An older client receiving warfarin, with alternating doses of 2.5 mg and 5 mg, has an INR of 6.3. What are the immediate nursing interventions for this client? Select all that apply.
1. Prepare to begin a heparin infusion.
2. Administer vitamin K as prescribed.
3. Evaluate liver function tests.
4. Withhold the next warfarin dose.
5. Determine if there is a recent type and crossmatch
2. Administer vitamin K as prescribed.
4. Withhold the next warfarin dose.
5. Determine if there is a recent type and crossmatch
Explanation: 1. The INR is used to measure the effects of warfarin. Heparin is not administered for an elevated INR. If the client must remain anticoagulated, heparin may be started at a later time once the INR has stabilized and the client is not in danger of hemorrhage. This will take days to accomplish.
2. Vitamin K is the antagonist for warfarin and will most likely be prescribed for the client. For INRs between 5 and 9, the recommendation may be to administer vitamin K 1.0 to 2.5 mg by mouth.
3. The older adult client does experience decreased hepatic clearance of warfarin, and hepatic dysfunction can lead to an increased INR. However, the immediate need is not to determine the cause, but to immediately begin to reverse the INR before bleeding occurs.
4. For INRs between 5 and 9, the recommendation may be to omit the next several doses of warfarin.
5. This client may require blood products such as fresh frozen plasma or packed red blood cells. The nurse needs to know if the client has a recent type and crossmatch available in the lab. These are usually only good for 48 hours.
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