In the hospital, the nurse is caring for a client of Asian descent who was just started on warfarin (Coumadin). What would be the best plan of care for the client? (Select all that apply.)

Question

a. Start warfarin at a high dose to decrease the chance for further clotting problems.
b. Monitor international normalized ratio (INR) once a day in the hospital.
c. Teach the client to frequently check for any bruising.
d. Initiate fall precautions and strict activity limitations.
e. Start warfarin at a lower-than-normal dose owing to slower metabolism of the drug.

Answer 1

B, C, E
Most individuals of Asian heritage have a single nucleotide polymorphism in the CYP2C19 gene that results in low activity of the enzyme produced. This mutation greatly reduces the metabolism of warfarin, leading to increased bleeding risks and other serious side effects. Any person of Asian heritage who needs anticoagulation therapy should be started on very low dosages of war-farin and should have his or her international normalized ratio (INR) monitored more frequently. The nurse can always teach about the risk of bleeding and can monitor for any bruising. It is not necessary to initiate fall precautions and to limit activity based on the administration of warfarin.