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Nevertheless, an unscheduled PT test performed in the ER during her second visit provided markedly different results indicating a prolonged coagulation time despite no known changes to the patient's medication regimen or diet.
As a result of the results of the PT test performed in the ER, her physician lowered her daily dosage of Coumadin to 2 milligrams per day, with instructions to repeat PT testing weekly for the time being. Four days later, the patient returned to the ER complaining of excessive bleeding from the nose and gums (on flossing) again, despite following her physician's instructions to decrease her Coumadin dosage.
Administration of intravenous saline and elevation of the affected extremities again resolved her symptoms, but this time, she was admitted to the hospital for observation and more extensive testing scheduled by her cardiologist for the nest day.
Resolution:
While interviewing the patient and her family in great detail the next day, her physician inquired again into every over-the-counter (OTC) medication taken since her return from Europe and again reviewed dietary guidelines intended to avoid unintended interference with the desired effects her Coumadin regimen. The interview failed to disclose any medication interactions or dietary issues. Only after the interview concluded, did the patient ask "Doctor, does it matter what kind of tea I drink?" On the physician's subsequent inquiry, the patient disclosed that she had begun drinking Ginseng tea that a friend in...
The physician advised that Ginseng has been shown, in at least one study, to decrease the effectiveness of Coumadin's anticoagulant effects.
The physician then inquired more particularly into whether the patient had taken any other natural remedies" and stressed the importance of considering any and all types of dietary changes, including any so-called "naturopathic" products. The patient then related that the same person who had provided the Ginseng tea had also suggested
Ginkgo Biloba and St. John's Wart for "mood elevation." According to the patient, she first began taking those two herbal agents shortly after her first visit to the ER, specifically because she was depressed over the recurrence of her DVT symptoms.
After reiterating his instructions about avoiding "any and all" dietary changes without first consulting him, he instructed the patient to discontinue the Ginseng tea, St.
John's Wart, and the Ginkgo Biloba, the last of which, in particular, has specifically been linked to increasing the effect of blood thinning medications like Coumadin, resulting in excessive bleeding. Following her discharge the next day, the patient was returned to her previous 2.5mg/day dosage of Coumadin without subsequent medical incident. She is presently looking forward to her next European trip in July of 2008.
Ginkgo Biloba and St. John's Wart for "mood elevation." According to the patient, she first began taking those two herbal agents shortly after her first visit to the ER, specifically because she was depressed over the recurrence of her DVT symptoms.
After reiterating his instructions about avoiding "any and all" dietary changes without first consulting him, he instructed the patient to discontinue the Ginseng tea, St.
John's Wart, and the Ginkgo Biloba, the last of which, in particular, has specifically been linked to increasing the effect of blood thinning medications like Coumadin, resulting in excessive bleeding. Following her discharge the next day, the patient was returned to her previous 2.5mg/day dosage of Coumadin without subsequent medical incident. She is presently looking forward to her next European trip in July of 2008.
Interactions: the patient had informed me about his medical history and his psychological state so as to compensate and recommend the best possible drug dosage. Nursing implications: This drug has mild side effects. However, the patient was still advised to consult me if any unusual problems occurred. Client Implications: the eye irritation caused by swimming had been completely cured. Patient Education: the patient had been instructed to ensure regularity in all his appointments 9.
Pharmacology: Moclobemide Moclobemide is classified as an antidepressant, a MAO (monoamine oxidase) inhibitor. Antidepressants are designed to inhibit the reuptake or reabsorbtion of specific neurotransmitters, increasing the levels of these neurotransmitters around the nerves of the brain (Gbemudu, 2011:1). Neurotransmitters such as serotonin, dopamine and norepinephrine (noradrenaline) are often called 'feel good' chemicals that elevate the patient's mood. Drug class A deficit of mood-enhancing chemicals is associated with depression, although there is no
Spinal vs. General Anesthesia The outcome of patients after undergoing transurethral resection of the prostate is examined under varying clinical situations to assess whether spinal anesthesia is associated with greater likelihood of positive outcome. Also examined in great detail are the potential for increased morbidity and mortality based on whether patients underwent general or spinal anesthesia during surgery. A large body of evidence indicates that there is no statistically significant
This keeps prices all for all users of oil high at present, given the overall escalation of users in total and insulates the price of gas and oil from subtle increases and decreases upon the part of individual suppliers. (Halcomb, 2005) However, other possible causes may be simple hysteria and gouging. Historically, even when there has been a wholesale price of gas of $1.45 a gallon, gas stations have been
Oil Price Fluctuation Actions adopted by the government to reduce or limit price fluctuation Oil Price Fluctuation iii This report will focus on the actions adopted by the government to reduce the fluctuation in oil prices. A brief introduction is discussed in the assignment. The reasons are also described in the assignment for which the oil prices fluctuate. This assignment also puts light on the price stability and why governments need to intervene
Gasoline Prices Why do gasoline prices fluctuate so wildly and frequently? One month the price of gasoline is around $3.50 and the next month prices have jumped to $4.00. Why does this happen? There are several reasons that are given by authorities and other sources and they will be presented in this paper. Reasons Why Gasoline Prices Fluctuate According to the U.S. Energy Information Administration (IEA), the price of crude oil on the