Cardiovascular Case Study

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Cardiovascular Case Study: Atrial Fibrillation and Oral Anticoagulation

Scenario
You are the nurse working in an anticoagulation clinic. K.N. is a patient who has a longstanding irregularly irregular heartbeat (atrial fi brillation, or A-fi b) for which he takes the oral anticoagulant warfarin (Coumadin). Recently, K.N. had his mitral heart valve replaced with a mechanical valve. You know that there are different PT/INR (prothrombin time/International Normalized Ratio) goal recommendations based on the indication for anticoagulation. (NOTE: PT has now been replaced by or is reported, in most cases, with INR [International Normalized Ratio], an international value that allows for laboratory standardization. PTT is more properly written …show more content…

CASE STUDY PROGRESS
You know that sometimes the only needed action is to stop the warfarin several days before the surgery. Other times the provider initiates “bridging therapy,” or stops the warfarin and provides anticoagulation protection by initiating unfractionated heparin or low-molecular-weight heparin. After reviewing all his anticoagulation information, the provider decides that K.N. should be on enoxaparin (Lovenox) before surgery.

9. How should you explain the importance of enoxaparin to K.N.?

You can let KN know that bleeding is a concern when a person is having surgery (especially when he has had high INR levels) and Lovenox has a shorter half life than Coumadin, so it will only stay in his system a short while. So if we stop the Coumadin and switch to Lovenox, we can prevent too much blood loss during the surgery since the Lovenox can be out of your system quicker.

CASE STUDY PROGRESS

Your next patient has a history of taking his medication sporadically and doesn’t show up for his PT/INR testing on a regular basis. His noncompliance is not due to financial problems or cognitive impairment.

10. What content areas should you address during this patient encounter?

You can ask if there is any reason he is not taking his meds and offer to come up with a solution together to whatever the reason is. You can understand that there are different learning styles and approach your teaching in a different

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