off
    • Frequent headaches
    • Body aches and pains from tension

    How can Med-Surg nurses avoid burnout?

    First and foremost, leave work at work. Try not to worry about patients when you are not at work. On your days off, schedule "me" time, if at all possible. Play with your kids, spend time with your family, pursue a hobby, get a massage. By nature, nurses are passionate people. Nursing is physically, mentally and emotionally draining. The days we spend away from our job should be spent fulfilling our needs and the needs of those we love. We must reserve some of our passion for something besides caring for the needs of our patients. Once you do that, it becomes easier to find a work/home balance that works for you.