S6 · Likely to bleed easily
Risk Safety and protection
Definition
Blood-thinning medicine, low platelets, or illness raise the chance of bleeding.- Blood thinners
- low platelets
- liver disease
- trauma
- surgery
- Easy bruising
- bleeding gums
- nosebleeds
- blood in urine or stool
📋 Scenario
A patient has just started warfarin after a heart valve operation.
Subjective (S): "The doctor said this medicine can make me bleed."
Objective (O): Started warfarin 3 days ago; INR 3.4 (target 2.0-3.0); platelets normal; no bruising or bleeding seen; walks with a stick.
Assessment tools for this scenario: CP-SAFE Safety & Falls Score
Validated scales to consider: Morse Fall Scale
**CarePath diagnosis:** Likely to bleed easily related to blood thinners and an INR above target (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check blood tests (INR) as ordered and report values above target. | INR shows how long blood takes to clot, so regular tests and reporting values above target let the doctor adjust the dose before bleeding occurs. |
| Check with the prescriber before each warfarin dose while the INR is above target; give at the same time each day as ordered. | Warfarin is dosed by the INR, so a result above target needs the prescriber's decision before the next dose. Giving it at a fixed time keeps blood levels steady. |
| Use a soft toothbrush and electric razor. | Soft brushing and electric razors cause less gum and skin injury, lowering the chance of bleeding. |
| Avoid unneeded injections and protect from falls. | Injections and falls can cause bleeding or bruising, so limiting them lowers risk, especially as the patient walks with a stick. |
| Apply firm pressure to any bleeding and report it. | Firm pressure helps a clot form to stop bleeding, and reporting it lets staff check whether the dose or INR needs review. |
**Expected outcomes**
- No uncontrolled bleeding during the stay.
- INR within the target range by the date set by the doctor.
- Patient uses a soft toothbrush and reports bleeding early.
**Linking the data to the diagnosis**
The patient started warfarin 3 days ago after a heart valve operation, and says the doctor told them this medicine can make them bleed. The INR is 3.4 against a target of 2.0 to 3.0, platelets are normal, and no bruising or bleeding is seen. Since bleeding has not occurred, this is a risk diagnosis resting on blood thinners and an INR above target. The patient walks with a stick, so falls are also a concern. The plan aims for no uncontrolled bleeding, INR within target by the date the doctor sets, and the patient using a soft toothbrush and reporting bleeding early.
CarePath diagnosis
Likely to bleed easily related to blood thinners and an INR above target (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Check blood tests (INR) as ordered and report values above target. | INR shows how long blood takes to clot, so regular tests and reporting values above target let the doctor adjust the dose before bleeding occurs. |
| 2. Check with the prescriber before each warfarin dose while the INR is above target; give at the same time each day as ordered. | Warfarin is dosed by the INR, so a result above target needs the prescriber's decision before the next dose. Giving it at a fixed time keeps blood levels steady. |
| 3. Use a soft toothbrush and electric razor. | Soft brushing and electric razors cause less gum and skin injury, lowering the chance of bleeding. |
| 4. Avoid unneeded injections and protect from falls. | Injections and falls can cause bleeding or bruising, so limiting them lowers risk, especially as the patient walks with a stick. |
| 5. Apply firm pressure to any bleeding and report it. | Firm pressure helps a clot form to stop bleeding, and reporting it lets staff check whether the dose or INR needs review. |
Expected outcomes
- No uncontrolled bleeding during the stay.
- INR within the target range by the date set by the doctor.
- Patient uses a soft toothbrush and reports bleeding early.
Linking the data to the diagnosis
The patient started warfarin 3 days ago after a heart valve operation, and says the doctor told them this medicine can make them bleed. The INR is 3.4 against a target of 2.0 to 3.0, platelets are normal, and no bruising or bleeding is seen. Since bleeding has not occurred, this is a risk diagnosis resting on blood thinners and an INR above target. The patient walks with a stick, so falls are also a concern. The plan aims for no uncontrolled bleeding, INR within target by the date the doctor sets, and the patient using a soft toothbrush and reporting bleeding early.