Month: November 2020

                                     How I made a Difference

            Over the course of the semester, I was very fortunate enough to be able to experience a clinical rotation in person as well as online. There were many times that I felt that the little help I was able to offer the nurses and patients at my clinical sight made a difference in their day or even their stay. However, one moment that really stood out to me was when I walked into the room of a patient that was very disoriented to where she was. \As soon as she saw me walk in, her face lit up and was shocked because she thought it was her son whom she hasn’t seen in a few days because of her hospitalization walked through the door. I started doing vital signs on her and she just couldn’t stop talking to me about how much she missed him and how she wanted to see him. Luckily the floor was particularly slow that day, so I was able to stay and talk to her for a little bit before having to move on to the next room. As I was wrapping up with this client and getting ready to leave, she grabbed me by the hand and gave me a huge thank you and told me how nice it was to see a somewhat familiar face when she woke up even though it wasn’t who she thought it was.

            This interaction really stuck with me after all of these weeks because I never really thought that something so simple as just talking with someone about a person they miss with a complete stranger could have such an impact on a person. When I left clinical that day, I knew that I made a difference for the client. I may not have helped her recover from the procedure that she was receiving but I know that I helped make her time at the hospital a little more bearable.

Client Name BG                                                          Date of Review 11/3/2020

Allergies: none

Storage of Medication (How and where does client store medication?): places them in a weekly pill holder to be able to make sure he has taken his pills

Keeps medications in original container?      Yes or No.  If no, please explain: no, places in a daily pill holder with other medications. Keeps the next weeks meds in the original container

Access issues (in obtaining meds, trouble opening, reading labels, comprehension, functional issues – i.e. arthritis, hearing deficit, glasses)? May forget if he has taken his medications if weekly holder isn’t made up.

How many providers does this client use? Client has one provider

One of the safety concerns that this client has with his medication Diazepam is that it makes him extremely nauseous. This medication is known to cause the client to have severe nausea and vomiting (Kluwers 2020). Whenever they would take the drug it ended up in the client violently throwing up. This would then often make the client stop taking the medication which would then result in their “high anxiety episodes” to come back. As a result of this nausea the provider put him on the medication ondansetron (Zofran). This drug allows for the relief of his nausea and vomiting (Kluwers 2020). The safety concerns associated with the drug Diazepam are not only the sever nausea and vomiting that they are experiencing but also the possibility that the client will stop taking his medication allowing for the anxiety episodes to return once again.

While the benefits of taking Zofran allow for the ability to take their Diazepam (and some of the other drugs), it still poses a safety concern for the client. Zofran causes this client to become constipated (Kluwers 2020). A safety concern with the constipation is dehydration. Constipation is often caused by a lack of fluids and this client has stated that he often doesn’t drink enough water throughout his day. A second safety concern related to the Zofran is the arrythmias (Kluwers 2020) that the client has experienced. These arrythmias do not happen very frequently but they have happened enough to be alert for the potential of them happening.

Regarding the medication amlodipine (Norvasc) there are a few safety concerns regarding this drug for this client. When the client first started taking the drug, they reported fits of dyspnea, which is one of the adverse effects of the drug (Kluwers 2020). This is a safety concern because they are typically unpredictable and happen for long periods of time. Another safety consideration for this drug would any hypotension that could arise from the drug. Despite being a client with hypertension it is important for knowing that hypotension can still happen (Kluwers 2020).

With taking the bisacodyl which is a laxative, the client is at risk for the further dehydration and electrolyte imbalance (Kluwers 2020). The client is already at an elevated risk for being dehydrated with not drinking enough water throughout the day and taking a laxative on top of that could result in even more fluid loss. The laxative causes increased peristalsis and diarrhea which causes the client to lose the fluid that they are getting (Kluwers 2020). Along with losing fluids the client is also at risk for electrolyte imbalance. If peristalsis is increased the nutrients consumed go through the intestine at an accelerated rate causing not as much absorption.   

