Given the patient’s risk factors, list what may have contributed to Mr. Matthews’ stroke?
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Mr. Matthews is a 70 year old, 280 pound African American man admitted through the ER for a possible stroke. He has partial paralysis on his left side and is unable to speak. His blood pressure is 190/110 and his CT confirms a recent stroke. He is a lifetime tobacco user. During his hospital stay, it was also discovered that Mr. Matthews has atrial fibrillation and heart failure.
While in the hospital, Mr. Matthews was given the following medications: reteplase/Retavase, bumetanide/Bumex, heparin, warfarin/Coumadin, and lisinopril/Prinivil
His discharge medications include the following: furosemide/Lasix, warfarin/Coumadin, diltiazem/Cardizem, and lisinopril/Prinivil
Three months later, Mr. Matthews comes back to the hospital as he is fatigued, weak, and has found bright red blood in his stool for the last few days during bowel movements. It was discovered he has an INR of 5.6
1. Given the patient’s risk factors, list what may have contributed to Mr. Matthews’ stroke?
2. Give the rationales for each of the medications prescribed those given in the hospital and those prescribed when he was released (why were they prescribed in this case)? Your answer should indicate the purpose of the medication for this particular patient. Your answer should be brief, but accurate
Drugs given in the hospital
reteplase (Retavase)
bumetanide (Bumex)
heparin
warfarin (Coumadin)
lisinopril (Prinvil)
Drugs prescribed on release:
furosemide (Lasix)
warfarin (Coumadin)
diltiazem/Cardizem
lisinopril (Prinvil)
3. From the medications prescribed, which type of stroke do you think this patient had? Explain why.
4. Explain why Mr. Matthews was given both warfarin and heparin while in the hospital?
5. What lab values for warfarin and heparin need to be monitored?
6. What education would you provide Mr. Matthews with regard to his warfarin?
Consider lifestyle factors and precautions such as activities to be cautious about, physical changes, foods to watch, and lab values that should be monitored.
7. What pain medications should Mr. Matthews avoid and why? (think about clotting)
8. What lifestyle changes would you provide education to Mr. Matthews about?
9. With regard to the INR level three months post initial discharge, explain why this is an issue
10. Discuss a medication that should be administered at this point and why. (again, think about clotting)
