History:
You are FY2 in Anti coagulant clinic. A 52 year old man came to the clinic for routine follow up, he was diagnosed with DVT 6 weeks back and was given Rivaroxaban. He has learning disabilities. He knows what this medicine does but he takes it when his leg hurts. He doesn’t understand big words like HTN,DVT,INR. He doesn’t have any new symptoms
Task: Talk to him and explore the reason of 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