Keep or stop the anticoagulant? An MN610 Unit 5 reflection about a composite faller with atrial fibrillation records the first answer, the argument that reversed it and the resulting plan. Searches like "mn 610 unit 5 assignment example", "mn610 unit 5 sample" and "mn610 unit 5 example" land here.
Two Falls and a Blood Thinner: A Seminar Reflection on Stopping Anticoagulation at 86
[Student Name]
Purdue University Global
MN610: NP III Clinical - Primary Care Focus
Unit 5 Seminar Reflection
[Instructor Name]
[Date]
The case discussed is a composite prepared for teaching. Classmates are not named.
Setting and Case
Our session asked when fall risk justifies stopping an anticoagulant in an older adult. The case: a composite 86-year-old woman with atrial fibrillation, taking apixaban for four years. Her CHA2DS2-VASc score is 6, from her age, her sex, hypertension and a transient ischemic attack three years ago. She has fallen twice at home in six months, neither time hitting her head. On gait assessment she turns slowly and with a wide base. Her daughter, who drives her to appointments, asked that the blood thinner be stopped: "I'm terrified she'll fall and bleed into her brain."
My First Position
I argued to stop it. Two falls in six months seemed like a pattern, and the next fall might be the one that caused a brain bleed. I said that at 86 the priority should be avoiding a catastrophic injury, and that the daughter, who sees her mother every day, knew the risks better than we did. I believed I was being cautious and respectful of the family. Two other classmates agreed with me at first, and one pointed out that she lives alone, so a fall at night might not be found for hours, which made a bleed more dangerous. That point still seems right to me, but it argues for a way to call for help, not for stopping the drug.
The Question That Turned It
A classmate asked how many falls would have to occur before the bleeding risk outweighed the benefit of stroke prevention. I did not know. The group went looking, and found a decision analysis that addressed exactly that question for older adults on warfarin with atrial fibrillation: a person would have to fall about 295 times in a year for the risk of a subdural hematoma from falling to outweigh the benefit of anticoagulation (Man-Son-Hing et al., 1999). The analysis was built on warfarin, and apixaban carries a lower risk of intracranial bleeding, which would push that number higher still.
A Number Put to the Fear
We then set her stroke risk beside it. In the cohort used to develop the score, patients with a CHA2DS2-VASc score of 6 had a stroke or thromboembolism rate of close to 10 percent a year without anticoagulation (Lip et al., 2010). Two falls in six months was a real problem, but it was a problem to be treated, not a reason to accept a one-in-ten yearly chance of stroke. The 2023 atrial fibrillation guideline advises against using a bleeding risk score on its own to decide whether a patient should receive anticoagulation, and it encourages addressing modifiable bleeding risks instead (Joglar et al., 2024). Falls are one of those risks. Several of hers may be reversible: the group noticed that her blood pressure medicine had been increased two months before the first fall, and that she takes a sleeping pill most nights. Neither had been reviewed since the falls began.
The Plan That Emerged
Continue apixaban at her current dose, after confirming that the dose is correct for her age, weight and kidney function. Refer her to physical therapy for gait and balance training. Review her medications for anything that could be adding to falls, such as sedatives or drugs that lower blood pressure on standing. Check her orthostatic blood pressure. Arrange a home safety evaluation. And schedule a family conversation with her and her daughter, framed around what she wants: when asked, she had said she wants to keep living in her own home and "not end up in a wheelchair from a stroke like my sister."
The documentation would now read: "Anticoagulation continued after discussion of stroke and bleeding risk with patient and daughter; falls addressed with PT referral, medication review and home safety evaluation."
Why I Had It Wrong
My error was treating the falls as a reason to stop a drug, rather than as a problem in their own right. I also let the daughter's fear stand in for an assessment of risk, when the fear deserved an answer, not agreement. The patient's own stated priority, avoiding a disabling stroke, pointed the other way from her daughter's, and I had not asked her. The next time I see a patient on an anticoagulant who is falling, I will address the falls first and ask the patient what she fears most before I discuss stopping anything. I expect to test that in my next clinical rotation, where many patients are older adults on anticoagulants.
References
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., Gorenek, B., Hess, P. L., Hlatky, M., Hogan, G., Ibeh, C., Indik, J. H., Kido, K., Kusumoto, F., Link, M. S., ... Van Wagoner, D. R. (2024). 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 149(1), e1-e156. https://doi.org/10.1161/CIR.0000000000001193
Lip, G. Y. H., Nieuwlaat, R., Pisters, R., Lane, D. A., & Crijns, H. J. G. M. (2010). Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The Euro Heart Survey on Atrial Fibrillation. Chest, 137(2), 263-272. https://doi.org/10.1378/chest.09-1584
Man-Son-Hing, M., Nichol, G., Lau, A., & Laupacis, A. (1999). Choosing antithrombotic therapy for elderly patients with atrial fibrillation who are at risk for falls. Archives of Internal Medicine, 159(7), 677-685. https://doi.org/10.1001/archinte.159.7.677
How this MN610 Unit 5 example is structured
The reflection opens with the question the seminar set: when does fall risk justify stopping an anticoagulant in an older adult? The case is then given exactly as it was presented to the group, including the daughter's request, since that pressure shaped the author's first position. The next paragraph states that position honestly, with the reasoning behind it. The turning point is reported as a paraphrased question from a peer, followed by the numbers the group assembled: annual stroke risk at her score set against the bleeding risk a fall adds. The 2023 ACC/AHA/ACCP/HRS atrial fibrillation guideline is cited for its advice against using a bleeding risk score on its own to decide eligibility. A plan paragraph sets out what would now be documented and how the family conversation would be framed. The last paragraph identifies the specific error corrected and where it will be tested next.
Get an MN610 Unit 5 example written to your instructions
Live session or written option, a Unit 5 reflection is drafted from three things you share: the patient your MN610 group argued over, what moved your thinking, and the rubric. It costs nothing the first time, is back within 24-48h, and records your opening position and the argument that shifted it before ending on the chart entry your final view supports. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN610 Unit 5 questions, answered
Does the reflection have to reach a firm conclusion?
It should state yours, even if the group never agreed. Record the strongest argument on each side, say which one you find more persuasive for this patient, and explain what additional information would change your view. Most close calls stay close, and graders assess the quality of the reasoning rather than whether the room reached consensus.
How much clinical evidence belongs in a seminar reflection?
Enough to support the turning points. In a case like this, the stroke risk score, one guideline recommendation and one study on falls carry the argument. A literature review would crowd out the reflection itself. Cite where a claim would otherwise rest on memory, and let the rest of the piece stay in your own reasoning voice.
Should family wishes change the clinical recommendation?
They shape the conversation and sometimes the decision, and the reflection should show how. Record what the family asked for, what information they were given, and whether the plan changed. A reflection that dismisses the request, or one that follows it without explaining the risks, misses the shared decision-making this course expects to see.