            For this client I would begin to develop a teaching plan knowing that they are somewhat health literate and are fairly capable and eager to learn. With knowing that the client is somewhat literate to some healthcare language so I would talk to them in a way that they would understand by using words like the common name of drugs but mix in some basic healthcare terms that they are aware of. This would allow for the client to feel that they are not being talked down to but included in the conversation, which is a way that this client has expressed is a better way to learn new information.

As for what I would teach this client in regard to Diazepam I would definitely make sure to educate the client on the importance of taking the medication in adjunct to the Zofran. Even though taking the Diazepam made the client nauseous without it the anxiety attacks come back. If this client continues to have these anxiety attacks new problems could arise. Anxiety plays a role in potentially developing heart problems, already having hypertension the client doesn’t need to increase his risk. A second education point I would make for this client would to be to make sure that they are avoiding consuming alcohol while on this medication. With Diazepam being a depressant of the CNS (the point), alcohol would only further depress the CNS which could lead to worsening adverse effects on the client. Of which could include respiratory depression and bradycardia.

Some educational considerations for the medication Zofran would be in the relation to the possible constipation and occasional arrythmias. A point that I would emphasis the importance of teaching would be for the constipation would be to stay hydrated. With this client already stating that they do not typically drink enough water in a day this puts them at a slightly higher chance of developing constipation. Educating the client on the importance of hydration will help to prevent constipation. For the arrythmias I would educate the client on the importance of going to their provider to get regular EKGs done. While the arrythmias that this client had experienced were not very frequent, regular screening for them can help to monitor that everything with the heart is staying normal. With other drugs possibly causing arrythmias as well it also puts a stress on the importance of checking telemetry.

When it comes to teaching this client about the Norvasc I world emphasize the importance of being able to know how to read a blood pressure cuff and how to use one. With already suffering from hypertension this should be a skill that this client should know how to do. Since Norvasc is helping to lower the clients blood pressure it is essential to be able to check if the blood pressure dropped too low. Since this is a skill that can be done at home, I would suggest to this client to possibly getting an electronic blood pressure cuff so they wouldn’t have to learn how to do the blood pressure manually. A second education point would be what to do if the client began to feel like he was having a fit of dyspnea. I would teach them proper breathing techniques that promote productive breathing.

Like along with Zofran, an educational focus on the medication bisacodyl, the potential for dehydration is still high. The education for this drug however needs to focus on replacing fluids that have been lost and not the ones that are lacking. With the medication moving things along the GI tract the water and nutrients are not absorbed as much as they typically would be if the medication wasn’t taken. A good way to make sure the client is getting enough fluids would be to educate him on other ways to get the fluids needed not just from drinking water. Other sources may include foods like spinach and cucumbers (Harrison, 2018). This way the client is having a variety of fluids.

                                                            References

Harrison, M. (2018). 10 water-rich foods that will help you stay hydrated. Retrieved November 05, 2020, from https://www.bupa.co.uk/newsroom/ourviews/ten-water-rich-foods-hydration

Kluwers, W. (2020). Lippincott Advisor. Retrieved November 05, 2020, from https://advisor-edu.lww.com/lna/document.do?bid=6

Kluwers, W. (2020). VitalSource Bookshelf Online. Retrieved November 05, 2020, from https://coursepoint.vitalsource.com/

There were a few safety concerns regarding the medications that this client was on. Among those safety concerns were dehydration and electrolyte imbalances, constipation, dyspnea, and severe nausea. These safety concerns came from the adverse reactions of one of the medications that this client is taking. This client was aware of the medications that he was on. This is important because this client was experiencing adverse effects from one medication, so their prescriber prescribed a new medication to help combat the adverse effects. This client was fairly well literate medically, so they were able to understand what each medication was for and what it was doing in their body. Each of the medications did a different job and reason for being prescribed to this client making the drugs not have any overlap on what they did for the client and in the client’s body.