Diet and Meds

[jnrsmommy]

Just curious how other facilities handle this. Residents/patients that are on certain meds that have food interactions (Coumadin, specifically). I was helping out on our rehab side one day and brought a resident lunch, which had "greens" on it. She stated "I can't have this, I'm on Coumadin." I brought this to the attention to the charge nurse and the manager, who stated "Well, she knows not to eat it."

Now, I have residents that are on Coumadin that are not "with it" and CNAs who don't know any better. Even getting the doc to order the diet to exclude the food was like pulling teeth (mostly, due to family). I charted out the wazoo, but again, I'm curious, how do others handle it?

[cardiacmadeline, RN]

People on coumadin are allowed to eat greens and foods with vitamin K...as long as the intake of these foods remain consistent. If someone consistently eats a large amount of greens everyday, they will need to take a larger coumadin dose to balance it out. The trouble can arise when there is a change in someone's diet and they are now taking in more or less vitamin K. If the coumadin dose isn't adjusted for it, then the INR wil be increased or decreased. Consistency is the key. The resident in your post who stated she can't have greens needs to be reeducated. After all, greens are part of a healthy diet, why would we tell anybody not to eat them? We give coumadin all the time on my floor, and we have never asked for a doctor's order to restrict foods. Like I said, intake of vitamin K needs to be consistent. Just a side note, when educating patients about coumadin, don't forget to tell them to ask their MD before taking vitamins as some of them have vitamin K in them. I should also add that people should avoid or drink small amounts of certain beverages like cranberry juice and alcohol as they can increase the effects of coumadin.

[Be_Moore]

A facility I worked at in a past life actually had "coumadin diet" as a selection. 1800cal ADA Low Fat/Low Chol 2gm Na+ Caffeine Free Lactose Free Coumadin diet. As an example.

[NotFlo]

Was this real dark leafy greens or iceberg lettuce? The nutritionist at my facility will fight to the death with anyone that suggest pts on coumadin can't eat greens.

[jnrsmommy]

Aaah, time for me to go read up on my nutrition again. I was taught no dark green leafy veggies at all.

As for the pt in question, it was collard greens.

[CapeCodMermaid, RN]

I'm thinking that one serving of greens wouldn't impact anyone's INR. I've been doing this for years and we've never restricted anyone's diet because they were on Coumadin.

[jnrsmommy]

I guess, my curiousity (hate spelling that word) came from remembering in the hospital setting a lot of teaching regarding food and meds and interactions, but I really don't see it in the LTC setting. Thank you guys very much that have responded. Been doing a bunch of reading today