Question

Rita Simms is a 28-year-old Caucasian woman. She is being discharged from the hospital today after a recent deep venous thromboembolism. She is being discharged with a prescription for warfarin (Coumadin) 5 mg with directions to take one tablet daily at 5 p.m. The physician has asked the nurse to complete discharge counseling with Ms. Simms.

1. How often will Ms. Simms need her prothrombin time and international normalized ratio tested?

2. What are the signs of warfarin overdosage?

3. What should Ms. Simms be told about starting new medications?

Answer 1

1 ) How often will Ms. Simms need her prothrombin time and international normalized ratio tested?

It is monitored less often when the dose is stable.A typical frequency of monitoring for stable dosing is approximately every four or six weeks.In addition to increased monitoring, changes in her other medications or medical condition may result in the need for a higher or lower daily warfarin dose.When she first start warfarin, she needs to have blood tests every few days or weekly.The internationl normalized ratio (INR) should be measured monthly once therapeutic levels are achived and are stable for atleast 8 weeks,although treatment should be increased frequency may be required by some patients.

2) What are the signs of warfarin overdosage?

Signs of overdose may include blood/black/terry stools,pink/ dark urine,unusal/prolonged bleeding.Some other signs include red spots on skin that look like rash,severe headache or dizziness,heavey bleeding after an injury,heavy bleeding duringmonthly period in women,sometimes severe stomach pain and vomit blood.

3) What should Ms. Simms be told about starting new medications?

Never double a dose because you missed a dose,don't start new medications,herbals, or suppliments without talking to your healthcare provider,don't make changes to your warfarin dose without talking to your healthcare provider.Watch for any signs and symptoms of bleeding.Take warfarin exactly as prescribed.Remember to tell anyone giving you medical or dental care that you are taking warfarin.Many medications can alter the effectiveness of warfarin ,resulting in an INR that is either too high or too low.Warfarin interacts with alcohol and with certain foods like vitamin -k rich foods ,it can lower the PT and INR.