What additional aspects of Sally’s management are important for the nurse to consider?
Sally’s safety:
- House: safety issues should be addressed as part of a holistic assessment. This may be through discussion with the person and his/her family or significant others.
- Mental health: social isolation can be a risk factor for poor coping and management of long term conditions. Continue to review mental health, self care, and medication compliance.
- Diet: to reduce cardiovascular risk it is important to eat a well balanced diet & keep weight within normal limits. Diabetics should endeavour to keep their blood sugar within normal limits. In relation to anticoagulation, major changes in diet can affect how the body reacts to medication. Foods rich in vitamin K (like green leafy vegetables, liver, egg yolks, blue cheese) can affect INR results & should be eaten in moderation. Cranberry juice should be avoided as it can increase the anticoagulation effect of warfarin, which might trigger bleeding.
- Alcohol: alcohol can increase INR so should be limited to small amounts on a regular basis & no binge drinking. Should not exceed the national guidelines of 3 units per day for a man or 2 units per day for a woman. This also reduces overall cardiovascular risk.
- Senses: it is important to check that the patient is able to see their medications (bearing in mind some people are colour blind or have impaired eyesight and will struggle to differentiate between different coloured tablets) as well as read the labels.
Pulse point
To calculate a patient’s bleeding risk when considering anticoagulation, you may wish to use the HAS-BLED score. Patients who score >3 are at greater risk of bleeding and so anticoagulation should be administered cautiously with close monitoring, if at all.
Page last reviewed: 29 Jul 2020
