Nursing Care for a Diabetic Patient Co-existing with Atrial Fibrillation and Warfarin-Induced Complications : A Case Study

Abstract

      This study was case study aimed to explore the nursing care approach for a diabetic patient with AF and warfarin toxicity, ensuring prompt and safe management, preventing severe complications, and enhancing self-care capabilities for post-discharge continuity of care at home. An in-depth single case study was conducted at the Medical Outpatient Department, Samut Sakhon Hospital, from January 3, 2025, to March 27, 2025. Data were gathered through physical assessments, laboratory investigations, nursing diagnoses, clinical interventions during hospitalization, and post-discharge follow-ups at the outpatient clinic.

      Results: An 84-year-old Thai female with a 20-year history of diabetes and a 4-year history of AF presented with a 3-day history of ecchymosis on her right thigh, fatigue, and weakness. Her health behaviors included a preference for sweets, lack of exercise, and medication non-adherence. Initial assessment revealed critical hyperglycemia (DTX 395 mg/dL, HbA1c 10.5%), a dangerously elevated International Normalized Ratio from warfarin toxicity (INR 7.5), AF with Rapid Ventricular Response (RVR), and hypokalemia (K 3.2 mEq/L). The patient was triaged for urgent medical evaluation within 30 minutes. Nursing interventions focused on preventing shock, correcting hypoxia, minimizing bleeding risks, and ensuring safe transfer to the medical ward. During hospitalization, Orem's theory and counseling sessions were applied to the patient and caregivers, emphasizing bleeding surveillance, dietary control, and strict medication adherence. The patient's condition significantly improved; vital signs stabilized, the INR decreased to 3.8, and blood glucose settled at 132 mg/dL on discharge. At the 1-week follow-up at the Warfarin Clinic, the patient demonstrated good self-management, no recurrence of bleeding, and well-controlled blood glucose levels.