Where you are:
You are an FY2 in anti-coagulation clinicWho the patient is:
Pal Johnson, a 40 year-old man who has come in for a routine follow up at the clinic. He was diagnosed with Deep Venous Thrombosis 6 weeks ago and was given warfarin. He has some learning disabilityOther information you have about the patient:
INR Target: 2-3
INR Results
1 week: 1.2
2 week: 1.4
3 week: 1.5
4 week: 1.3What you must do:
Nurse Smith who usually takes blood from the patient has asked you to talk to the patient and explore the reason for sub-optimal INR and address his concerns
Concern: Dr talks too fast, I don’t understand big words how to take the medicine.
Examination and investigation: Take observation, head to toe, INR test results as follows 1st week 1.2, 2nd week 1.4, 3rd week 1.5, 4th week 1.3
Management:
- greet and confirm identity
- paraphrase the scenario
- ask about general health, red flags, any new symptom
- Explore DVT, any difficulties in walking etc, explore warfarin, how many doses, is he taking it regularly etc
- Explore learning difficulties and follow ups, MAFTOSA & DESA
- Now explain DVT in easier way that he has pipes in his body where fluid runs,called blood, if it gets think can block the pipes, that’s why he is having leg pain,needs medicine to thin the blood so that blood can flow freely
- Explain INR,INR value has been low which means his blood is thick-like jelly. This increases the chance of developing a clot in his brain,heart or any organ
- Address how patient takes his drug.
- Tell his you will write down easily in a paper
- Encourage him to take medicine and come for follow up
- Offer warfarin card,and tell him to tell doctors before any surgical procedure
- Safety netting of bleeding