Question

Ethel Goetz is a 72 year old patient has returned to the clinic this morning with questions regarding her medications. She shows you a prescription that reads: “K-Dur 20 mEq bid”, and asks :          --“Should I still take the potassium?”          --“Should I take Dyazide and Capoten together?”          --“How is Dyazide different from Capoten?” The patient states that her “family doctor” put her on Dyazide (triamterene + HCTZ) instead of the Lasix (furosemide) that she had been taking for years. Then, she claims that her “heart doctor” started her on Capoten. Ethel appears to be confused and she is unsteady on her feet when she stands.

You notice that her clothes are very loose. You recognize that she may also be a poor historian, but she reports losing 20 pounds in the least 2 weeks. Her doctors may not be aware of each other’s prescriptions. Her meds are filled by different pharmacies. Three physicians have been prescribing for her. Ethel had lab work done in the clinic yesterday, and is coming in to see what they found. You note the following: Creatinine: 3.2, K+ 5.0, BUN 82. Her Specific gravity is 1.032. Her pulse is 98, Respirations 26, BP: 146/46, and she is afebrile.

This assignment does not require a title page, but please cite at least 2 references (in APA format) to support your decisions. Limit your answers to two pages if possible.

1. How would you teach this client about her medications/s?
2. Teach the client about each lab test and result. Are they normal? Are they abnormal? What might that grouping of labs and symptoms mean?
3. Create a primary goal for this plan (what do you ultimately want to see happen?)
4. Identify 3 teaching strategies that you could use to do this work.
5. What instruction does the client need?
6. What instruction does the family need? How will you include them?
7. List adverse reactions that both client and family need information on. Be sure to include what to do if they see one or more of the reactions discussed.
8. Describe any barriers to patient success that you see in this scenario.

Answer 1

ANS 1: Firstly she should know that various drugs may have interactions with each other hence her doctors should about all the medications. Her queries should be answered as follows:

She needs to tell her doctors about the other medications she is taking as.

- She can stop the potassium

- If taken with Capoten, Dyazide have the following drug interactions - (Major) ACE inhibitors can increase the risk of hyperkalemia, especially in the presence of renal impairment. This combination should be used with caution and serum potassium levels monitored. The Beers Criteria recommends avoiding routine use of this combination in older adults. (Moderate) Patients with hyponatremia or hypovolemia are more susceptible to developing reversible renal insufficiency when given angiotensin converting enzyme (ACE) inhibitors and diuretics concomitantly.

- Thiazide diuretic and a potassium-sparing diuretic; used for HTN and edema; triamterene counteracts potassium loss, whereas CAPOTEN is a specific competitive inhibitor of angiotensin I-converting enzyme (ACE) used in hypertension.

ANS 2 : The normal serum creatinine range is 0.6–1.1 mg/dL in women. Generally, a high serum creatinine level means that your kidneys aren't working well.

The normal BUN level for healthy adults (and children) is 7–20 mg/dL. A high BUN (82 mg/dl) may mean kidney function that is less than normal

Ideally, urine specific gravity results will fall between 1.002 and 1.030 if kidneys are functioning normally. Specific gravity results above 1.010 can indicate mild dehydration. The higher the number, the more dehydrated one may be.

blood potassium level is normally 3.6 to 5.2 millimoles per liter (mmol/L)

Pulse and Respiration is within normal range but blood pressure is abnormal.

- The grouping of lab results and symptoms point towards some problem kidney functioning. If kidneys are affected, doctor will need to go through the medications prescribed again.

ANS 3 : The primary goal is to control the intake of medication and improve the kidney functioning with regular monitoring.

ANS 4 : Teaching strategies that could be used are-

- Using actual medications, i.e., the one she is taking while taking about the medications.

- Can use notes.

- Asking her to repeat whatever she understood

- Clarify any doubts that may be present

- Diet Chart