lab computation, PT/aPTT

Patients can have an elevated PT/PTT because of liver failure; and not that they are receiving coumadin and/or heparin.

What other problems can cause these to rise? This is how you need to look at it.

What can you do to bring these numbers down if a patient needs to have a procedure done? This is what the exam is going to be looking for.

No problem, but the norms are not going to help for this exam. How to fix things are, and that is the point that I was trying to make.

This is what needs to get focused on, not how to do a computation between the PT and INR for an example. But what to do to fix it and not always rely on it being up because of meds. Many other factors can increase it and this is what the exam will ask if anything about these lab values. How to get them down in a hurry.

thanks for the replies. about the lab values, nothing to worry about, it has been drilled into my brain. Now that suzanne mentioned it, thats my other weakness, drug-drug interaction towards coumadin and drugs that can increase it's effects. about bringing the coumadin down quickly, you give them the antidote right? Vit.K

What i want to know is the computation, its somewhat problematic for me. Ive been doing practice questions on saunders cd and occasionally, it throws up questions about coumadin. Like patient's PT is 28, nurse should withold drug and call the doctor, give drug and document. As far as i know there is a computation right? with the patient's PT and the INR. that is where i get confused. If anyone out there who can point to me to have coumadin/heparin computations, i would be delighted. THanks so much

Again, you are focusing on what coumadin would do, but what if you were not using coumadin and the PT was close to 30 and your patient needed an emergeny invasive procedure done. What would you do and this is what I am trying to get you to think about. Forget about coumadin, there are many other issues that involve an elevated PT and what are you going to do about those is what you will see on your exam, not coumadin related issues in most cases.

I was taught that each facility has their own NORM values for the Pt, but all facilities use the same INR norm value. You should only have to decide what to do next by looking at the INR value. Coumadin's antidote is vitamin K (ALL OF THE TIME), and heprin's antidote is protamine sulfate (ALL OF THE TIME). Hope this helps.

Forget about protamine and aqua-mephyton. You are not going to see that on an exam, but what else would you expect to see? And what would you do about it?

The exam is interested in what you would do in a certain situation, making you think about it. Not what you already had in school and is very well known.

All PT/INR relationships are going to be similar, no matter what the facility. Determining what you want your patient's range of INR is going to be dependent on what is going on with them and why they need to be anti-coagulated to begin with.

thanks for the replies. about the lab values, nothing to worry about, it has been drilled into my brain. Now that suzanne mentioned it, thats my other weakness, drug-drug interaction towards coumadin and drugs that can increase it's effects. about bringing the coumadin down quickly, you give them the antidote right? Vit.K

What i want to know is the computation, its somewhat problematic for me. Ive been doing practice questions on saunders cd and occasionally, it throws up questions about coumadin. Like patient's PT is 28, nurse should withold drug and call the doctor, give drug and document. As far as i know there is a computation right? with the patient's PT and the INR. that is where i get confused. If anyone out there who can point to me to have coumadin/heparin computations, i would be delighted. THanks so much

There is no computation that you are going to worry about. Anytime a PT is reported in the US, an INR is reported with it. Same thing for heparin, the PTT is not anything that you are going to compute or do anything with. Each facility has their own standard for the administration of heparin and what you are to do if the PTT is of a specific number.

Do not focus on these computations are anything having to do with them, that is not what you are going to see on your exam.

What are you going to do to get the INR down for an emergency procedure if you need to? You still have not answered that and it is the one thing that I can see them asking on an exam.

Remember that Vitamin K does not work right away and usually is given over three days.

You have a patient that has an INR of 4. And they need to have invasive lines or a pacemaker placed today. What are you going to do or what should you be considering?

This is how you need to look at things. And I am still waiting for an answer. Not one of you posting on this thread has even thought of what would be needed.

Someone's life depends on this.