Question

. 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 five 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. Describe the direction that your assessment might take in this situation.

2. 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.

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

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

Answer 1

1.Assessment

Here the patient have history of gastric ulcer, arthritis, and also present situation of macular degeneration. So assessment should start here as physical assessment includes neurological assessment ( because she is not able for providing answers correctly).

So main physical assessment includes

?Neurological assessment: Here assess the orientation to place- person- time,consciousness, etc

?Physical assessment includes:

General health: cleanliness, healthy, nourished, etc.

After that system wise assessment includes head, face, neck, throt, chest, abodomen, extremeties, geintalia and rectum.

So here main in Eyes: want to check vision, retina, conjunctiva, eyelashes, eyebrows etc. Through vision test,it can able for identify macular degeneration. .

In abodomen: percussion ( for identify fluid collection), palpation(for identify mass collection or tenderness), observation ( any deviation from normal structure), Auscultation (listening of bowel sounds) . So by it, gastric ulcer symptoms like tenderness, gas collection etc can be identify.

Extremities: By assessing extremeties, arthritis symptom also can identify.

2.If client takes diuretics overdose, then it will lead to dehydration, low sodium level in body, electrolyte imbalance, low level potassium in blood etc.

If client takes potassium chloride more, then it will lead to fatal condition. Because it may cause, irregular heart beat, shallow breathing, etc seizure or cardio pulmonary arrest also occurs . Potassium chloride should be taken very carefully.

Comparing to other drugs, these 2 have more side effects which will leadctobgemreat complications.

3.first assess condition of patient.

?Check the medication bottles, and arrange them according to administration.

?Nurse can keep the medicine near to patient according to needed number at the time. Eg. Analgesic can give, only if patient complaints pain.

?Emergency medicines like potassium chloride sholud not keep with patient, because patient not much aware .

?Nurse sholud monitor side effects of drugs.

?She sholud check, whether patient take medicine properly or not.

4.Pharmacist help is necessary here. Because pharmacist can give some more ideas regarding that specific medications.

Doctor' s help important because, the patient is not much aware. And doctor provided so many medications also. Safety of patient is important here. So nurse can take help from doctors.