Nurse: Good morning Mrs. C. Thank you for letting me visit you in your home. My name is Stephanie, I am a nurse educator working with your clinic. I am following up with you a week after your last appointment. I would like to ask you some questions about your medications, would that be alright?
Patient: Sure, I would like to review them, I hope I can remember everything.
Nurse: “I want to hear you read as many words as you can from this list. Begin with the first word and read aloud. When you come to a word you cannot read, do the best you can or say, ‘blank’ and go onto the next word.”
|Word||Patient says all correctly|
Nurse: How many pharmacies do you use to fill your prescriptions?
Patient: one, the Walmart isn’t too far of a walk.
Nurse: Have you ever had difficulty affording your medications?
Patient: Sometimes the medications are very expensive, but my daughter helps me if Medicare doesn’t cover it.
(See Case Key for Patient Responses for each drug)
Why do you take___________. How does it work?
How do you take it?
What is the goal of this medication?
What do you need to watch/monitor for while on this medication?
Are there any side effects of this medication? Have you experienced any of these?
What would you do if you experienced any?
Is there any food or liquids you need to avoid while on this medication?
How about herbals, OTC, or other medications?
Do you think this drug is effective, that it is working?
Segway: Let’s talk about the next medication
Let’s move onto the third one.
We’re almost done.
This is the last one.
AT THE END: Do you have any questions about your medications?
There seems to be some areas that should be reviewed. Would now be a good time? We have 15 minutes left in the appointment. I will provide a handout before you leave so don’t feel you need to memorize everything now.
You seem to know some things about your medication. There are some areas I would like to review.
Hydrocodone: RN Teaching Info
Monitor: Have you noticed a decrease in pain in your chest? This med can also help with pain.
SE: constipation (increase fluid intake, 30 minute walks, increase insoluble fiber like brown rice), dry mouth (suck on sugarless candy, increase fluids, mouth rinses); GI irritation/nausea: take with food or milk to decrease. This drug can make you drowsy, I know you said it makes it easy to sleep at night. Do you feel any sleepiness when you take it in the morning? If so, you should avoid driving or heavy equipment use like a lawn mower.
Food interactions: You should continue to abstain from alcohol while on this drug.
Importance of Cough, deep breathing to open airways
SE: it can make it hard to sleep at night, tremors, heart palpitations.
_Do not take more than ordered.
-Need to prime canister before first use.; use of a spacer!
(does have gero warning for dec dose to dec AE)
Admin: should start taking it 30 minutes before a meal (usually before the first meal of the day). Chew tablet to work quicker (WRONG). Do you have any swallowing difficulty? If so,
Monitoring: Liver function, abdominal pain, stools for diarrhea, black/tarry, bloody, pus stools (may be pseudomembranous colitis)
SE: diarrhea-do not treat at home, let us know (like you did today) Could be C. Diff
Food/drug: etoh use and NSAIDs. If a food started to cause you distress, you would want to avoid that.
Non-pharms: loose clothing, sit up a couple hours after eating
SE: diarrhea/nausea/abd cramping/pseudomembranous colitis for weeks after completion of drug. It is a good thing to take in AM can cause insomnia. Rash: could be Steven Johnson Syndrome (call us right away if you develop). If you suddenly have difficulty walking/weak/falling or joint pain, stop exercise and use of affected joint call us as this drug can affect your tendons. If you notice a change in your skin color or pain on the upper right side, call us so we can check your liver function. Check your tongue, if you notice changes such as plaques or hairy growth this could be thrush.
Drug: Avoid OTC heartburn medications while on this drug. (Technically wrong, just need to space out by 2 hours); calcium (specifically milk products)/iron/zinc/magnesium/aluminum supplements such as functional foods (oj w/ Ca++ added)
Extra care watching for allergies, antibiotics are more common to cause
I know you said you are feeling better since starting this drug, it is important that you take the last three doses even if you continue to feel better.
How much fluid are you drinking each day? You need to consume at least 1500mL/day (about a 2L bottle of soda)
I want you to take the APAP as soon as you have a fever and take another dose as soon as needed. You can take up to 5gm/day
GENERAL Pt Education : if you forget a dose, take it as soon as you remember unless it is almost time to take the next dose; do not double dose
:take dose at the same time everyday
:stop taking and call if you develop a rash or swelling/difficulty breathing as these are signs of an allergic reaction
Medication Analysis Assignment
Drug treatment plays a significant role in maintaining and enhancing the quality and quantity of human lives. Drug treatment, however, is not without risks. There are inherent risks related to the effectiveness, interactions and side effects of each drug, and these risks are multiplied when individuals are treated with polypharmacy. The Institute of Medicine (IOM) estimates that “nearly one third of adults will take 5 or more different medications” (IOM, 2006). The US Department of Health and Human Services estimated that about 1 of every 7 (13.5%) hospitalized Medicare patients had permanent harm from a medical error, 37% of these inpatient injuries were associated with medications and alarmingly half of these adverse drug events were preventable (Levinson, 2010)! Nurses play a major role in the promotion of effective and safe medication therapy. In addition to assessing for effectiveness, adverse effects and interactions, the nurse is also responsible for providing medication education and support such that individuals can take a more active role in their medical care.
