Final answer:
The nurse should discuss fall risks, and due to the bruising, they should order an INR with PT and PTT to assess the patient's coagulation profile, as well as possibly an H&H. Holding warfarin is not immediately necessary without other signs of bleeding issues.
Step-by-step explanation:
The nurse practitioner should immediately address multiple factors regarding this patient's situation. Firstly, they should discuss fall risks with the patient to understand potential underlying issues that might have contributed to the fall. Since the patient is on warfarin therapy, which is an anticoagulant medication used to prevent blood clots, it's also important to check whether her fall might have led to any internal bleeding that hasn't presented obvious symptoms apart from the bruising. Therefore, the nurse practitioner should order an INR with PT (prothrombin time) and PTT (partial thromboplastin time) to ensure there are no issues with the patient's coagulation profile, especially considering her current anticoagulation therapy. An H&H (hemoglobin and hematocrit) should also be considered to assess for any signs of anemia or acute blood loss.
However, without additional signs of over-anticoagulation or bleeding, holding the warfarin dose might not be necessary and could increase the risk for thrombotic events. Every action should be performed considering the patient’s specific clinical context and in accordance with current medical guidelines. It’s imperative to monitor the patient closely for any signs of deterioration and reassess the situation as needed.