Hubby's INR results

[lance]

Husband has a stent because of blocked artery and takes warfarin. Recommended INR range 2-3.

PCP advised spouse to use my XS and between the doctor's office and myself he would be kept in range.

PCP feels weekly testing is "overkill" and has requested a once per month vein draw.

He tests weekly and I advise his dose between the monthly vein draws. Weekly tests have shown a .2 reduction in INR. 2.7, 2.5, 2.3 and finally 2.1. The 2.1 was a vein draw only. So doctor's office told spouse to continue the same dose and test in one month.

Uh uh--no you don't and I increased his dose by 2 mg over the following week causing the XS test of 2.5. Nurse, because of privacy reasons will tell only my spouse of the INR vein draw result so I have no chance to express my view.

The doctor's office was not aware of the falling INR level. Spouse is slowly losing weight, becoming more active and attends cardiac rehab twice a week.

Nurse and I have banged heads before--not the doctor. Spouse has PCP appointment and I'm advising him to inform the doctor of the "incorrect to me" warfarin recommendation resulting from the 2.1 vein draw. Spouse unwilling to "rock the boat" but trusts my judgement completely where warfarin is concerned and wants to continue ignoring the nurse.

I want to talk to the nurse because this will continue to happen and the doctor's records will be inaccurate.

So to remain quiet or speak up that's the question. No one likes a butinsky.

 

[Freddie]

I may not be very good at this, but the first thought I had was this 'nurse' is USING the privacy act on you. I can get my INR results over the phone and my SO has phoned for the results when I was unable. Your name should also be on his file as 'next of kin' so with holding any medical information from you is wrong.
I would approach the doctor and explain the conflict and see what he say's.
As for spouses not wanting to "rock the boat"........for some strange reason I think its in their nature not to butt heads with doctors.........but that's why God gave them US.

 

[Bina]

Sandra, Speak Up.
Try to get a couple of minutes with the Doc and tell him that you increased the dose.
You know what you are doing ,and just forget about Nurse Ratched.

 

[escargome]

Talk to his doctor when you get a chance. But get a release of medical information form that states he gives authorization to you to be kept abreast of his medical test results. HIPPA will allow you the information as long as signed form is in his medical records. My thought would be that you know him better than that nurse does....

 

[Susan BAV]

I think I would talk to the nurse first. If she continues to be "uncooperative" then I would talk to the doctor.

There was a very mean nurse at my very nice family doctor's office when I had my valve replaced.
I think she was capable of causing a lot of trouble when crossed. I'm so glad she's not there anymore.

 

[terryj]

Even though my husband signed a release I was still having a hard time getting the coumadin nurse to give me his results. I went directly to the doctor and talked to him. He wrote on the front of my husbands chart with a black marker that I was to get the results. We are fine with the nurse now. She called Hubby last week and told him his inr was 3.6 and he needed to repeat test in a week. He said Crystal you know me better than that I will see you in a month. She just laughed and said we were her 2 favorite people because we know more about coumadin management than the doctor does. Sad but true.

 

[Jkm7]

Good you have reached the place where you, your DH and the nurse can all work together for the benefit of your DH. Sometimes it takes a bit of 'doing' but it's good when it works out.

 

[lance]

Thanks to everyone.................

Thanks to everyone.................

for your informed input.. Freddy, I'm chuckling over your closing comments.

We are truly blessed with our PCP. When my spouse explained why the dose was increased PCP responded with something akin to it being fine with him, he expected this would happen, keep up the good work and noted the past three test results on the chart. He also mentioned reading that water intake, especially over the summer, has an effect on INR. Anyone else encounter this?

PCP has done a 360 degree turn about how he views home testing. Four and one half years ago he wouldn't discuss the subject stating he needed a vein draw. Now he agrees with home testing and how we handle the INR. PCP had more to say than I have posted above--he was very positive.

We are very lucky to have him.

Once again thanks to all your support.

 

[Freddie]

I'm glad I made you chuckle

 

[Bina]

Sandra, congrats. You have educated another Doctor....and "maybe" a nurse.

 

[lance]

Hopefully ...................

Hopefully ...................

PCP will have conversation with nurse.

It's easy for us to learn about anti-coagulation because we are the patients taking it. Nurse needs to be better informed. Perhaps we should offer to teach her (wink, wink). Present her with a copy of Al's chart?

When hubby goes for another vein draw in a couple of months I will be the butinsky and discuss her recommendations with her and reach a mutually agreeable course of action.

 

[Ross]

PCP will have conversation with nurse.

It's easy for us to learn about anti-coagulation because we are the patients taking it. Nurse needs to be better informed. Perhaps we should offer to teach her (wink, wink). Present her with a copy of Al's chart?

When hubby goes for another vein draw in a couple of months I will be the butinsky and discuss her recommendations with her and reach a mutually agreeable course of action.

Oh lord don't even think about teaching them. They take that as, "Your wrong" and automatically tune you out. I've tried, beleive me.

Here is my case in point--I'm blebs:

http://allnurses.com/forums/f300/patient-teaching-guide-coumadin-therapy-262172.html#post3138917

 

[Bina]

Oh lord don't even think about teaching them. They take that as, "Your wrong" and automatically tune you out. I've tried, beleive me.

Here is my case in point--I'm blebs:

http://allnurses.com/forums/f300/patient-teaching-guide-coumadin-therapy-262172.html#post3138917

Ross, you handled that very well.

 

[lance]

Oh lord don't even think about teaching them. They take that as, "Your wrong" and automatically tune you out. I've tried, beleive me.

Here is my case in point--I'm blebs:

http://allnurses.com/forums/f300/patient-teaching-guide-coumadin-therapy-262172.html#post3138917

Hi Ross,

Visit the nurses again. There have been a couple of updates to that thread that will interest you.

 

[Bina]

Good stuff, Sandra!!

 

[Ross]

Ok, I think they got the hint. Don't expect them to listen, but they got the hint.