Question

Case Scenario # 4

You are making a nursing visit to an older woman in her retirement facility. She was recently discharged from the hospital after treatment for a gastric ulcer that resulted from pain medications she was taking for arthritis. During your initial conversation, as you inquire about her health, you notice that the patient appears distracted and seems to have difficulty following questions and giving answers. When you ask about her current medications, her responses indicate that she is unsure about what they are for and how to take them. When you ask her to show you her medications, she produces a large brown paper bag with about 10 bottles: two bottles of a diuretic labeled “Take two tablets twice a day,” three bottles of potassium chloride labeled “Take fi ve tablets a day in divided doses,” one bottle of a histamine blocker labeled “Take one capsule daily,” one bottle of analgesic containing oxycodone to take “as needed arthritis pain,” one bottle of extra-strength acetaminophen, one bottle of stool softener capsules to take “as needed,” and one bottle of another analgesic containing codeine to take “every 4 hours as needed.” As you continue inquiring about which medications she takes and when she takes them, you learn that she has age-related macular degeneration and is legally blind.

   

   1.   From the information the woman shared with you, identify possible factors that may make it difficult for the patient to adhere to her medication regimen, possibly threatening her health.

   2.   Propose a course of timely and appropriate nursing actions.

   3.   What other individuals or healthcare professionals might you want to collaborate with concerning this situation?  

Case Scenario # 5

Answer 1

Arthritis

Arthritis is the inflammation of a joint or joints , causing pain , stiffness , swelling and disability. It may occur due to infection, trauma , metabolic disorders or degenerative changes.

Gastric ulcer: A peptic ulcer located in the stomach is called a gastric ulcer.

1.Possible factors that causes non adherence to medications:

* Inadequate knowledge regarding medications and its schedule

* Vision impairment, that make it difficult to identify the meditations.

* Side effects of the drug, may make her to avoid medications some times

* Too many medications

* fear or confusion

* lack of symptoms

* mistrust on physician or pharmacist.

Ignorance about medication regimen may leads to over consumption or missing to have medications, that may danger her health. Overconsumption of Analgesics may lead to gastric ulcers. Diuretics over dose may lead to dehydration or fluid and electrolyte imbalance. Codeine , may have the side effects of drowsiness, sedation, itching , dizziness etc.

2. Nursing actions:

* Build a trusting relationship with the patient through open communication

* Assess her mental ability or understanding capacity

* Educate the woman regarding the disease process and about the medications, its actions and what will be the outcome.

* Instruct her about the possible side effects of drugs,  so she can cope with that and give her tips to manage the side effects .

* warn her about the possible complications of nonadherence of medications

* Collaborate with her pharmacist and teach her about the drug prescription, timings and frequency.

* Write or label the drug bottles in big fonts and size, probably 16 , as the woman has problem with vision .

* Use colour code for tablet bottles. For eg: blue for morning, yellow for night time medications for easy understanding.

* Write AM or PM specifically in the drug containers to identify the timings of medications.

* Use of innovative technologies to assist medication regimen, such as Automatic medicine dispenser , customised machines are available, that can remind the patient , and dispense tne correct dose of medications as per entered prescription.

3. Collaboration with other health care providers:

The nurse can collaborate with other health care providers to obtain a solution for the scenario and to assist the woman to adhere with her medication prescription.  

* Pharmacist can help the patient by educating her regarding the medications, its importance and regimen or schedule for each medicines. They can arrange the technical devices that assist her in adhering with the medication regimen, such as ' talking Prescription Containers ' .

* Social workers, who support visually impaired persons by providing assistance by make use of ' Brail labels' .

* Patient care manager or nursing assistants in the retirement facility, can help her to be complaint with her medications.