Question

Critical Thinking Case Study

NS is a 72-year-old woman who immigrated to the United States from Egypt 5 years ago. She is a widow, has five grown children, and follows Islamic doctrine. She lives with her oldest daughter, and a younger daughter and three sons live near her home. NS is currently hospitalized due to a recent cerebral vascular accident. She has left-sided paralysis. The attending physician tells the patient she should go to a rehabilitation unit for 3 weeks for physical therapy. The oldest daughter is present for the physician’s visit. Both the patient and her daughter appear anxious but do not ask the physician any questions.

Medications Prescribed Warfarin 3mg DQ, check INR every week, Aspirin 81mg, Metoprolol 25mg DQ, Hydrochlorothiazide 12.5mg. , Celexa 10mg QD, The RN develops a discharge teaching plan to address anxiety, medications, safety & depression.

List the goal for this teaching/coaching plan Anxiety,Medications,Safety & Depression

Describe three teaching resources what resources can she use to complete teaching?

Identify the teaching strategies that can be used

List the specific instructions that may be needed regarding her medication and what adverse reactions to be aware of/and what to do

Identify two factors that may negatively influence adherence to the medication and how they can be overcome

Describe how to include the family

Provide information on how and when she should seek support and help

Answer 1

●The goal of this teaching is to reduce anxiety, provide knowledge anger the medication regimen and how to stay sage and avoid depression

●The nurse can use the following teaching resources for the patient

• Communication by one and one method where the nurse explains and patient hears and understands .Any query can be asked and clarified .Similarly thd nurse can also assess whether the patient has understood the teaching or not
• The use of internet like comprehensive health enhancement support system is a reliable resource to get information online
• Center for Disease Control and prevention is a most reliable and government run site for the patient to 6ake as a resource

● The teaching strategy which can be implemented here is by audiovisual or a motion picture aides where language cannot be a problem.

Use of technology in the teaching is a good teaching strategy

●The following instructions us needed regarding the medication are

• Warfarin: is a blood thinner, to be taken in evening time ,no OTC,monitor platelets and clotting factor ,avoid garlic in food,report side effects like bruises, bleeding, dark urine ,hemetemesis, hemolysis, malena, etc.,Stop in case of any severe reactions and seek medical help
• Aspirin:is a painkiller ,to be taken in the after ,no OTC drugs, no overdose or underdose, Avoid painkillers like NSAID ,ibuprofen ,Report in case of side effects like bruises,bleeding, fever,tachycardia ,tinnitus ,edema,rash severe nausea and vomiting
• Metoprolol is an antihypertensive drug, monitor blood pressure and pulse rate ,restrict salt in diet ,report any adverse reactions immediately
• Hydrochlorothiazide is a water pill and reduces the blood pressure.Urine output has to be monitored and proper fluid replacement is necessary to prevent fluid loss ,hypotension
• Celexa is a medication used to treat depression. Take as directed . Any major psychological changes like hallucinations, suicidal behavior, behavior problems has to be reported immediately

●The factors which can negatively influence medication adherence are

• Oldage and the mental illness can make patient to skip medication
• Anxiety
• Lack of knowledge on medication

●The family can be involved by health education about the care , family therapy can be done to involve the members to understand about the management if the condition effectively

●The following time she has to seek support

• Any adverse reactions because of the drug
• Weakness or no improvement
• Report immediately in case of any bruises ,bleeding, malena, hemoptysis ,hemetemesis, malena,suicidal thoughts.