Patient Teaching Guide: Coumadin Therapy

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    This is an informational guide that I created for patients who are presently on Coumadin or expected to be on Coumadin upon discharge. It is in article form because it was a freelance article that I wrote. As we all know, it is up to nurses to do patient teaching, not the doctors! It is written in simple terminology that all patients can understand. When I was a home health nurse, it seemed that I was always doing research on diseases and conditions so that I could make up my own patient teaching guides. Not all hospitals have teaching resources on hand for nurses to use. Feel free to use this for teaching purposes if you wish.

    The medication Coumadin is classified as a an anticoagulant. It is also known by its generic name, warfarin. Coumadin is, simply put, a "blood thinner". It thins your blood to prevent blood clots from forming. There are several medical conditions that warrant the use of Coumadin. Here, we will discuss just a few.

    Pulmonary Emboli (PE): A pulmonary emboli is a blood clot in the lung. When you are hospitalized with a pumonary emboli, anticoagulants will be administered in either injection form (Heparin or Lovenox) or as an IV drip (Heparin drip). After the blood clot has resolved and you are discharged from the hospital, you will probably be given a prescription for Coumadin to take at home.

    Deep Vein Thrombosis (DVT): A deep vein thrombosis is a blood clot deep in the vein. These usually develop in the legs. If the clot is serious enough to require hospitalization, you would be treated with either Heparin or Lovenox injections or a Heparin drip. Again, Coumadin is usually prescribed after hospitalization to prevent another blood clot from forming.

    Atrial Fibrillation (A-Fib): Atrial fibrillation is an irregular heart rhythm. For some, this is a chronic condition, which means that their heart beats irregularly all the time. Patients with atrial fibrillation usually take Coumadin for the rest of their lives to prevent blood clots. With atrial fibrillation, blood clots can occur because the heart is pumping blood out at irregular intervals, so the volume of blood in the circulatory system is not consistent.

    After hip and leg surgery: Surgery of the hips and legs requires some bedrest after surgery. This period of immobility can cause blood clots to form because your range of motion is compromised. Although precautions are taken to prevent blood clots after surgery, Heparin or Lovenox injections are usually used as well. Physical therapy is usually started in the hospital and then continued at home. When you are discharged home, you will be usually be on Coumadin short term.

    What are the risks of taking Coumadin? The main risk is that your blood may become too thin. This is why your doctor will want you to have your blood drawn regularly to check the PT/INR. The PT/INR results will tell your doctor how long it takes for your blood to clot and adjust your Coumadin dosage accordingly. It is very important to follow your doctor's orders concerning the blood work and dosage changes. Signs and symptoms of abnormally thinned blood are bleeding from the gums, excessive bruising, black, tarry stools (very dark or black bowel movements the consistency of tar) and blood in your urine.

    As with most medications, Coumadin should be taken every day at the same time. Ask your doctor what time he wants you to take it. Usually it is in the evening hours. If you miss a dose, you will need to contact your doctor so he can advise you what to do.

    When you are taking Coumadin, there are some important things to remember. You should avoid an excessive diet of foods that are high in Vitamin K, such as green leafy vegetables, broccoli, green onions, asparagus and olive oil. Coumadin and Vitamin K work against each other. Vitamin K actually helps thicken the blood. It is given in injection form when someone's blood is dangerously thin. You should also avoid dangerous or hazardous activities which could result in bleeding or fractures. You should use a soft bristle toothbush when brushing your teeth. Carry a card with you at all times that states that you are on Coumadin. Be aware of any signs of abnormal bleeding and report them to your doctor immediately. Let all of your physicians know that you are on Coumadin.

    Coumadin, when taken as prescribed, works very well. By knowing a little bit more about this medication and following these tips, you become an active participant in your medical care.

    Some information in this article provided by Mosby's Nursing Drug Reference, 2007
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    About Bugaloo, RN

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    23 year(s) of experience in Med-Surg, HH, Tele, Geriatrics, Psych

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  3. by   BarbaraNP
    Thanks for the teaching material! You are is nurses and nurse practitioners that teach patients.

    May I suggest changing the "ask your doctor" to "ask your heatlh care provider"? As a NP, I often prescribe and manage patients on coumadin - and I do so independently - meaning there are no physicians involved.

    There is something subtle in the words "ask your doctor" that underminds both nurses and nurse practitioners.


  4. by   Bugaloo
    Barbara, Thanks so much for the input. I will change that. You are correct. NP's do an awesome job! Bugaloo
  5. by   blebs
    Quote from Bugaloo
    Coumadin is, simply put, a "blood thinner". It thins your blood to prevent blood clots from forming.
    Bugaloo this particular statement is incorrect. It is taught to everyone and needs to be brought up to date.

    Coumadin is an anticoagulant. True

    Coumadin does not thin the blood or change it's viscosity in anyway. It merely inhibits inhibits Vit K uptake in the liver. Reducing the bloods ability to clot.

    One should avoid binge eating of high Vit K content foods, but should otherwise eat them as always and have the Coumadin dose adjusted for that diet. People need these nutrients and some managers have told them to avoid them altogether. Best thing you can do is allow a person to eat like they normally do, never bring up the Vit K thing and then it won't be so hard to stabilize them, because they won't be trying in vane to reduce their Vit K intake.

