help!! PT/INR and prioritizing!

  1. 0
    I'm really struggling here. I was given a pharm assignment and this patient has a PT/INR of 80/5. She is receiving Warfarin therapy so the INR isn't TOO high, it should be under 5 though, but isn't the PT supposed to be like 13?? How can it be 80, what does that mean?

    Also, I need to prioritize 15 problems with her and I'm just so lost at how to go about it, but I've listed a general list below for some background,
    Atrial Fibrillation
    BP 90/60 (she normally has HTN so I thought this was significant)
    Irregular Heart Rhythm
    PT/INR
    Large Hematoma on R forehead
    low Potassium (3.1)
    low sodium (128)
    low-grade fever (99.6)
    Headache (5/10)
    Pitting edema on ankle (WHY does she have low sodium and K if she has edema? wouldn't here sodium and K be elevated bc of fluid retention?)
    Weak Peripheral Pulses (posterior tibial, dorsalis pedis 1+ bilaterally)
    Bruising
    on R side of face, R hip and R shoulder
    Osteoarthritis
    Occasional Incontinence
    Dry, Flaky Skin

    I am also expected to give rational for the ranking of each and a treatment
    any help is so so very appreciated!!!!

    More background: Pt has had two MIs, class 1 HF, CAD, and atrial fibrillation
    she is currently taking:
    Aspirin 325mg PO daily
    Furosemide/Lasix 40mg PO daily
    Metolazone/Zaroxolyn 5mg PO daily
    Potassium chloride/K-Dur 20mEq PO daily
    Rosuvastation/Crestor 10mg PO daily
    Warfarin/Coumadin 5mg PO daily
    Garlic 2 capsules PO daily
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  4. 0
    Quote from pegan64
    I'm really struggling here. I was given a pharm assignment and this patient has a PT/INR of 80/5. She is receiving Warfarin therapy so the INR isn't TOO high, it should be under 5 though, but isn't the PT supposed to be like 13?? How can it be 80, what does that mean?

    Also, I need to prioritize 15 problems with her and I'm just so lost at how to go about it, but I've listed a general list below for some background,
    Atrial Fibrillation
    BP 90/60 (she normally has HTN so I thought this was significant)
    Irregular Heart Rhythm
    PT/INR
    Large Hematoma on R forehead
    low Potassium (3.1)
    low sodium (128)
    low-grade fever (99.6)
    Headache (5/10)
    Pitting edema on ankle (WHY does she have low sodium and K if she has edema? wouldn't here sodium and K be elevated bc of fluid retention?)
    Weak Peripheral Pulses (posterior tibial, dorsalis pedis 1+ bilaterally)
    Bruising
    on R side of face, R hip and R shoulder
    Osteoarthritis
    Occasional Incontinence
    Dry, Flaky Skin

    I am also expected to give rational for the ranking of each and a treatment
    any help is so so very appreciated!!!!

    More background: Pt has had two MIs, class 1 HF, CAD, and atrial fibrillation
    she is currently taking:
    Aspirin 325mg PO daily
    Furosemide/Lasix 40mg PO daily
    Metolazone/Zaroxolyn 5mg PO daily
    Potassium chloride/K-Dur 20mEq PO daily
    Rosuvastation/Crestor 10mg PO daily
    Warfarin/Coumadin 5mg PO daily
    Garlic 2 capsules PO daily
    look up coumadin and see what it will do to a PT..
  5. 0
    does not explain the value of INR
  6. 0
    pt/inr: the test | prothrombin time and international normalized ratio

    what does the test result mean?

    the test result for pt depends on the method used, with results measured in seconds and compared to the average value in healthy people. most laboratories report pt results that have been adjusted to the international normalized ratio (inr) for patients on anticoagulant drugs. these patients should have an inr of 2.0 to 3.0 for basic "blood-thinning" needs. for some patients who have a high risk of clot formation, the inr needs to be higher - about 2.5 to 3.5.

    the patient is exhibiting bruising. i assume they fell. the eleveated pt will increase bleeding. the ideal target inr range will vary from person to person depending on a variety of factors such as the reason for taking anticoagulants, other medical conditions, and a number of other issues. your anticoagulation clinician will determine the appropriate inr range for you. the most common inr target range for someone on warfarin is somewhere between 2.0 and 4.0. inrs of 5 or more typically are avoided because the risk of bleeding increases significantly at inrs above 5.

    blood clot & anticoagulation websites: clotcare

    prioritization is done by the patient's most important needs. keep in mind that the care plan is a problem solving process, so each nursing diagnosis is actually a patient problem. you list the problems in the order of which is most important of needing attention first. most instructors suggest prioritizing by maslow's hierarchy of needs. the hierarchy from most important to least important is as follows:
    1. physiological needs (in the following order)
      • the need for oxygen and to breathe
      • the need for food and water
      • the need to eliminate and dispose of bodily wastes
      • the need to control body temperature
      • the need to move
      • the need for rest
      • the need for comfort
    2. safety and security needs (in the following order)
      • safety from physiological threat
      • safety from psychological threat
      • protection
      • continuity
      • stability
      • lack of danger
    3. love and belonging needs
      • affiliation
      • affection
      • intimacy
      • support
      • reassurance
    4. self-esteem needs
      • sense of self-worth
      • self-respect
      • independence
      • dignity
      • privacy
      • self-reliance
    5. self-actualization
      • recognition and realization of potential
      • growth
      • health
      • autonomy
    http://allnurses.com/nursing-student...lp-276459.html
    nursing resources - care plans

    critical thinking flow sheet for nursing students

  7. 0
    "Pitting edema on ankle (WHY does she have low sodium and K if she has edema? wouldn't here sodium and K be elevated bc of fluid retention?)"

    getting lasix, is CHF, so bilat edema. She is peeing out her electrolytes.

    Is the afib a new DX?
  8. 0
    This is a long and tough list of problems. Here what I came up with. I ordered them according to what I would address. I'm no expert. Keep that in mind

    Atrial Fibrillation
    Irregular Sinus Rhythm
    PT/INR
    Large Hematoma
    Headache
    Bruising
    BP
    Low potassium
    Low Sodium
    Fever
    Weak Pulses
    Pitting Edema
    Osteoarthritis
    Incontinence
    Skin


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