護理師對一位因心房顫動而服用 warfarin 的病人進行衛教。病人的哪項陳述表示需要進一步的衛教？
The nurse is providing education to a client prescribed warfarin for atrial fibrillation. Which statement by the client indicates a need for further teaching?
- AI will use a soft-bristled toothbrush to brush my teeth我會使用軟毛牙刷刷牙
- BI should stop eating green leafy vegetables entirely✓ 正解我應該完全停止食用深綠色葉菜類
- CI will avoid high-impact sports like football我會避免參與足球等激烈運動
- DI need to have my blood checked regularly for INR levels我需要定期抽血檢查 INR 數值
Warfarin 是維生素 K 拮抗劑，藥效深受飲食中維生素 K 攝取量的影響。正確的飲食衛教不是『禁絕』綠葉蔬菜，而是『保持攝取量的穩定』（Consistency）。如果病人突然完全不吃或突然吃很多，會導致 INR 值劇烈波動，造成血栓或出血風險。因此，選項 B 的陳述是錯誤的，反映出病人對飲食管理的誤解。選項 A（軟毛牙刷）和 C（避免劇烈碰撞運動）都是為了預防出血，是正確的自我照顧。選項 D（定期監測 INR）是 Warfarin 治療的必要組成部分，用以確保藥物濃度在安全範圍內（通常目標為 2.0-3.0）。
Warfarin is a vitamin K antagonist whose effect is strongly influenced by dietary vitamin K intake. Correct dietary teaching is not to prohibit green leafy vegetables but to maintain consistency of intake. If the client suddenly eliminates them or suddenly eats a large amount, the INR will fluctuate significantly, leading to risks of thrombosis or bleeding. Therefore, option B is incorrect and reflects a misunderstanding of dietary management. Option A (soft-bristled toothbrush) and option C (avoiding high-impact contact sports) are both intended to prevent bleeding and are correct self-care behaviors. Option D (regular INR monitoring) is an essential component of warfarin therapy used to ensure that the drug concentration remains in the safe range (typically a target INR of 2.0-3.0).
美國醫護非常強調『Consistency of Vitamin K』。台灣部分醫療人員有時會簡單告知病人『不要吃綠色蔬菜』以求安全，但這在 NCLEX 考試中被視為錯誤觀念，應強調量的恆定。