How would you have handled this?

DusktilDawn · Mar 25, 2007

I think you handled it correctly. After speaking with the surgeon, how can you have any doubts about it? It seems that despite what the surgeon has said about the coumadin in regards to this patient previously, the LPN family member has her own inflexible opinion on the matter. To have even tried to converse with her on this matter probably wouldn't have went well anyway. Hopefully the surgeon gets through to the patient and the patient heeds him. I've my doubts about the surgeon ever getting through to his family member.

CritterLover, BSN, RN · Mar 25, 2007

what problem did the family member have????

it is pretty common knowledge that patients who have any kind of heart valve replacement are going to be on life-time anticoaguation, or suffer the consequences.

i don't see any problem in what you said.

just because the family member has been a nurse for 35 years, doesn't mean they are well-versed in the care for post-valve replacements. yes, the surgeon will re-eval the blood work in a few weeks, but that will be to determine the doseage, not the acutal need for the coumadin itself.

the only thing i can think of (and it is minor) is sometimes i will tell patients something like "well, no you don't have to take it. you certainly have a choice in what you do with your own body. however, the consequeces of not taking the coumadin is pretty bad. it is your choice, but the other option is not pretty."

my guess (and it is only a guess) is that the family member knows quite a bit about the adverse effects of coumadin, but maybe doesn't really understand why post-valve replacement patients are anticoagulated for life, and the consequences of not taking it.

and for the record, yes this most certainly should have been discussed before the surgery. maybe it was, and the patient/family had other things on their mind and it didn't really sink in.

Happeetxn · Mar 25, 2007

my guess (and it is only a guess) is that the family member knows quite a bit about the adverse effects of coumadin, but maybe doesn't really understand why post-valve replacement patients are anticoagulated for life, and the consequences of not taking it.

the family member referred to it as "rat poison" because that is what its original use was for. now i have no idea if this is true or not, but i didn't exactly have time to go research the hx of coumadin and its original intended uses.

thank y'all for the replies. i appreciate the input.

craig

RunningWithScissors · Mar 25, 2007

I had a patient a few months back that was taking Coumadin for atrial fib. A "paramedic friend" of hers told her to stop taking it because she thought she saw some blood in her stool.

She came in with a MASSIVE stroke and DIED.

Craig, remember this: just because someone sez they's a nurse doesn't mean they iz.

Pumpkin1621 · Mar 25, 2007

Coumadin is facing a new law suit that is getting much air time due to the fact that hemorrhages are more likely to occur than indicated by the company.

My Grandmother was recently hospitalized and had brain surgery b/c she had a brain hemorrhage from coumadin. She had the flu and when she was heaving it bursted a vessel in her brain. With the coumadin it wouldn't stop.

That is probably what all that was about. I don't know. I think you did exactly what you should have done, and she can settle this with the doctor. There are other brands of blood thinners.

CritterLover, BSN, RN · Mar 25, 2007

the family member referred to it as "rat poison" because that is what its original use was for. now i have no idea if this is true or not, but i didn't exactly have time to go research the hx of coumadin and its original intended uses.
thank y'all for the replies. i appreciate the input.
craig

yeah, a derivative of coumadin is the main ingredient in rat poison. however, that doesn't mean that coumadin doesn't have its place.

(as an aside, dog food is very high in vit k. so if you have a rat/mouse problem, and choose to deal with it by poisoning them, be careful as to where the dog food is stored. if the vermin get into the dog food, the rat poison will never work.)

moonchild20002000 · Mar 25, 2007

I think you handled the situation well.

I wonder how reassured your patient was with the "rat poison" comment? I think thats an awful thing to say to your loved one. Talk about increasing someones anxiety..... :madface:

justme1972 · Mar 25, 2007

I had a patient a few months back that was taking Coumadin for atrial fib. A "paramedic friend" of hers told her to stop taking it because she thought she saw some blood in her stool.
She came in with a MASSIVE stroke and DIED.
Craig, remember this: just because someone sez they's a nurse doesn't mean they iz.

.......excellent point....it goes to show if you take medical advice from someone who is giving it outside of your scope of practice...you never know what might happen.

daisy1972 · Mar 25, 2007

you have done the right thing. we are always instructed by our CI's that we have to inform our patients about their drugs should they asked for it.

widi96 · Mar 25, 2007

Wow. Okay, thanks for the info Critter Lover. I first learned about the 'rat poison' / coumadin about five years back when my precious little dog decided to eat a bag of it (that I didn't know was there). She got multiple Vitamin K injections and had to take pills morning and night for a month due to it's long half life.

Now, more on topic - yeah Coumadin can cause some pretty bad adverse reactions, but do you know how much higher the morbidity and mortality rate would be if we didn't have this drug?

PickyRN · Mar 25, 2007

Coumadin is warfarin is rat poison. It's a little more complicated than that, otherwise, you could use coumadin as rat poison, and take rat poison instead of your coumadin (DONT DO THIS!).

Here are a few helpful links.

http://www.flounder.com/warfarin.htm

http://www.fvleiden.org/ask/26.html

I think you handled the situation almost perfectly. I agree with the nurse who mentioned the patient's right to refuse the medication. But otherwise, your comment was fine. You have to have a thick skin sometimes when dealing with the patient's family. There is somebody in every family that the patient looks to for medical advice. "Well, my sister is a nurse/doctor/pharmacist/veterinarian (don't laugh, I got that one night), and THEY said...." Just tell the patient what the medicine/treatment is for, and why it would be a good idea to do it.

BTW, if you disagree with the doctor about the efficacy (but not the safety) of the prescribed treatment, don't bring it up with the family, that would be unprofessional. I have heard nurses tell the patient, "Oh, I don't know why the doctor ordered that for you. He's an idiot," and things to that effect. If you disagree with the doctor, there are always subtle ways to tell the family. For instance, "The doctor has ordered this for you. If you don't agree with it, you can always ask for a second opinion." It could be as simple as reminding them of their right to refuse.