INR Flashcards
What is INR
time taken for blood to clot via the extrinsic pathway
What does an increased and decreased INR mean and how does this affect bleeding risk?
Increased= increased time for blood to clot= increased bleeding risk
Decreased= decreased time for blood to clot= increased clotting risk
What is the INR target for patients
2-3
What type of medication is Warfarin and how does it work
Vitamin K antagonist
decreases factors 10, 9, 7 and 2= slows clotting cascade
What is high INR symptoms 5
(increased bleeding risk)
1. headaches
2. increased bruising
3. increased bleeding time
4. blood in urine/ when brushing gums
5. increase in menstrual blood loss
What are low INR symptoms 5
(increased clotting risk)
1. new SOB
2. new chest/ leg pain
3. speech difficulties
4. any sudden onset weakness/ tingling/ numbness in arms/legs
5. vision changes
What is the general structure for INR chronic disease management 7
- Ask about patient’s PC
- Checking patient’s understanding
- Ask about patient’s condition
- Ask the patient about their medication
- Effect of diabetes on patient
- PMH, DH, FH, SH
- ICE
What to ask when checking patient understanding regarding INR 4
- Explain their condition if they don’t understand it
- explain their medication if they don’t understand
- explain what INR is and normal range and why it’s good to stay in the range
- explain their results if results are in the initial brief
What to ask about patient’s condition regarding INR 3
- how long have you had this condition
- how well do you think this has been managed
- any symptoms of low or high INR
What to ask patient about their medication regarding INR 4
- When did they start warfarin and WHY are they on warfarin (explain if they don’t know)
- Adherence (if skipping why, how often, doubling doses?)
- side effects/ adverse effects?
- How effective has the medication been at controlling their condition
What to ask about effect of condition on patient 5
- mood
- sleep
- diet
- ADL
- affecting work/ personal life
Things to ask about PMH regarding INR 2
and why are they relevant
- liver failure (decrease in clotting factor production= increased bleeding risk= high INR)
- bleeding disorders eg haemophillia/ von willebrand’s disease= high INR
What to ask about rest of patient’s drugs history regarding INR 5
- other medication/ over the counter
- any OTP/ HRT (decreases INR)
- any NSAIDs: aspirin/ ibuprofen (increases INR)
- recreational drugs
- allergies
Social history question regarding INR 5
- diet changes (leafy greens)
- supplements
- weight loss
- binge drinking alcohol
- smoking
Treatment for high INR 3
- if no clear reason- lower warfarin and repeat INRs
- vitamin K
- transfusion with blood components to stop bleeding
