— 藥理與非經腸給藥 · MEDIUM · SATA —
護理師對服用華法林（warfarin）的病人進行衛教，下列哪些指導是正確的？（選所有適合的）
A nurse is teaching a client about taking warfarin. Which instructions should be included? (Select all that apply.)
- AMaintain a consistent intake of vitamin K-rich foods✓ 正解維持維生素 K 豐富食物的穩定攝取
- BUse a soft-bristled toothbrush to prevent bleeding✓ 正解使用軟毛牙刷以防止出血
- CReport any unexplained bruising or nosebleeds✓ 正解報告任何不明原因的瘀青或鼻出血
- DIncrease intake of green leafy vegetables significantly大幅增加綠色葉菜類的攝取量
- EAvoid using aspirin or NSAIDs without medical approval✓ 正解未經醫療許可避免使用阿斯匹靈或非類固醇消炎藥
— Explanation · 中文詳解 —
Warfarin 是一種維生素 K 拮抗劑，透過抑制肝臟合成維生素 K 依賴性凝血因子（II, VII, IX, X）來產生抗凝血作用。病人衛教重點在於抗凝血效果的穩定性。攝取含維生素 K 食物（如綠色蔬菜）必須維持一致，不可驟增或驟減，以免影響藥效（INR 值波動）。同時需採取出血防護措施（如軟毛牙刷）並避免併用會增加出血風險的藥物（如 NSAIDs）。
Warfarin acts by inhibiting vitamin K-dependent coagulation factor synthesis (II, VII, IX, X) in the liver. Client teaching focuses on stable anticoagulation. Vitamin K intake (e.g., green vegetables) must remain consistent and should not be drastically increased or decreased to avoid INR fluctuations. Bleeding precautions (e.g., soft-bristled toothbrush) and avoiding drugs that increase bleeding risk (e.g., NSAIDs) are also essential.