Question

Millie Larsen is an 84-year-old Caucasian female who lives alone in a small home. Her husband, Harold, passed away a year ago and she has a cat, Snuggles, who is very important to her. Millie has one daughter, Dina Olsen, who is 50, that lives nearby, and is Millie's major support system. Her current medical problems include: hypertension, glaucoma, osteoarthritis of the knee, stress incontinence, osteoporosis, and hypercholesterolemia.

Millie is at the clinic for routine examination and medication follow up. She is taking several anti-hypertensive medications, diuretics, and analgesics. During the monologue, Millie provides important details of how she views her current life situation.

Medications include

50mg metoprolol PO BID

20mg lisinopril PO QD

240mg diltiazem PO QD

20mg furosemide PO QD

25mg hydrocholorthiazide (HCTZ) PO QD

400mg ibuprofen PO BID

5/325 hydrocodone/acetaminophen (Lortab) 1-2 tablets PO Q8 hrs PRN severe pain

Several weeks have passed since the clinic visit, and Millie is now in the hospital with a diagnosis of urinary tract infection and dehydration. Her presentation is atypical and she is confused.

At the 3:00 PM shift change. Millie has been in her room on the medical-surgical unit for about six hours. She was in the Emergency Department overnight because there were no available beds on the medical units. Due to her confusion, Millie did not take her medications properly in the days prior to admission and as a result, her blood pressure is very elevated. Millie's daughter, Dina is at the bedside and is quite concerned about the confusion and elevated blood pressure.

Based on the
clinical case provided develop a teaching/coaching plan that includes the
following information.

1. List the goal for this teaching/coaching plan
2. Describe three teaching resources
3. Identify the teaching strategies that can be used
4. List the specific instructions that may be needed regarding her medication and what adverse reactions to be aware of/and what to do
5. Identify two factors that may negatively influence adherence to the medication and how they can be overcome
6. Describe how to include the family
7. Provide information on how and when she should seek support and help

Answer 1

1 . GOALS

• Define accepted guidelines for diagnosing and staging the severity of hypertension.
• Describe elements of lifestyle modification in both healthy , pre hypertensive patients and hypertensive patients.
• Describe basic management principles of patients with essential hypertension.
• Define resistant hypertension.
• Describe lifestyle and home remedies
• Describe to practice healthy coping techniques
• Describe about get moving , walk .
• Describe about to reduce stress.

2 . TEACHING RESOURCES

• Hypertension communications kit ::Can share social media messages , graphics and resources to educate their audiences about hypertension.
• Hypertension patient education handouts :: Fact sheets and handouts can help patients understand how hypertension affects their health and how to make healthy lifestyle changes.
• Hypertension tools and training :: These materials can help health professionals devolop and support programs for preventing and managing hypertension.    3 . TEACHING STRATEGIES
• Stay healthy weight .
  • keep a food journal
  • eat foods low in saturated fat , cholesterol and refined sugar
  • eat atleast 5 servings of fruits and vegetables each day
  • watch your portion size
  • do not skip meals
  • be active
  • eat fiber 25 to 30 grams / day
  • drink plenty of water
• Follow the DASH eating plan
  • rich in fruits
  • vegetable rich
  • low fat dairy products
  • low in sodium
  • low in fat
• Eat less sodium
  • avoid processed foods
  • use fresh ingredients
  • use salt substitute
• Eat foods rich in Potassium
  • spinach
  • beans
  • banana
  • sweet potato
  • beetroots
  • oranges
• Regular exercises
  • spend 30 mts
  • safe exercises like aerobics
• Limit alcohol intake & Tobacco
• Control stress and anger
• Follow up regularly

4 . SPECIFIC INSTRUCTIONS & ADVERSE REACTIONS

• Metoprolol should be taken with a meal or just after a meal.
• Do not take Lisinopril for a long period and drink plenty of water while taking this medicines.
• Diltiazem should use regularly to get effect
• furisemide may reduce potassium level , so drink plenty of water
• Hydrochlorothiazide should taken 4 hrs before bedtime
• Hydrocodone is an extended release tablet so donot lick , pre soak, wet the tab before put it in mouth.
• common adverse reactions of these medications are dizziness ,lightheadedness , nervous , erection problems , nausea , vomiting , weightlosSS
• 6. HOW TO INCLUDE FAMILY
  • ask to help in healthy weight management
  • help in coping
  • help in exercises
  • control sodium intake
  • help in taking medicines
  7.   how to seek help
  • ask for medicinal assistance
  • seek help for exercise