    I know it seems nitpicky, but there are so many people out there that honestly think their blood is water or diluted by Coumadin, and that is not at all the case. I hope you can understand the criticism. It's not meant to be negative, but to bring an end to myth and further education.

    Oh yeah, you left out Mechanical Heart Valve Patients as another group that needs Coumadin. :wink2:
  6. by   Bugaloo
    Blebs, Thanks for your input. You must realize that I created this article as a guide for patients with no formal medical training or knowledge whatsoever. If you get too technical, some patients simply do not "get it".

    This was not written for a nursing or medical journal, but for our patients.

    But thanks for taking the time to comment.
  7. by   blebs
    And I applaud your efforts. Like I said, it's nitpicky, but there are far too many people thinking that their blood is "thinned" to the consistency of water, when in fact, there is no thinning at all, just inhibition of vit k uptake. I'm just trying to get people to understand that their blood is not like oil where the mechanic put 10w40 oil in and taking Coumadin makes it 5W30.
  8. by   rubles
    Good morning everyone.

    It's encouraging to learn medical personnel are interested in teaching anti-coagulated patients about this potentially dangerous drug. This information is sorely needed.

    Let me tell you a bit about myself. I'm not a nurse, received a mechanical heart valve 9 years ago, was advised by my surgeon that "warfarin is just a little pill you take every day requiring blood tests every so often". If given the opportunity I'd like to see those words shoveds down her throat. Horribly inaccurate and misleading to say the least.

    The vein i my arm was torn during right-sided heart catheterization and was tied shut. It took almost a year before I became aware of its non healing status.

    During my 9 years of warfarin use I have a lot about the eccentricities of this drug.

    Because of the permanently damaged vein in my riight arm and the subsequent scarring from many vein draws from the left vein I was motivated to use the "finger stick" method of blood tests using a home monitor and have been home testing since 2004. I check the blood at home, e-mail the results to my INR manager to the University Health Network in Toronto resulting in a 98% stability rate. During these years I have learned more about warfarin than the nurse in my PCP's office.

    In a perfect world patients on warfarin therapy would be accurately informed about this potentially dangerous drug. Dangerous because the medical personnel they will probably encounter are so ill-informed about warfarin they persistently refer to it as a "blood thinner". After all blood thinner and anti-coagulation are both two words. Why not be "professional" and use the correct term". Patients are more afraid of stroking not bleeding out and shouldn't be constantly concened about minor injuries.

    Good luck educating the medical community about warfarin management. I feel sorry for every patient undertaking this hazardous course of treatment.

    I welcome your comments and you should feel free to contact me via e-mail or and on this board. Be as brutally frank as I have been.
  9. by   vancouverBC
    dear bugaloo (and blebs)

    i concurr with blebs about the accuracy of the information on warfarin in the article. it is not a "blood thinner".

    more disturbing is bugaloo, your response indicating that you must mislead or provide incorrect information to patients, because "they will not get it".

    i believe that patients can understand that warfarin prevents the clotting mechanism in blood.

    they should not be mislead, simply because you have the false and paternalistic belief that patients can not comprehend basic information about their diseases or drugs.

  10. by   muniraward1
    nice of you to share. Thank you.
  11. by   kcStudentRn
    This is a really nice and informal teaching plan - as you stated in the opening. thank you so much for taking the time to post it - I am writing up a teaching plan for this very thing right now as a 2nd semester student. I wanted to get some ideas on where to start with this - very helpful.

    As for some of the responses - that is about as catty as walking in to the L&D unit. Even in 2nd semester - I know that you have to tailor the plan to the slowest kid in the class - then if they are able to grasp you can go deeper into detail. I don't know how you all are taught to teach your patients - but we are taught to start on a 5th grade level as far as language and basic concepts are concerned. It does no good to say a bunch of fancy things if the patient doesn't speak the language. After all, it is very much like learning Latin - without the conjugations of course.
    No need to come down so hard on someone for sharing - I think she already made it out of nursing school.
    just sayin' - we can be constructive in our critiscisms.

    Anyway, I thought it was a very good plan. Again, thank you for taking the time to post it, it was an effective tool for me.
  12. by   CRF250Xpert
    Quote from blebs
    one should avoid binge eating of high vit k content foods, but should otherwise eat them as always and have the coumadin dose adjusted for that diet. people need these nutrients and some managers have told them to avoid them altogether. best thing you can do is allow a person to eat like they normally do, never bring up the vit k thing and then it won't be so hard to stabilize them, because they won't be trying in vane to reduce their vit k intake.
    thanks for that. please, nurse, never teach my pts to stop eating green leafy veggies. i want all of my patients to eat healthy food choices and that includes a diet rich in exactly those foods you guys are telling my patients to avoid. stop! thanks. instead, please do teach them that changing their vit k rich food intake alters the inr. use a balance beam analogy, pushing vs. pulling, etc. just get them to eat the same amount all of the time and avoid huge changes. thanks.

    remember when you mom said, "eat your veggies"? she was right!
  13. by   KYRN2B
    You are correct!