Anticoagulant Case Study - Day 3
Patient Story (Day 3)
By Day 3, Thomas Jameson’s aPTT is stable at 65 seconds, and his INR is 2.2. The provider discontinues the IV Heparin and continues Warfarin therapy at home. His bleeding episodes have diminished, and he is comfortable ambulating. Discharge is planned for tomorrow with home health follow-up.
Discharge Orders & Teaching Points
- Warfarin 5 mg PO daily
- Follow-up lab draws for INR every few days until stable
- Encourage consistent intake of vitamin K foods (no sudden changes)
- Bleeding precautions: use soft toothbrush and electric razor
- Educate on signs/symptoms of serious bleeding
- Avoid NSAIDs; watch for interactions with antibiotics
Vital Signs (Day 3)
- BP: 130/80 mmHg
- HR: 95 bpm
- RR: 16 breaths/min
- SpO2: 96% on RA
- Temp: 37.0°C
Medical History
- Hypertension (5 years)
- Type 2 Diabetes Mellitus (15 years)
- Atrial Fibrillation (6 months)
- Hyperlipidemia
- No known drug allergies
Labs & Diagnostics (Day 3)
| Test | Value | Reference Range | Indicator |
|---|---|---|---|
| aPTT | 65 s | 60–80 s | NORMAL |
| INR | 2.2 | 2–3 (therapeutic) | NORMAL |
Medication Administration Record (MAR)
| Medication | Time | Status |
|---|---|---|
| IV Heparin 25,000u/250mL | 09:00 | Discontinued |
| Warfarin 5 mg PO | 10:00 | Continued |
| Metoprolol 25 mg PO BID | -- | Scheduled |
Documentation
Day 3: Discharge
You are getting ready to discharge your patient and have completed the final set of vitals. Chart the below vitals in the "documentation" tab in the patient's chart. Make sure to click "File" to register your vitals.
- Blood Pressure: ~120/80 mmHg
- Heart Rate: 60–100 bpm
- Respiratory Rate: 12–20 breaths/min
- Temperature: 36.5–37.5°C (97.7–99.5°F)
- SpO2: 95–100% on room air
Which points should be emphasized to ensure patient safety at home? (Select all that apply)