A Question about Coumadin

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I have a question about Coumadin. If you had an elderly Patient who is hospitialized due to several episodes of her ICD discharging and she admits that she cannot remember to take her Amiodarone 200 mg per day. even though she is on amiodarone, she begins to have atrial fibrillation. Her weight is 45kg. she is on a heparin drip with therapeutic PT/INR levels. the physician ordered the client to get Coumadin 10 mg po yesterday. Today's labs reveal a PT of 120/ INR of 15, PTT 150 seconds.

as the nurse, what is your initial action?

Wouldn't you stop the medication and call the doctor? I know that with elderly clients, they may have a greater than expected PT/ INR. But these labs are through the roof!

as the nurse, what assessments do you want to perform on this client?

for one, LOC. assess for bleeding and hemorrhage (bleeding gums, nose bleed, unusal brusing, tarry stools, hematuria, fallin BP or hematocrite.

what medication do you anticipate the MD to order?

vitamin K (Phytonadione, Aquamephyton)

What blood products might the MD order for this client and why? whole blood or plasma may be required in severe bleeding because of the delayed onset of vitamin K. it also increases hematocrit and hemoglboin levels. whole blood is used to replace large volumes of blood loss because it increases volume and improves the oxygen carrying capacity of the blood.

Can anyone tell me if I'm on the right track? :banghead:

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Specializes in SICU, NTICU.

Did you redraw?

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I didn't put that in, thanks. They would also have to repeat the PT, PTT and the INR, right?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

coumadin takes several days for its levels to build up in a person's system. so stopping the drug is not going to lower the pt and inr levels for several days. the antidote for coumadin overdose is vitamin k.

http://www.drugs.com/pro/coumadin.html - drug monograph for coumadin

http://www.drugs.com/pro/vitamin-k1.html - drug monograph for vitamin k injection

you would be assessing for signs and symptoms of hemorrhage. don't forget to assess for fluid and electrolyte disturbances as well.

whole blood is not generally given anymore. the factors needed to be replaced can be transfused much easier and faster. see this chart: chart of commonly transfused blood products.doc

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