When administering Lithium, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.
In-depth explanation
Clinical reasoning summary
Warfarin transition rule
Warfarin inhibits the synthesis of new vitamin-K-dependent clotting factors (II, VII, IX, X) and proteins C, S. Existing factors must clear before INR rises into therapeutic range — this typically takes 5-7 days. During the warm-up period, the patient is paradoxically pro-thrombotic because protein C (anticoagulant) drops faster than factor II.
Standard transition (CHEST/ACC guideline):
• Start warfarin and parenteral anticoagulant (UFH, LMWH, or fondaparinux) on day 1 simultaneously when feasible.
• Overlap for at least 5 days AND until INR ≥2.0 for at least 24 hours.
• Then stop the parenteral agent and continue warfarin.
• Mechanical valves, large clot burden, malignancy may require longer parenteral therapy.
Option 1 (stop tomorrow) leaves the patient unprotected. Option 3 (stop warfarin) defeats the long-term oral plan. Option 4 (delay warfarin) is wrong — warfarin and parenteral start together to overlap.
For study reference only. Always follow current clinical guidelines and your institution’s protocols.