Anticoagulant Case Study (Pearl) - Day 3
Patient Story (Day 3)
On Day 3, Pearl’s INR is nearing therapeutic range. She mentions wanting to take “Ecotrin” for backache, along with herbal supplements (ginkgo, garlic, and ginger). The staff warns that these may increase bleeding risk, and the provider may adjust her warfarin dose accordingly. Pearl feels stable, denies new headaches, and is eager to be more mobile.
Orders (Day 3)
- Continue Heparin SubQ until INR is therapeutic
- Continue Warfarin 5 mg PO daily (adjust if INR too high)
- Evaluate OTC/herbal usage with PharmD consult
- Educate patient on dietary and herbal interactions
Vital Signs (Day 3)
- BP: 134/80 mmHg
- HR: 90 bpm
- RR: 18 breaths/min
- SpO₂: 97% on RA
- Temp: 36.8°C (98.2°F)
Medical History
- Subdural Hematoma (6 weeks ago)
- Pulmonary Embolism (2 weeks ago)
- Hypertension
- No known drug allergies
Labs & Diagnostics (Day 3)
| Test | Value | Reference Range | Indicator |
|---|---|---|---|
| aPTT | 34 s | 25–35 s | HIGH-NORM |
| PT/INR | 14 s / 1.8 | PT: 11–13.5; INR: 2–3 (therapeutic if on Warfarin) | NEAR THERAPY |
| Platelets | 210,000/µL | 150,000–400,000/µL | NORMAL |
Medication Administration Record (MAR)
| Medication | Time | Status |
|---|---|---|
| Heparin 5,000 units SubQ | 09:00 | Given |
| Warfarin 5 mg PO daily | 10:00 | Continued |
| Aspirin 81 mg PO daily | -- | Possible order |
| Herbal supplements | -- | Patient request |
Day 3 Scenario Questions
15) How will these herbal supplements (ginkgo, garlic, ginger) affect her prescribed medications?
16) What additional dietary education does Pearl need?
17) Arrange these self-care instructions in the best daily sequence (1→4):
Step #1
Step #2
Step #3
Step #4