Hypertension and Hypercholesterolemia Teaching Plan

Teaching Plan
Patient Name: Mr. M
Age: 52 years old
Brief: Patient suffers from uncontrolled hypertension and hypercholesterolemia. Patient has no other medical history. Patient also has no allergies, and has not been taking any medications previously.
A: Learning Need Assessment
This teaching plan is based on the premise that although the diagnosis as well as proper treatment of a disease are of great relevance to the prognosis of a patient, there is need for the patient to be well informed on not only when and how to take the prescribed medications, but also the said medications’ therapeutic actions and side effects. As a matter of fact, various studies have clearly indicated that medication teaching has a positive impact on both compliance and outcomes.
· In essence, “hypertension and hypercholesterolemia are important modifiable risk factors for cardiovascular disease (CVD)” (Wong, Lopez, and Williams, 2006). In that regard, therefore, the relevance of improved treatment outcomes cannot be overstated in this particular case. Patient education would facilitate patient involvement in the treatment plan – effectively improving outcomes (both physiological and psychological).
· Mr. M. is returning home. In essence, perceived patient understanding in the hospital setting does not guarantee adherence to the treatment or drug regimen when at home (Marcus, 2014). More specifically, in the words of the author, “even if the patient appears to understand the teaching during a verbal consultation, this does not assure the ability for self-care when the patient goes home” (Marcus, 2014). Teaching of Mr. M. about his medications would, therefore, be of great relevance during my home visit.
· Despite being a good English speaker, Mr. M. has sixth grade education. This effectively means that he may lack the appropriate grasp of not only the therapeutic actions of the medications, but also the indications and side effects. Medication teaching would come in handy on this front. Research has in the past indicated that patients leaving hospital often have little, if any, information on drug interactions, adverse effects, as well as when to call for emergency services (Alfandre, 2009).
B: Instructional Approach
Medication training will in this case target not only the patient, but also his caregivers and family. I will begin by establishing rapport with Mr. M. so as to stimulate his interest. I will also get to list down all his concerns regarding the various aspects of his treatment. Further, I will encourage him to ask questions at specific points during my presentation so as to enhance his grasp of all the relevant concepts. Caregivers too will be encouraged to seek the relevant clarifications.
C: Medications
1. Metoprolol 75mg PO BID
Indications: a beta-blocker utilized in hypertension treatment
Dosage: a single dose – 100mg/day PO. Drug should be taken at the same time on a daily basis, i.e. in the morning. Patient must stick to the recommended dosage and must not take the medication in smaller or larger doses. Drug must not be stopped suddenly. If a dose is skipped, it must be taken as soon as it is possible – but not at about the same time as the next dose.
Therapeutic actions: decreased blood pressure
Side effects: could cause drowsiness, weakness and fatigue. In addition to blurred vision, it could also cause mild rash or itching. Other side effects include loss of memory and diarrhea. Patient will be advised to be careful when engaging in activities that need a high level of alertness.
Call 911 in case of: overdose, light-headedness, shortness of breath, and slowed heartbeat.
Drug interactions: should not be used with clonidine, diltiazem, or verapamil as this could increase the risk of bradycardia. Increased myocardial depression could be an unintended consequence in general anesthesia administration. Acute alcohol ingestion when using the drug could cause increased hypotension.
2. Lipitor® 20mg PO QHS
Indications: used in hypercholesterolemia management as an add-on or adjunct therapy to diet.
Dosage: a single dose in the morning – 20mg daily.
Therapeutic actions: lowers lipids
Side effects: could cause hot flushes, fatigue, and dizziness.
Call 911 in case of: any kind of allergic reaction, i.e. tongue or lip and face swelling. It would also be advisable to call emergency services if dark-colored or brown urine is observed. Muscle problems that are persistent could be a precursor to kidney problems (call 911 in case of tenderness or weakness of muscles).
Drug interactions: ezetimbe’s effectiveness could be negatively impacted upon by simultaneous use with cholestyramine. Also, used simultaneously with fenofibrates, it could lead to increased cholelithiasis risk.
3. Terazosin 2mg PO QHS
Indications: used in the treatment of hypertension
Dosage: a single dose – 2mg daily at bedtime.
Therapeutic actions: decreased blood pressure via the relaxation of arteries and veins.
Side effects: could cause dizziness, headache, nausea and weakness.
Call 911 in case of: a ‘passing out’ feeling, painful erection of the penis that lasts for more than 4 hours, and feet or hand swelling.
Drug interactions: there is increased risk of significant hypotension when used simultaneously with some antihypertensive agents.
4. Nitroglycerin 0.4mg SL x3 PRN
Indications: used in the prevention of angina
Dosage: 1 tablet dissolved under the tongue prn, i.e. at onset of chest pain.
Therapeutic actions: causes the dilation of blood vessels – effectively easing the heart’s pumping of blood.
Side effects: could cause a persistent or severe headache upon administration. Could also cause palpation and weakness.
Call 911 in case of: an overdose - overdose symptoms include, but they are not limited to, cold and clammy skin, passing of dark urine, sore throat, paralysis, loss of appetite, fever, and breathing difficulties.
Drug interactions: hypotension could be caused by concurrent use of alcohol and nitrates. Concurrent aspirin administration could further enhance nitroglycerin’s hemodynamic and vasodilatory effects. Contraindication for PDE-5 inhibitors patients.
D: Learning Outcomes
There are a number of goals that I would intend my medication teaching to accomplish at the end of my assigned home visit. These outcomes have been highlighted below:
· To reduce (or eliminate) prescribed medication difficulties, i.e. with regard to timing and dosage.
· To enhance the patient’s level of control over the treatment plan (in what is expected to enhance compliance).
· To minimize chances of fatal complications by, amongst other things, being able to correctly identify side effects. The patient will know when he should call 911.
· To supplement/reinforce oral instructions given at the hospital so as to improve outcomes.
· To further enhance self-care so as to minimize unnecessary hospital visits and professional interventions.






References
Alfandre, D.J. (2009). “I'm Going Home”: Discharges against Medical Advice. Mayo Clinic Proceedings, 84(3), 255-260.
Marcus, C. (2014). Strategies for Improving the Quality of Verbal Patient and Family Education: A Review of the Literature and Creation of the EDUCATE Model. Health Psychology and Behavioral Medicine, 2(1), 482-495.
Wong, N.D., Lopez, V. & Williams, T.S. (2006). Prevalence, Treatment, and Control of Combined Hypertension and Hypercholesterolemia in the United States. American Journal of Cardiology, 98(2), 198-203.