![]() Perform hand hygiene before patient contact.Encourage questions and answer them as they arise. ![]() Instruct the patient to use an electric razor for shaving instead of a razor with a blade.Discuss any dietary concerns with the patient, family, and caregivers.Teach the patient, family, and caregivers the signs and symptoms of a blood clot and provide instructions on when to seek additional care.Teach the patient, family, and caregivers to distinguish between minor and major bleeding, and teach them emergency measures for major bleeding.Instruct the patient, family, and caregivers to contact the practitioner before taking any new prescription or over-the-counter medication.Teach the patient, family, and caregivers the importance of a wallet card or medical alert bracelet or necklace to inform emergency health care providers that the patient is taking oral anticoagulants.Teach the patient, family, and caregivers to correctly perform the procedure.Teach the patient, family, and caregivers proper storage for test strips.Provide developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, and overall neurologic and psychosocial state.Some devices also have internal quality control, eliminating the need for an external quality control solution. The manufacturer of the coagulometer provides control solution with a known INR value to test functioning, not the accuracy of the monitor. Quality control is an important part of PT/INR testing to ensure that the coagulometer is functioning correctly. Dietary modifications may not be necessary when initiating a regimen of vitamin K antagonists. Research results are mixed regarding the effect of dietary intake of vitamin K on the coagulation response. Medication dosage changes are based on the INR results to reduce the risk of complications therefore, all PT/INR results must be reported to the practitioner. 2 Optimized management of oral anticoagulation therapy improves the quality of treatment. 3 Excessively milking the finger-stick site, not allowing alcohol to dry before performing the finger-stick, delaying the application of the blood sample to the test strip, or applying an inadequate amount of blood to the test strip can cause distorted INR results. An INR above 5 seconds is considered a critical value and should be reported to the practitioner immediately. The therapeutic range is typically between 2 and 3 seconds, 3 depending on the reason the patient is on anticoagulation therapy. ![]() In the home setting, monitoring of the INR can be done with a portable blood coagulometer using a finger-stick blood sample applied to a test strip (which may come in cartridge or cassette form, depending upon the manufacturer). Point-of-care INR testing eliminates delays in waiting for the result of PT measurements to be processed by a laboratory and the subsequent delay in adjustment of anticoagulation dosing. ![]() Oral anticoagulant therapy requires regular and frequent monitoring to ensure that the INR is within the therapeutic range and to reduce the risk of hemorrhage and blood clots. Good therapeutic control via regular monitoring of PT/INR to analyze the clotting tendency of blood is imperative to minimize adverse events. The purpose of monitoring the PT/INR is to determine the clotting tendency of the blood. Oral anticoagulation therapy with vitamin K antagonists (e.g., warfarin) is prescribed both prophylactically and therapeutically for patients at risk of venous thromboembolism, such as those with prosthetic heart valves, atrial fibrillation, or venous thrombosis. The daily dose may be increased, decreased, or kept the same depending on the PT test results for that day. If the patient is receiving warfarin, obtain the blood specimen before the patient receives the daily dose of warfarin. Prothrombin Time/International Normalized Ratio Testing (Home Health Care) - CE ALERT ![]()
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