Question

An 88-year-old Chinese-speaking woman is admitted for complaints of dizziness and s/p a syncopal episode while attending a local senior center program. She was brought to the emergency department. She lives with her son and his family in a two-family home, which she owns. She is independent in all activities of daily living (ADLs) and participates in a daily tai chi exercise group with her friends at the local park. She did not want to go to the emergency department, but instead wanted to go home and have some "herbal medicines."

A medical workup reveals that she has aortic stenosis, atrial fibrillation, and hypertension. She is started on an antihypertensive, coumadin, and aspirin and discharged home with her family.

One week later she is readmitted to the hospital with rectal bleeding and bleeding from her gums. She denies taking excessive amounts of coumadin or aspirin. When you ask her son to bring in her medications, only prescribed medications are present, and he reassures you that she is taking the medications according to the physician's orders. She reports that she has not altered her routine at all; she practices tai chi every morning and eats lots of fruits and vegetables. A colonoscopy reveals a polyp, which is removed, and she is transfused with 2 units of packed red blood cells. She is discharged home with her family 2 days later, and home health care is ordered. The home health care nurse visits her 1 day after discharge.

A Chinese-speaking nurse visits her and learns that she is taking all of her prescribed medications as ordered. However, she is taking a supplement of a Chinese herb (gingko biloba) in tablet form twice per day to maintain her memory, and she is also consuming an oriental herbal tea (containing Chinese ginseng, ginger, and garlic) three to four times per day. She states, "I take my pills just like the doctor says, but it is this tea that is making me feel better. It is made of special herbs. It is better than all of those pills." The nurse suggests that the woman stop taking the supplement and drinking the tea until she can find out what herbs it is made of, but she is reluctant to do so because she believes it is the secret to longevity.

1. What actions should the home health nurse take?
2. What information should the nurse include in the medication teaching plan for the patient?
3. Based on the information in the above scenario, do you think that her regimen is causing her rectal bleeding and bleeding gums? Why? Specifically, what elements of her regimen may be contributing to the bleeding?

Answer 1

1. Home health nurse first want to assess the patient conditby complete physical examination. Need to assess patient dietary habits,daily activities and treatment regimen because some types of dietary foods also interact with medication action and causes side effects,daily activities also interact with medication actions. *Home health nurse duty to educate the patient about nutrition diet,and want to plan menu according to required calories by patient. *Nurse has to administer medications according to doctors orders. *She works as a bridge between the hospital and the home for the patient.

2. Medication teaching plan consistent of things about. *Dosage of medication *Time and frequency of medication. *What may be the side effects due to prescribed medication. *How to prevent this side effects to the patient. About these things we need to educate patient.

3. Patient is following two regimens one is with doctor orders coumadin and aspirin. Second regimen she using herb's without doctors orders. Yes ,present complaint of patient that is rectal bleeding and gums bleeding occurred due to patient regime. The medication doctor ordered coumadin is warfarin that is anti coagulant,its common side effect is unusual bleeding. Aspirin NSAID. Those drugs interact with each other and increase risk of bleeding. But side effects due to these two medication overweight by advantages and uses so using for treatment to prevent or reduce blood clots in Veins thrombosis and in cardiovascular disorders.

4.patient second regimen that taking herbs with out physician order including ginkgo, garlic, ginger, ginseng are works by aggravating platelets activity there by effects the action of Coumadin and aspirin and cause side effects .