help!! PT/INR and prioritizing!

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I'm really struggling here. I was given a pharm assignment and this patient has a PT/INR of 80/5. She is receiving Warfarin therapy so the INR isn't TOO high, it should be under 5 though, but isn't the PT supposed to be like 13?? How can it be 80, what does that mean?

Also, I need to prioritize 15 problems with her and I'm just so lost at how to go about it, but I've listed a general list below for some background,

Atrial Fibrillation

BP 90/60 (she normally has HTN so I thought this was significant)

Irregular Heart Rhythm

PT/INR

Large Hematoma on R forehead

low Potassium (3.1)

low sodium (128)

low-grade fever (99.6)

Headache (5/10)

Pitting edema on ankle (WHY does she have low sodium and K if she has edema? wouldn't here sodium and K be elevated bc of fluid retention?)

Weak Peripheral Pulses (posterior tibial, dorsalis pedis 1+ bilaterally)

Bruising on R side of face, R hip and R shoulder

Osteoarthritis

Occasional Incontinence

Dry, Flaky Skin

I am also expected to give rational for the ranking of each and a treatment

any help is so so very appreciated!!!!

More background: Pt has had two MIs, class 1 HF, CAD, and atrial fibrillation

she is currently taking:

Aspirin 325mg PO daily

Furosemide/Lasix 40mg PO daily

Metolazone/Zaroxolyn 5mg PO daily

Potassium chloride/K-Dur 20mEq PO daily

Rosuvastation/Crestor 10mg PO daily

Warfarin/Coumadin 5mg PO daily

Garlic 2 capsules PO daily

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I'm really struggling here. I was given a pharm assignment and this patient has a PT/INR of 80/5. She is receiving Warfarin therapy so the INR isn't TOO high, it should be under 5 though, but isn't the PT supposed to be like 13?? How can it be 80, what does that mean?

Also, I need to prioritize 15 problems with her and I'm just so lost at how to go about it, but I've listed a general list below for some background,

Atrial Fibrillation

BP 90/60 (she normally has HTN so I thought this was significant)

Irregular Heart Rhythm

PT/INR

Large Hematoma on R forehead

low Potassium (3.1)

low sodium (128)

low-grade fever (99.6)

Headache (5/10)

Pitting edema on ankle (WHY does she have low sodium and K if she has edema? wouldn't here sodium and K be elevated bc of fluid retention?)

Weak Peripheral Pulses (posterior tibial, dorsalis pedis 1+ bilaterally)

Bruising on R side of face, R hip and R shoulder

Osteoarthritis

Occasional Incontinence

Dry, Flaky Skin

I am also expected to give rational for the ranking of each and a treatment

any help is so so very appreciated!!!!

More background: Pt has had two MIs, class 1 HF, CAD, and atrial fibrillation

she is currently taking:

Aspirin 325mg PO daily

Furosemide/Lasix 40mg PO daily

Metolazone/Zaroxolyn 5mg PO daily

Potassium chloride/K-Dur 20mEq PO daily

Rosuvastation/Crestor 10mg PO daily

Warfarin/Coumadin 5mg PO daily

Garlic 2 capsules PO daily

look up coumadin and see what it will do to a PT..

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does not explain the value of INR

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

pt/inr: the test | prothrombin time and international normalized ratio

what does the test result mean?

the test result for pt depends on the method used, with results measured in seconds and compared to the average value in healthy people. most laboratories report pt results that have been adjusted to the international normalized ratio (inr) for patients on anticoagulant drugs. these patients should have an inr of 2.0 to 3.0 for basic "blood-thinning" needs. for some patients who have a high risk of clot formation, the inr needs to be higher - about 2.5 to 3.5.

the patient is exhibiting bruising. i assume they fell. the eleveated pt will increase bleeding. the ideal target inr range will vary from person to person depending on a variety of factors such as the reason for taking anticoagulants, other medical conditions, and a number of other issues. your anticoagulation clinician will determine the appropriate inr range for you. the most common inr target range for someone on warfarin is somewhere between 2.0 and 4.0. inrs of 5 or more typically are avoided because the risk of bleeding increases significantly at inrs above 5.

blood clot & anticoagulation websites: clotcare

prioritization is done by the patient's most important needs. keep in mind that the care plan is a problem solving process, so each nursing diagnosis is actually a patient problem. you list the problems in the order of which is most important of needing attention first. most instructors suggest prioritizing by maslow's hierarchy of needs. the hierarchy from most important to least important is as follows:

  1. physiological needs (in the following order)
    • the need for oxygen and to breathe
    • the need for food and water
    • the need to eliminate and dispose of bodily wastes
    • the need to control body temperature
    • the need to move
    • the need for rest
    • the need for comfort

[*]safety and security needs (in the following order)

  • safety from physiological threat
  • safety from psychological threat
  • protection
  • continuity
  • stability
  • lack of danger

[*]love and belonging needs

  • affiliation
  • affection
  • intimacy
  • support
  • reassurance

[*]self-esteem needs

  • sense of self-worth
  • self-respect
  • independence
  • dignity
  • privacy
  • self-reliance

[*]self-actualization

  • recognition and realization of potential
  • growth
  • health
  • autonomy

https://allnurses.com/nursing-student...lp-276459.html

nursing resources - care plans

critical thinking flow sheet for nursing students

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"Pitting edema on ankle (WHY does she have low sodium and K if she has edema? wouldn't here sodium and K be elevated bc of fluid retention?)"

getting lasix, is CHF, so bilat edema. She is peeing out her electrolytes.

Is the afib a new DX?

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Specializes in Progressive, Intermediate Care, and Stepdown.

This is a long and tough list of problems. Here what I came up with. I ordered them according to what I would address. I'm no expert. Keep that in mind

Atrial Fibrillation

Irregular Sinus Rhythm

PT/INR

Large Hematoma

Headache

Bruising

BP

Low potassium

Low Sodium

Fever

Weak Pulses

Pitting Edema

Osteoarthritis

Incontinence

Skin

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