• Serum creatinine

• CBC with platelets

3. Medications:

• Screen the patient's pharmacy profile for potential drug-drug interactions with anticoagulation therapy

• Initiate UFH or LMWH or fondaparinux by injection (see Table 10-3 for dosing guidelines)

• Start warfarin sodium orally every evening (see Fig. 10-9 for dosing guidelines)

• Start pain medication if necessary (avoid nonsteroidal anti-inflammatory drugs)

4. Patient education:

• Educate the patient regarding the purpose of therapy and importance of proper monitoring of anticoagulant drugs. Assist the patient to determine an appropriate provider for long-term monitoring of anticoagulation therapy.

• If LMWH or fondaparinux is selected, teach the patient how to self-administer (if the patient or a family member is unwilling or unable to self-administer, visiting nurse services should be arranged). Initial injection should be administered in the medical office or hospital.

• Inform patient about the effects of vitamin K-rich foods on warfarin therapy. Moderate intake (less than 500-1,000 mcg) of vitamin K is acceptable. Provide patient with written material regarding vitamin K content of foods.

• Inform the patient about the potential drug-drug interactions with warfarin, including over-the-counter medications and dietary supplements (Tables 10-8, 10-9, and 10-10). Instruct the patient to call the health care practitioner responsible for monitoring warfarin therapy before starting any new medications or dietary supplements.

• Instruct the patient regarding nonpharmacologic strategies including elevation of the affected extremity and antiembolic exercises such as flexion/extension of the ankle (for lower extremity VTE) or hand squeezing/relaxation (for upper extremity VTE).

5. Next steps:

• If the patient is to be treated at home, dispense to the patient a 5-to 7-day supply of prefilled LMWH or fondaparinux syringes in patient-specific dose.

• If the patient is to be treated with UFH, measure aPTT (or antifactor Xa activity) 6 hours after initiating the IV infusion. Adjust dose if necessary (Table 10-5) and measure aPTT (or antifactor Xa activity) every 6 hours after each dose change until therapeutic. Measure aPTT (or antifactor Xa activity) daily thereafter.

• Arrange for follow-up and long-term anticoagulation therapy management. Communicate with the patient's primary care physician and/or refer to a local antith-rombosis service, if available. If the patient is to be treated primarily in the hospital, these arrangements can be made 1 to 2 days prior to hospital discharge.

6. Document all activities in medical record.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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