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1- what risk factor’s put Bob at a higher risk for bleeding?

Alcohol use and taking aspirin and tylenol puts patients at an increased risk for bleeding when taken concurrently with Warfarin.

2-   What patient education should be provided to Bob?

Avoid alcohol and OCT meds, employ nonpharm measures to avoid thrombi formation, advise client to wear medical alert bracelet for warfarin use, teach client to self monitor PT/INR at home as appropriate, use soft bristle toothbrush and electric razor

3- What should the nurse be most concerned about with Bob?

The 3 cm gash on Bob’s forearm, because he is taking Warfarin he is at an increased risk for bleeding. Also taking Warfarin increases PT, aPTT and bleeding times making it harder to stop bleeding.

4-What is the therapeutic use of Warfarin?

Treatment of venous thrombosis, thrombus formation in clients who have a-fib or prosthetic heart valves, prevention of recurrent MI, TIA, PE, or DVT

5- What are interactions and precautions with Warfarin therapy?

Other anticoagulants, aspirin/acetaminophen glucocorticoids, sulfonamides, parenteral cephalosporins (increase) phenobarbitol, carbamzepine, phenytoin, oral contraceptives, vitamin K (decrease) also food high in vitamin K like lettuce, spinach, cabbage, broccoli, brussels sprouts.

Pregnancy category, low platelet count or uncontrolled bleeding, vitamin K deficencies, liver disorders, alcohol use disorder which increases risk for bleeding, cautions with clients with hemophilia, dissecting aneurysm, peptic ulcer disease, severe HTN

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Jacob Price

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Jacob Price

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Jacob Price

Bob is a 65-year-old man with atrial fibrillation and just underwent a left total knee replacement 7-days ago. Bob was sent home with a new order for Warfarin 4mg once daily. A month later Bob presents to the emergency department and states he tripped over a rug and hit the floor. Upon further investigation, Bob admits to drinking "some beer" earlier that day and also states that he had a headache a few days ago and took aspirin which did not help so he took Tylenol. When asked how often he drinks and uses OTC drugs, Bob states he drinks a few days out of the week and takes aspirin or Tylenol at least three times a week for headaches or pain in his knee.
On examination: BP 140/80 mmHg; pulse rate 102, irregular; Respirations 20; Temp 101.2. Physical examination shows evidence of multiple large bruises on Bob's arms, legs, head, and abdomen. Bob also has a 3 cm gash on his forearm.

1- what risk factors put Bob at a higher risk for bleeding?

2-   What patient education should be provided to Bob?

3- What should the nurse be most concerned about with Bob?

4-What is the therapeutic use of Warfarin?

5- What are interactions and precautions with Warfarin therapy?

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Karch, A. (n.d.). Karch: Focus on Nursing Pharmacology, Seventh Edition.

Retrieved from https://coursepoint.vitalsource.com/#/books/9781496358462/

cfi/6/514!/4/2/2/10/10/4/10@0:100

Henry, N. J. E., Mcmichael, M., & Johnson, J. (2016). RN Pharmacology for

Nursing. Assessment Technologies Institute LLC.

[NRSNG - NCLEX REVIEW](2016, September 15) Heparin Nursing Considerations, Side effects, and Mechanism of Action, Pharmacology for Nurses. [video file] Retrieved from https://www.youtube.com/watch?v=1zkJVt7wNBE

NRSNG - NCLEX REVIEW](2016, September 7) Partial Thromboplastin Time Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing. [video file] Retrieved from https://www.youtube.com/watch?v=zBZBZ6napUY

NRSNG - NCLEX REVIEW](2016, August 4) Clopidogrel Nursing Considerations, Side effects and Mechanism of Action Pharmacology for Nurses. [video file] Retrieved from https://www.youtube.com/watch?v=a5vHkOJmBcE

Dosage Calculation 2.0 Desired Over Have: Critical Care Medications. (n.d.).

Retrieved February 11, 2017, from Ati Nursing website:

https://student.atitesting.com/Tutorial

NRSNG - NCLEX REVIEW](2016, September 11) Bleeding Precaution RANDI Mnemonics Nursing School Study Tips. [video file] Retrieved from https://www.youtube.com/watch?v=wLR2D7wcDCo

Blood Clotting Tests. (2012, January 10). Retrieved February 11, 2017, from http://www.healthcommunities.com/blood-tests/blood-clotting-tests.shtml

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Jacob Price

R- Razors
A- Aspirin
N- Needle sticks smallest gauge
D- Decrease needle sticks
I - injury

Lab/Diagnostic
PT

aPTT
INR

Platelet count

Bleeding times

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Jacob Price

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Jacob Price

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Mechanism of Action Pharmacology for Nurses

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Mechanism of Action , Pharmacology for Nurses

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Clopidogrel Nursing Considerations, Side Effects, and Mechanism of Action Pharmacology for Nurses

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Grab our free cheatsheet covering the 50 most commonly prescribed medications right here: http://NRSNG.com/50meds Listen to all the episodes at: https://www.nrsng.com/medmaster-podcast/ View the blog post here: https://www.nrsng.com/clopidogrel-plavix/ Clopidogrel Generic Name: clopidogrel Trade Name: Plavix Indication: atherosclerotic events, MI, CVA, PVD, acute coronary syndrome Action: inhibits platelet aggregation Therapeutic Class: Antiplatelet

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Jacob Price

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Mechanism of Action Pharmacology for Nurses

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Partial Thromboplastin Time Nursing Considerations, Normal Range, Nursing Care, Lab Values Nursing

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Grab our free cheatsheet covering the 63 Must Know Labs for nurses right here: http://www.NRSNG.com/labs Listen to all the episodes at: https://www.nrsng.com/labspodcast/ View this post on our blog: https://www.nrsng.com/partial-thromboplastin-time/ Partial Thromboplastin Time (PTT) Normal: 25 - 35 seconds Indications:  Detection of coagulation disorders  Evaluate response to Heparin (PT for Coumadin)  Preoperative assessment Description: Partial Thromboplastin Time (PTT) evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII.

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Jacob Price

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Mechanism of Action Pharmacology for Nurses

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Side Effects and Mechanism of Action Pharmacology for Nurses

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Heparin Nursing Considerations, Side Effects, and Mechanism of Action, Pharmacology for Nurses

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Grab our free cheatsheet covering the 50 most commonly prescribed medications right here: http://NRSNG.com/50meds Listen to all the episodes at: https://www.nrsng.com/medmaster-podcast/ View the blog post here: https://www.nrsng.com/heparin/ Heparin Generic Name: heparin Trade Name: Hep-Lock Indication: Venous thromboembolism prophylaxis and treatment, low dose used to ensure patency of IV catheters Action: increases the inhibitory effect of antithrombin on factor Xa Therapeutic Class: anticoagulant Pharmacologic Class: antithrombotic Nursing Considerations:  monitor for signs of bleeding  monitor platelet count  may cause hyperkalemia  have patient report any signs of bleeding

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Jacob Price

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Jacob Price

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Jacob Price

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Jacob Price

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Jacob Price

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Jacob Price

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This is my most recent national spot, shot in southern California in January of 2016.