A nurse is reviewing the medical records of four clients.
The nurse should identify that which of the following client findings requires follow-up care?
A.
A client who received a Mantoux test 48 hr ago and has an induration.
B.
A client who is taking warfarin and has an INR of 1.8.
C.
A client who is scheduled for a colonoscopy and is taking sodium phosphate.
D.
A client who is taking bumetanide and has a potassium level of 3.6 mEq/L.
The Correct answer and Explanation is:
Correct Answer: B. A client who is taking warfarin and has an INR of 1.8.
Explanation:
Warfarin is an anticoagulant medication that is used to prevent blood clots. It is often prescribed to patients with conditions such as atrial fibrillation, deep vein thrombosis, or pulmonary embolism. The effectiveness of warfarin is monitored through the International Normalized Ratio (INR), which measures the time it takes for blood to clot. For most patients taking warfarin, the target INR range is typically between 2.0 and 3.0, though this can vary depending on the specific condition being treated.
An INR of 1.8 is below the therapeutic range for most indications of warfarin therapy. This suggests that the patient’s blood is not being sufficiently anticoagulated, which places them at an increased risk for developing blood clots. This is a significant concern because the formation of a clot can lead to serious complications such as stroke, myocardial infarction, or pulmonary embolism. Therefore, follow-up care is required to adjust the warfarin dosage to bring the INR within the therapeutic range. This may involve increasing the dose of warfarin or evaluating potential factors that could be interfering with the drug’s effectiveness, such as dietary vitamin K intake, other medications, or the patient’s adherence to the prescribed regimen.
For the other options:
Option A: A client with an induration after a Mantoux test needs further evaluation to determine if it is indicative of tuberculosis infection. However, this does not necessarily require immediate follow-up care, unlike the INR issue.
Option C: Sodium phosphate is commonly used as a bowel prep for colonoscopy. If used correctly, it typically does not require follow-up care unless the patient shows signs of dehydration or electrolyte imbalance.
Option D: A potassium level of 3.6 mEq/L is within the normal range (3.5-5.0 mEq/L), so this does not require follow-up care. However, patients on bumetanide, a loop diuretic, should have their potassium levels monitored regularly as the drug can cause hypokalemia.
In conclusion, the client with an INR of 1.8 while on warfarin therapy is at a higher risk and requires follow-up care to adjust the medication and prevent potential complications.