Question

Medication Use in Older Adults

An 80-year-old patient is brought to the emergency department (ED) after fainting at home. He takes digoxin for heart failure, and his serum digoxin level is 2.3 ng/mL. He is transferred to a medical-telemetry nursing unit. The next day, the nurse asks the patient to tell her about his routine for taking his daily digoxin tablets. He states that he was told to check his pulse every morning before taking a pill. He does this in his kitchen because the clock on the wall has big numbers and he can see the second hand go around. The nurse asks him how long he measures his pulse. He replies, “I keep counting the beats until I get to 60. Sometimes it takes a long time. Then I take my heart pill.” Later he tells the nurse that he hates “having to take so many pills” and admits having trouble remembering to take his pills. He states that he sometimes can’t remember which pills to take with breakfast and which to take at night.

1. Identify two statements made by this patient that are a safety concern.

2. Discuss how age-related changes can affect drug absorption, distribution, metabolism, and excretion for this elderly patient.

3. How can the nurse determine if the patient is having problems with cognition that are contributing to unsafe self-administration of drugs, or if there are other external factors that are contributing to the medication errors

4. What can the nurse suggest to assist this patient to take his multiple medications correctly?

5. Devise a teaching–learning plan to reteach this patient about taking digoxin at home.

6. Who should be included in the teaching session with this patient?

7. Discuss how the nurse can validate whether the teaching plan has been effective.

Answer 1