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
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
Pradaxa is a direct thrombin inhibitor indicated to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. The half life is 12 to 17 hours and he had been off it for over a week when those levels were taken. There is no reversal agent. PT measures how long it takes the blood to clot and INR is a comparative rating of a patient's prothrombin time (PT) ratio. Therapeutic range for Afib is 2.0 to 3.0 and his was 4.3. He is on anti-coagulation meds for Afib and history of MI.
Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body.In atrial fibrillation, the chaotic rhythm may cause blood to pool in the atria and form clots. If a blood clot forms, it could dislodge from your heart and travel to your brain. There it might block blood flow, causing a stroke. Treatment could include vitamin k and fresh frozen plasma (which he has had once already). Liver disease , herediatary factor deficiency, vitamin k deficiency, bile-duct obstruction, DIC, and massive blood transfusions are all I've found so far that could cause the elevated PT.
He was admitted with a left lower lung mass and general weakness. He has a hx of lung cancer. The biopsy is to determine what the lung mass is.
Just a thought - does he have impaired liver function?
No, it wasn't anywhere in his medical history or doctor's notes. He does have stage 3 renal disease which would contribute to a longer elimination time.
No, it wasn't anywhere in his medical history or doctor's notes. He does have stage 3 renal disease which would contribute to a longer elimination time.
AKD will lengthen the time it takes for the medication to be excreted, this is one reason dialysis is a reversal for pradaxa. But HD is used for active bleeding, uncontrolled by other interventions You are def on the right tract.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Do you see how you gave us information in little pieces slowly. Important pieces of information that were extremely important.
Here is how this started......
My client has a history of Afib and a previous MI. So he was on Pradaxa and a baby aspirin at home.
This patient actually has an elevated PT/PTT on pradaxa that has stage III renal failure (a big deal with pradaxa) in the hospital for a mass in his lungs to rule out malignancy who has a history of lung ca. These are huge details and very important in your assessment of the patient and their situation.
It's all about the patient......what does this patient have and need.
You need to look up Pradaxa and renal failure and elevated PT/PTT, malignancies and common metastatic places of Lung CA.
FWIW: We totally understand how hard it is to put together a big-picture when you have a very imperfect idea of what's important. But this is what nursing is all about-- knowing how to think about it all. This is why NCLEX is so challenging for people who have a problem with seeing the bigger picture and are devoted to memorizing small bits of data.
Hint: lung ca, renal failure, and elevated coags ~ important. :)
Thanks everyone for the help. I think what was tripping me up what my instructor said no to do specifics for my client, really just like in general what are the etiology, prognosis, medical and surgical treatments and nursing care for the admitting diagnosis: which was elevated pt and inr. I ended up having to give specifics for my client tho cause general elected pt and inr was way too broad.
Stoogesfan
152 Posts
Pradaxa is a direct thrombin inhibitor indicated to reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation. The half life is 12 to 17 hours and he had been off it for over a week when those levels were taken. There is no reversal agent. PT measures how long it takes the blood to clot and INR is a comparative rating of a patient's prothrombin time (PT) ratio. Therapeutic range for Afib is 2.0 to 3.0 and his was 4.3. He is on anti-coagulation meds for Afib and history of MI.
Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body.In atrial fibrillation, the chaotic rhythm may cause blood to pool in the atria and form clots. If a blood clot forms, it could dislodge from your heart and travel to your brain. There it might block blood flow, causing a stroke. Treatment could include vitamin k and fresh frozen plasma (which he has had once already). Liver disease , herediatary factor deficiency, vitamin k deficiency, bile-duct obstruction, DIC, and massive blood transfusions are all I've found so far that could cause the elevated PT.
He was admitted with a left lower lung mass and general weakness. He has a hx of lung cancer. The biopsy is to determine what the lung mass is.