The nurse is preparing a female client for discharge who will be prescribed Coumadin (warfarin) secondary to a diagnosis of thrombophlebitis. The nurse instructs the woman to:
1. Stop taking oral contraceptives.
2. Wear a peripad during menstruation and notify the doctor if the pad fills more than once an hour.
3. Continue medication if she learns she is pregnant.
4. Anticipate heavier-than-normal periods and call the doctor if bleeding continues for more than one week.
2
Rationale: The client taking anticoagulants might have heavier than normal periods, and should plan to use a peripad because it is impossible to determine amount of blood loss with a tampon. If the peripad fills more than once an hour, or hourly for more than two hours, the client should call her provider, because this is defined as heavy bleeding, and must be treated to prevent hemorrhagic shock. The physician will determine if oral contraceptives should be continued or changed to a different formula. Pregnancy should be avoided while on Coumadin (warfarin) because of the risk of fetal hemorrhage. Heavy bleeding should be reported immediately, not after a week.
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