NURS 1556 Clinical Medications Worksheets (You will need to make additional copies of these forms) Generic Name

Trade Name Classification Dose Route Time/frequency Warfarin Coumadin Anticoagulants 2.5 mg PO QD Peak Onset Duration For IV meds, compatibility with IV drips and /or 5-7 days 36-72 hours 2-5 days solutions Mechanism of action and indications (Why med ordered) Interferes with hepatic synthesis of vitamin K dependent clotting factors (II, VII, IX, and X). Prevention of thromboembolic events. For CHF. Nursing Implications (what to focus on) Contraindications/warnings/interactions - Uncontrolled bleeding. Open wounds. Active ulcer disease. Recent brain, eye, or spinal cord injury or surgery. Severe liver or kidney disease. Uncontrolled hypertension. Common side effects - Cramps, nausea, dermal necrosis, bleeding, fever

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) – NSAIDs, acetaminophen may increase risk of bleeding, many other drugs. Foods with Vitamin K, St. John’s wort, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, licorice and others.

Nursing Process- Assessment (Preadministration assessment) - Assess for signs of bleeding and hemorrhage (bleeding gums, nosebleed; unusual bruising; tarry black stools; hematuria; fall in hematocrit or blood pressure.

Lab value alterations caused by medicine - PT and other clotting factors should be monitored frequently during therapy. Hepatic function and CBC should be monitored before and periodically throughout therapy. Stool and urine should be monitored for occult blood before and periodically during therapy. Be sure to teach the patient the following about this medication – Don’t double doses. Dr. should be informed of missed doses at time of checkup or lab tests. Review foods high in vitamin K. Encourage a consistent intake of Vitamin K because it is the antidote for warfarin alternating intake could cause PT levels to fluctuate. Avoid IM injections and activities leading to injury. Use a soft tooth brush, do not floss, and shave with an electric razor. Report any signs of unusual bleeding. Assessment Evaluation Check after Why would you hold or not give this giving - Prolonged PT or med? - Evidence of bleeding or INR of 2-4.5 without signs hemorrhage. of hemorrhage.