B.B is a 29-year-old female who came to the emergency department with complaints of leg pain, swelling and warm that hasn’t subsided in the past two days. She’s lightheaded, and her vitals are Blood Pressure 130/90, Heart Rate 110, respiratory rate of 21, temperature of 101.1 F, O2 stat of 98%, and pain level 9 out of 10. Her right limb appeared swollen and tender. B.B mentions that the only medication she is on is Etonogestrel Ethinyl Estradiol but it’s inserted Vaginally, this medication is known as birth control and she has been using it for over 5 years. B.B is overweight with a BMI of 28.9 and has smoked for over 8 years. B.B reports that she does not exercise, eat healthy, or take any other medications or supplements. Doppler Sonography was ordered and early DVT was confirmed.

B.C Case Study

Acute Pain

Acute pain related to inflammatory response in the affected vein, as evidence by pain score 9 out of 10.

Ineffective Tissue Perfusion

Ineffective tissue perfusion related to venous stasis of the right leg as evidence by leg warmth, tenderness, redness, and swelling.

01

02

Priority Nursing Diagnosis

Vitamin K epoxide reductase complex in the liver is blocked by warfarin and other vitamin K antagonists (VKAs), which causes a depletion of the reduced form of vitamin K, which is a cofactor for the gamma carboxylation of vitamin K-dependent coagulation components. [1]

Mechanism of Action

Routes

Oral (PO)

Indication

Atrial fibrillation (AF)

Venous thromboembolism (VTE)

Prosthetic heart valves.

A.A Prescription

At first, 2 to 5 milligrams (mg) as a single dose once per day, at the same time each day

Warfarin

Warfarin is known as a drug class called anticoagulant’s but is also called blood thinners.

Warfarin is also used to treat or prevent pulmonary embolism and venous thrombosis

(swelling and blood clot in a vein) (a blood clot in the lung)

Severe headache

Severe bleeding

Red or Brown Urine

Black or tarry stools

Coughing blood

Joint pain

1

2

3

4

5

6

Side Effects

1

Large esophageal varices.

2

Patients who have undergone major surgery within the last 72 hours.

3

A platelet count less than 50 x 109/cu.mm, which constitutes significant thrombocytopenia

4

Hypersensitivity to the drug, such as skin ischemic necrosis or priapism.

Contraindications

Assessment for potential side effects

Laboratory tests for dose titration, and vigilance for potential drug and food interactions

Watch for signs of bleeding and hemorrhage, including bleeding gums, nosebleeds, unusual bruising, coughing up blood, black/tarry stools, hematuria, or a fall in hematocrit or blood pressure.

Assess for edema and decrease edema in affected limb

Monitor PT/INR

Follow up with scans to evaluate the clot

Monitor the patient’s coagulation and blood count

Encourage the patient to adhere to the follow-up schedules with the healthcare provider.

Advise the patient that if coumadin therapy is stopped, the anticoagulant effects of coumadin may last for 2 to 5 days.

Educate client to take the Warfarin at the same time every day, as directed by your doctor or nurse.

Interventions

Caution patient to avoid IM injections and activities leading to injury

Instruct patient to use a soft toothbrush, not to floss, and to shave with an electric razor during warfarin therapy

Advise patient that venipunctures and injection sites require application of pressure to prevent bleeding or hematoma formation

Take your warfarin as instructed and at the same time each day.

Talk with your healthcare provider before changing your diet or starting any new drugs, herbal products or nutritional supplements

Teaching Plan

B.C Case Study After administering Heparin in the hospital client received compression stockings and was sent home on Warfarin. Client was also ordered to stop taking her birth control and was educated on other contraceptive methods to reduce the risk of another DVT..

Mayo Foundation for Medical Education and Research. (2022, June 11). Deep vein thrombosis (DVT). Mayo Clinic. Retrieved July 17, 2022, from https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/diagnosis-treatment/drc-20352563

U.S. National Library of Medicine. (n.d.). Warfarin: Medlineplus Drug Information. MedlinePlus. Retrieved July 17, 2022, from

https://medlineplus.gov/druginfo/meds/a682277.html#:~:text=Warfarin%20is%20also%20used%20to,anticoagulants%20(‘blood%20thinners’).

Warfarin (Coumadin, Jantoven): Davis’s Drug Guide. Warfarin (Coumadin, Jantoven) | Davis’s Drug Guide. (n.d.). Retrieved July 17, 2022, from https://www.drugguide.com/ddo/view/Davis-Drug-Guide/51797/all/warfarin