Warfarin Winnie — Warfarin & INR: Vitamin K, Bleeding Precautions and the Salad Problem
Her nosebleed will not stop, her INR is 6.5, and the only thing that changed was a week of kale smoothies — then a week without them
Winnie comes in with a nosebleed she cannot stop and a bruise across her cheek. Her INR is 6.5, and she proudly reports she gave up salad two weeks ago.
Winnie takes warfarin to prevent clots. Warfarin blocks vitamin K-dependent clotting factors, so it is monitored with PT/INR — therapeutic for most clients is 2 to 3 (2.5 to 3.5 for mechanical valves). Vitamin K is both the antidote and the dietary variable: she does not have to avoid green vegetables, she has to keep her intake CONSISTENT. An INR above range means bleeding risk; an INR below range means clot risk. Warfarin takes days to work, interacts with many drugs, and is never combined casually with NSAIDs, aspirin or herbal blood thinners.
Read Warfarin Winnie's full story →The story arc
The setup
Winnie starts warfarin after a DVT. She is told to come back for regular blood draws and does not understand why.
The turn
She swings from daily kale smoothies to no greens at all, then adds an over-the-counter pain reliever for her back.
The crisis
A nosebleed will not stop, her gums bleed when she brushes, and a bruise spreads across her cheek. INR: 6.5.
The save
Warfarin is held, vitamin K is given, and Winnie learns the real rule: same greens every week, no new medicine without asking, soft toothbrush, electric razor.
NCLEX study section — Warfarin & INR: Vitamin K, Bleeding Precautions and the Salad Problem
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pharmacology
Take this chapter into practice questions on the same topic.