Elevated PT and INR

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My client yesterday had an elevated PT and INR. My instructor chose that as my clients diagnosis. On my paper it wants to know the etiology, S&S, medical and surgical treatments (if applicable if not only medical) and nursing care.

My client has a history of Afib and a previous MI. So he was on Pradaxa and a baby aspirin at home. That's what caused the prolonged PT and INR correct? Would that be the etiology? And the only medical treatment I can think of is stop the anticoagulants and I read where Vit K was given too. Right track? I know S&S would be bleeding and bruising correct?

Problem is I have to have a source for all this so even the stuff I can come up with I can't find in my books. Someone please tell me I'm at least thinking close to correct? Lol

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Specializes in Hospice, LTC, Rehab, Home Health.

For resources start with an online pharmacy site. For example Google / search the name of the meds as a place to begin.

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Specializes in Trauma Surgical ICU.

How elevated and were the levels therapeutic?? People with A-Fib need anti-coagulation.. why, what is the therapeutic range. They are on the meds for a reason. If the levels are above therapeutic, the MD will need to adjust their dose, if they are having active bleeding, etc then vit K maybe a good thing.. Read up on the medication first, then based on their levels, tell us what needs to happen.. If you don't understand A-fib and the complications from it; please read about it too...

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His Pradaxa was discontinued. He is still receiving his baby aspirin. He is waiting for his levels to lower so he can have a biopsy. His pt was 22.4 and inr was 4.3. I do know why he was on the anticoagulant, I understand why he needed it with Afib.

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I edited the last response cause I was going through my papers the instructor gave me at the end of the day and she had wrote them down for me since I couldn't get them by myself.

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Specializes in Trauma Surgical ICU.

My questions are only to get you to think :) Now my next set of questions.. What is the antidote to Pradaxa? Will vit K help? Will the PT/INR give true results for a pt on pradaxa therapy?

This is a new drug with a lot of controversy..

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Specializes in Trauma Surgical ICU.

This will help...

http://healthcare.utah.edu/thrombosis/newagents/TS.Dabi_Bleeding.pdf

Please check out other sources also :)

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No I'm thankful for the help. Problem is even if I know the answers, I have to cite sources for everything so I need a book or a website that I can use.

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Thanks for the link :)

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Ok. So I looked up pradaxa and it said that the pt and inr levels aren't sensitive to the concentration but it also said that if you needed to check levels to wait 1 to 2 days after discontinuing the med.

Well he's been off it for more than 2 days and his levels are still high. So does that mean the levels are accurate now? Also, he does have multiple bruises on his arms and legs and he's slightly anemic. I believe his hemoglobin was 8.7.

I think I'm just gonna put etiology is side effect of the pradaxa? Prognosis would be good once the pradaxa is excreted. Medical interventions would be discontinue the pradaxa, possible fresh frozen plasma? Nursing care would be monitor vitals, labs, signs of bleeding, watch for blood in urine and stool, and educate patient on what signs to report immediately?

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Another very useful resource for questions like this is the classic Laboratory and Diagnostic Tests with Nursing Implications, by Joyce LeFever Kee. if you were to look up PT and INR, you would find a wealth of information on related medications, precautions, and so forth. Even if your faculty didn't put this book on the bookstore list for you, it is definitely worth getting.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

There are several questions here. What is Pradaxa? What is it half life? Does it have a reversal agent? What is the blood test PT PTT INR indicative of? Are those values therapeutic for why the patient is anti-coagulated? What does a patient need tobe told about being on anti-coagulation medicine? Guide for Surgery

What is A fib? Why does this patient need to be anti coagulated? What is the treatment for an elevated PT/PTT? What are the causes for an elevated PT/PTT that are not med related?

What else is going on with this patient? Why are they in the hospital? You mentioned surgery for a biopsy? What is the biopsy for?

Google is your friend.

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