護理師正在評估一位服用華法林的病人。病人報告流鼻血且難以止住。護理師應問的最重要的問題是什麼？
A nurse is assessing a client who is taking warfarin. The client reports experiencing a nosebleed that is difficult to stop. Which question is most important for the nurse to ask?
- AHave you had any recent falls?您最近有跌倒過嗎？
- BWhat is your typical diet like?您平常的飲食習慣為何？
- CHave you taken your warfarin dose today?您今天有服用華法林嗎？
- DHave you taken any over-the-counter medications or supplements recently?✓ 正解您最近有服用任何非處方藥或補充品嗎？
華法林（Warfarin）是一種維生素 K 拮抗劑，其治療窗狹窄，極易與其他藥物、草藥或補充品產生交互作用，導致抗凝血效果改變。當病人出現不易止血的流鼻血時，這屬於出血警訊，必須優先評估是否有外源性因子增強了藥物作用。詢問非處方藥（OTC）或補充品是臨床最關鍵的評估步驟，因為許多常見補充品（如銀杏、大蒜、魚油）或 NSAIDs 會顯著增加出血風險。
Warfarin has a narrow therapeutic index and is highly susceptible to drug interactions that can alter its anticoagulant effect. When a client presents with difficult-to-stop bleeding, it is critical to assess for recent use of over-the-counter medications or supplements, as many (such as NSAIDs, ginkgo, or garlic) can significantly increase bleeding risk. Identifying these interactions is essential for managing the acute bleeding episode and preventing further complications.
美國病人對膳食補充品與草藥（Herbal Supplements）的使用非常普遍，且常不主動告知醫師，因此在美國臨床護理評估中，詳細詢問 'Any supplements?' 是強制且必要的步驟。