This assessment provides you an opportunity to demonstrate analysis ability level 4. Utilizing knowledge that you have gained from Anatomy and Physiology, Pathophysiology, Growth and Development, Health Assessment, Nutrition, Health Promotion including teaching learning principles and Pharmacology, you will complete an evaluation of an individual’s medication regimen. This will involve reading a medical history and watching a video of a nurse and patient interacting. You will also identify the education that is necessary to enhance the individual’s understanding such that the patient will be empowered to better participate in their own medical treatment.
The outcomes for this assessment are as follows:
2. Utilize knowledge of pharmacotherapeutics, pharmacodynamics, pharmacokinetics, pharmaceutics, and the individual patient to critically analyze the actual and potential effects of his/her medication regimen. (Course Outcome 2,3,4*)
3. Utilize the nursing process, teaching learning principles, and concepts related to health literacy to identify appropriate teaching that will promote participation in managing his/her care through medication therapy. (Course Outcome 4*)
* indicates related course outcomes
Gather Case Study Information
You will be assigned a case study regarding an individual patient with polypharmacy. Initially you will be provided a printed history and physical to review. After reviewing the chart, you will complete the drug profile tabular on the assigned medications.
Prepare a Drug Profile in Tabular Format
Complete the Drug Profile in the tabular format for each medication. Utilize a professional source to complete this tabular format for each medication (your text book is an excellent source and should be used) and cite reference(s) in APA for where the information was obtained.
Review Nurse/Patient Interaction Video
Next you will watch a video of a nurse interacting with the patient about the medications. I apologize for the poor quality of the videos, these were supposed to be redone, but with the Covid pandemic it is on hold. While you are viewing this, it is strongly encouraged that you take notes about the communication and patient education that occurs. Complete the Assessment and Evaluation of Patient’s Understanding of Drug Regimen questions, while watching the video. You will use your analysis ability to identify the accuracy of information. In addition, you will be evaluating the appropriateness and effectiveness of the current drug regimen.
These questions are to be answered in paragraph format. Your answers should be thorough and include rationale with citations as appropriate. The goal of your analysis is to be able to provide quality, holistic nursing care to the patient in regards to their medication regimen. You may want to organize your answers according to the drug being discussed.
Be sure to fill out the self-assessment and criteria sheet and submit it with your paper. Put your last name and first initial in the domain field before uploading it to Moodle.
a. The website www.drugdigest.org and http://reference.medscape.com/drug-interactionchecker are two of many resources you may use to assess drug interactions. Again, your book is also an excellent source. Identify the drugs with drug/food interactions to address in your paper.
***Remember that all essay questions start with a topic sentence, utilizing grammatical sentence structure, and cite all references with correct APA 6th or 7th edition formatting. Use https://owl.english.purdue.edu/owl/resource/560/01/ as a reference.
Please complete the following chart regarding the 5 required medications for your patient:
Revised Summer 2020
|Name of Drug:Generic (Trade)||Classifications||Route/Dose||Mechanism of Action||3 Most Common SE/AE||Required nursing assessment and labs before administration||How to evaluate effectiveness of the medication||3 Most important areas of patient education|
Please answer the following 10 questions meeting Level 3 Writing ability requirements (See online for level 3 writing ability standards):
1. Does your patient have any allergies? If so, what are they?
2. Are any of your patient’s medications on Beer’s List? If so, what concerns does this bring about for your patient?
3. Does your client have renal or hepatic impairment? If yes, how will this impairment affect the pharmacokinetics of their medications? What should the provider do to compensate for this impairment?
4. Do any of your patient’s medications (including OTC and supplements) interact with one another or with specific foods? If so, which interactions are of concern and why?
5. Are all your patient’s medication dosages within the adult therapeutic range? If yes, how do you know this? If no, which medications are outside the range?
6. Are there any medications your patient is taking that you feel are not effective? If so, which medications and why? If you feel they are all effective, why do you feel this way? Give specific examples.
7. What are the gaps in the patient’s understanding of his/her medications related to their purpose and method of administration? What information would you give to correct this knowledge deficit?
8. What are the gaps in the patient’s understanding of his/her medications related to their side effects and the management of those side effects? What information would you give to correct this knowledge deficit?
9. What are the gaps in the patient’s understanding of his/her medications related to food and drug interactions? What information would you give to correct this knowledge deficit?
10. Find a moment in which the nurse provides misinformation or does not address a key piece of patient education. How would you correct it?