INR LABS

xoCrash · Nov 25, 2015

Unless orherwise specified by a doctor, inr range for a resident on Coumadin is 2.0-3.0. Too low means they need a higher dose, too high means they need a lower dose. Always call the doc when your inr is out of range.

quiltynurse56, LPN, LVN · Nov 25, 2015

Again, find out from your facility. We have a page where we put the new INR in that has the previous ones listed as well as their coumadin dosages that we fax for all of our INRs. The doctor faxes it back with the new orders filled in, or they state no change in orders.

Lev, MSN, RN, NP · Nov 26, 2015

Hi Dr. Niceguy, this is Nikita calling from Safe Long Term Care Facility. I'm the nurse taking care of Larry Jones in room 123 today. I wanted to make you aware that his INR level came back at 1.2 today. He has 5 mg of coumadin scheduled every evening for dvt prophylaxis secondary to afib and he last recieved a dose at 6pm yesterday. I am wondering if you would like to increase his dose of coumadin and/or start him on another medication to bridge him til the INR is therapeutic?

And then document the conversation. If there are no new orders document that.

TakeTwoAspirin, MSN, RN, APRN · Nov 26, 2015

Hi Dr. Niceguy, this is Nikita calling from Safe Long Term Care Facility. I'm the nurse taking care of Larry Jones in room 123 today. I wanted to make you aware that his INR level came back at 1.2 today. He has 5 mg of coumadin scheduled every evening for dvt prophylaxis secondary to afib and he last recieved a dose at 6pm yesterday. I am wondering if you would like to increase his dose of coumadin and/or start him on another medication to bridge him til the INR is therapeutic?
And then document the conversation. If there are no new orders document that.

This answer is perfection! Not only do you need to tell them what the labs are, but it is helpful to let them know what the last labs were (so that they can note any trends), and what the current dose is.

If you are calling with INR it is also wise to know the prior H&H to see if it has dropped any since the last INR (especially if you are having trouble titrating a patient who is elderly, frail, or has a history of gi problems).

PyridiumP · Nov 26, 2015

Hi Dr. Niceguy, this is Nikita calling from Safe Long Term Care Facility. I'm the nurse taking care of Larry Jones in room 123 today. I wanted to make you aware that his INR level came back at 1.2 today. He has 5 mg of coumadin scheduled every evening for dvt prophylaxis secondary to afib and he last recieved a dose at 6pm yesterday. I am wondering if you would like to increase his dose of coumadin and/or start him on another medication to bridge him til the INR is therapeutic?
And then document the conversation. If there are no new orders document that.

"Secondary to" means "caused by." DVT is not caused by atrial fibrillation, so don't say that. For that matter, atrial fibrillation doesn't cause DVT, either.

Atrial fib may allow clots to form in the atria, and so if one floats out of the atrium and into the ventricle and out the aorta, it could cause a stroke or later as of blood flow to any other artery. If it floats out of the right ventricle it will block blood flowing to part of a lung, a pulmonary embolus.

Another reason to get a clot to the lung is when one forms in a deep vein and travels to the right heart and then to the lung, but that has nothing to do with atrial fibrillation.

A patient with risk factors for DVT might be on anticoagulation prophylaxis, meaning, something to prevent inappropriate clot from forming in the deep veins. A patient with atrial fib might be on anticoagulation prophylaxis to prevent clot from forming in his atrium.

Otherwise, the rest of it is fine. "No change in medical plan of care, no new prescription," or, "New prescription to increase/decrease dose to ..."

PyridiumP · Nov 26, 2015

This answer is perfection! Not only do you need to tell them what the labs are, but it is helpful to let them know what the last labs were (so that they can note any trends), and what the current dose is.
If you are calling with INR it is also wise to know the prior H&H to see if it has dropped any since the last INR (especially if you are having trouble titrating a patient who is elderly, frail, or has a history of gi problems).

Not quite perfection since DVT isn't caused by AF. But otherwise ...

Lev, MSN, RN, NP · Nov 26, 2015

An embolus can travel anywhere that blood flows. A fib is a definite risk factor for DVT in stroke patients. http://stroke.ahajournals.org/content/22/6/760.full.pdf

I understand how a fib causes clots to form.

Maybe I should have said VTE prophylaxis instead of DVT prophylaxis to be more inclusive.

Libby1987 · Nov 26, 2015

You might want to add whether there have been changes in diet and/or medications.

AlwaysLearning247, BSN · Nov 26, 2015

Don't be nervous when calling, I used to be too! Always call and just say the basics after saying where you're calling from. You should always tell the doctor why the patient is on Coumadin, the last INR and date, current INR, and the dose of Coumadin the patient is currently on. They will decrease, increase, or hold the dose depending on the level. It's always important to call no matter what. You should have an order for example that says "Coumadin 2.5 mg, check INR in 3 days," you wouldn't give the Coumadin until you got a new dose for the patient. You'll get the hang of it, it just takes time. Good luck!

jadelpn, LPN, EMT-B · Nov 26, 2015

Look at your order, and find out where the MD wants the therapeutic range of the INR to be. No 2 people are alike in where the MD would like the range at.

When the INR is complete, if the range is not in the therapeutic range, call the MD with "Mrs, Such and So is on _______Coumadin daily. Your range for her is _________. Today's INR came back at _____________. What would you like to do as far as dosing, and when would you like a repeat INR? "

Usually, if the level is too low, there will be orders regarding an increase for a couple of days, then a repeat of the INR--which would necessitate a phone call on your part as well. "As you may recall, Mrs. Such and So was not therapeutic last week, so per your order, we increased to ________ x _______days, and repeated the INR today. It came back as _____________. Where would you like to go from here?"

Just be sure that the orders are clear, and that all those giving medications are clearly following the new orders. It can sometimes get confusing with the increase for 2 days, hold for 3 days....whatever the order changes are. So be sure to point it out to the medication nurse, even mention it in report.

gonzo1, ASN, RN · Nov 27, 2015

You need to check your facilities policies and procedures. There should be a policy of what is considered a critical lab and the time frame a doctor has to be notified of it in. Also some doctors write parameters in their orders of what they want to be called about.