An older adult recovering from a myorcardial infarction (MI) has been taking subcutaneous heparin but is now to receive oral warfarin (Coumadin). The nurse prepares to teach the patient which topics? (Select all that apply.)
a. Administration of both medications for up to 5 days
b. Need to use a soft bristle toothbrush
c. Use of atropine as an antidote for exces-sive bleeding
d. Need to continue drawing partial throm-boplastin times
e. Need to drink at least eight cups of fluids daily
A, B, D
Heparin and warfarin (Coumadin) are anticoagulants used to prevent the enlargement of existing thrombi and new clot formation after an MI. Therapeutic effects of heparin are monitored by partial thromboplastin times; the antidote is protamine sulfate. Warfarin is monitored by the in-ternational normalized ratio (INR); the antidote is vitamin K. Patients who initially receive hepa-rin for anticoagulation and who need oral anticoagulation for maintenance usually take both forms of medication for 3 to 5 days to develop therapeutic blood levels. Bleeding is a complica-tion. Patients need to be taught bleeding precautions.
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