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Case Study #24 Chronic Anticoagulation 

Problem Identification

1.a Create a list of this patient’s drug-related problems.

Patient taking warfarin- anticoagulant- can cause bleeding. 

Ibuprofen- anti-inflammatory can increase risk of bleeding. 

1.b. What questions would you ask this patient to assess current warfarin therapy?

    Patient needs to be assessed on how often she takes warfarin, dosage, and when her last INR levels were, and what they are. 

1.c. What signs or symptoms might she experience if she develops a venous thromboembolism?

Patient can develop leg swelling, leg pain, cramping or soreness that often starts in the calf, redness on leg, and warmth. Other complications can include shortness of breath, chest pain, or discomfort when taking a deep breath, feeling dizzy or light headed, fainting, rapid pulse, rapid breathing, and coughing up blood (Mayo Clinic, 2022).

1.d. What is her risk of thromboembolism during interruption of warfarin therapy? (see table 24-1)

1.e. What are the risks of using nonsteriodal anti-inflammatory drugs (NSAIDs) inn combination with warfarin?

It will increase her chance of bleeding, bruising.

Desired outcomes

2. What are the goals of anticoagulation therapy in this patient?

Patient has a history of two DVT and has antiphospholipid syndrome making her a high risk patient for developing clots, the goal is to prevent her from developing a blood clot.

Therapeutic Alternatives

3.a. What are the options for extended therapy of venous thromboembolism?

3.b. What are the options for periprocedural management of anticoagulation?

 Optimal Plan

4.a. Based on today’s laboratory result, what is your recommendation for this patient’s warfarin therapy?

 

4.b. How should the plan for periprocedural management of anticoagulation be implemented? 

Outcome Evaluation

5. How will you monitor this patient’s warfarin therapy? 

Patient education

 6.  What information should this patient know regarding her upcoming bridging therapy for her colonoscopy procedure?

 

SCIENCE
HEALTH SCIENCE
NURSING
NRSG 675

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