Not a doctor, not a nurse, but a nursing student (about to graduate, but still, just a student) so take this for what it’s worth…
Coumadin is what people call a “blood thinner”. What it does is block the action of Vitamin K, which is one of the things your body needs to make blood clots. Most of us don’t need it because we want our blood to clot when we get a cut, but for some people, the body makes clots too much, or it makes them inside the blood vessels, not just when we get a cut. These clots inside the blood vessels can move along the body’s vessels with the liquid blood, and when they get to a teeny tiny vessel, they can block it. This means that little or no liquid blood can get around it, and whatever organs are further downstream don’t get enough blood, nutrients, oxygen and cell waste takeaway. So if a person has a type of condition where that’s likely to happen, their doctor will put them on coumadin so that they don’t clot so easily.
The effects of coumadin can and should be measured frequently (generally every 4-6 weeks) with a blood test, to make sure it’s at the right level and to adjust the dose, if it needs it. This test used to be called a “PT”. You’d get all kinds of different numbers depending on what procedure was used to test it. They normalized the tests using something called an “International Normalizing Ratio”, so now it’s more commonly called a “PT/INR”, or just an “INR” for short. If her doctor talks about her “INR level”, he’s talking about the results from the test which shows how quickly her blood clots. Usually it’s good between 2 and 3 for a patient on coumadin, meaning it takes 2 or 3 times as long for their blood to clot as yours or mine does. Ask the doctor what *her *INR should be, because it’s not always the same goal for each patient.
So if she’s on coumadin, she’s going to have a tendancy to bleed more and longer. That’s normal for her. What’s not normal is bleeding internally, and that’s why they’re worried. Their hope was that if her INR was too high and they lowered her coumadin dose, her body would start clotting more normally again and whatever’s bleeding inside would stop.
So now they’re probably trying to help her in ways other than just lowering her coumadin. They may be giving her extra Vitamin K - remember coumadin works by blocking the action of Vitamin K, so if they give her more of it, the coumadin still in her system can’t block it all. But it takes a while for coumadin to wear off and Vitamin K to kick in, so while this is an important treatment, it can also be slow.
They may also decide to give her some plasma - the watery part of the blood that someone donated - or some platelets - one of the parts of the blood that does the clotting. If she’s lost a lot of blood, they may also give her some red blood cells so her body has enough to carry oxygen around until it can make of her own. There’s a possibility they may give her Whole Blood, which is plasma, platelets and red blood cells all together, but most doctors prefer to give the blood parts, instead of whole blood. It gives them more control to tweak exactly what they need to.
Of course, the most important thing is for them to find out where she’s bleeding and why. The most common place for coumadin patients to bleed internally is somewhere in the gastrointestinal (GI) tract. Could be her esophagus, her stomach or her intestines. They may order some tests to look at these places for bleeding. Problem is, some of these tests themselves, like a colonoscopy, themselves increase the risk of bleeding. So they can’t do them until she’s able to clot better. That’s why the wait, most likely. If the Vitamin K, blood products and, most importantly, time and her body’s own healing, improve her INR a bit, then they can do the tests.
She could also be bleeding in her liver, her kidneys or just “we dunno”, but those are less likely than her GI tract. ETA: And reading your further replies, it sounds like she’s got a generalized problem with clotting in lots of little places, not one huge bleed somewhere specific.
As for how urgent this is, I’m afraid I can’t tell you. Sometimes this is a big deal and sometimes it isn’t. But if she allows her nurse to tell you about her medical condition (her choice), then you can ask the nurse over the phone. Don’t be afraid to be blunt, “Should I start driving now, or wait until Sunday?” is a perfectly acceptable question, and one that they’ve heard before.
I hope this helps a bit. Hang in there, and don’t be afraid to ask lots of questions. Nurses and doctors tend to hang back a bit with the information, because honestly, most people don’t want to know a lot of detail, or they’re so panicked they can’t process the information. And then patients and families get frustrated because no one is telling them anything! But if you ask, they know you’re ready to hear it, and they’ll answer your questions as best they can.
Yes, they do teach it, at least at my school. And then they put questions on the test that make it seem like you have to avoid spinach like Kryptonite. sigh I try to learn everything in sets - one set of answers for reality, and one set of answers for test questions. Frustrating, but true.