Question

You are caring for a patient who has come in from a nursing home to the ER with a fractured hip at 0900. You receive the patient onto the surgical unit at 1100. The patient is supposed to go to the OR later today.

PMHx: chronic atrial fibrillation, COPD. She also recently has had a flare up of her Chrohn’s disease so has been put on prednisone 10 mg daily for two weeks followed by a tapering dose.

Medications at the nursing home: Warfarin, steroid puffer OD and Ventolin prn, Prednisone 10 mg OD x 1 more week then reducing dose.

Pre-op bloodwork: INR 2.3, ptt normal, Hb 129, K 4.0

1. You are receive and order for Vitamin K stat. Why would you be giving this drug? What should you record in the MAR before giving it?
   
2. What lab work do you expect will need to be drawn and be within normal before the patient goes to the OR? What if it comes back abnormal?
   
3. This patient is ordered Solumedrol (IV steroid) IV on call to the OR. Why?

Answer 1

Warfarin is the anticoagulant drug which is used to avoid blood clotting in the vessels. This patient had fractured hip so patient at complication of developing deep vein thrombosis or DVT.

Vitamin k is the antidot for warfarin. Which allow to form blood clot. Some times the use of warfarin get more effect so need to administer the vitamin k to avoid bleeding.

Before given the drug we should monitor the vital signs and PTT. They should be normal. And also ask for any bleeding history.

The lab reports should include PTT , clotting time and WBC count etc.