Before administering the first dose of warfarin, the nurse questions the patient about all drugs taken during the previous 2 to 3 weeks (if the patient was recently admitted to the hospital). If the patient took any drugs before admission, the nurse notifies the primary health care provider before the first dose is administered. Usually, the prothrombin time (PT) is ordered and the international normalized ratio (INR) determined before therapy is started. The first dose of warfarin is not given until blood for a baseline PT/INR is drawn. The dosage is individualized based on the results of the PT or the INR.
If the patient has a DVT, it usually occurs in a lower extremity. The nurse examines the extremity for color and skin temperature. The nurse also checks for a pedal pulse, noting the rate and strength of the pulse. It is important to record any difference between the affected extremity and the unaffected extremity. The nurse notes areas of redness or tenderness and asks the patient to describe current symptoms. The affected extremity may appear edematous and exhibit a positive Homans' sign (pain in the calf when the foot is dorsiflexed). A positive Homans' sign is suggestive of DVT.
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