Patient Education Teaching Nursing 2600, Group 8 Suzanne Taylor Fawn Beatty Mindi Arnett Tessa Herrmann Learning

Assessment We decided to use the knowledge assessment tool, asking Mr. Totino to rate himself on a 4 point scale regarding his diagnoses and current medications. We changed the topic, but closely followed the question outline as below, to assess his knowledge about hypertension, diabetes and coronary artery disease.

He rated himself at a 2 on most items, but had slightly less understanding of how his co-morbidities affected his overall health in tandem. We have determined through our assessment that Mr. Totino has some college education but does not understand medical terminology and needs to have information on hypertension, diabetes, and coronary artery disease explained to him so that he can understand how to improve his health. He learns well verbally, as long as he is able to ask questions, and not be rushed. He also expressed that when he can see something, it helps him remember what he has learned. We would spend some time one on one with Mr. Totino, in short time increments and use the following outline as a guide to teach him as well as give him the attached handouts. Patient Goals Based on Mr. Totinos presenting symptoms and disease history, the goals we have identified are: Mr. Totino will be able to identify his disease conditions, and his specific symptoms related to each. He will understand the purpose of his medications, and will be compliant to his medication regimen.

He will be able to identify lifestyle changes to improve the quality of his health and avoid further complications. He will have the tools/skills he needs to accomplish the above goals, and will know when to see his doctor, as well as symptoms of an acute exacerbation.

We will know he has met these learning goals by repeating our learning assessment.

Disease Process
for Hypertension, Coronary Artery Disease, and Diabetes Hypertension What is Hypertension? The heart pumps blood into the arteries (blood vessels), which carry the blood throughout the body. Blood pressure is the measure of the force of blood pushing against blood vessel walls. High blood pressure, also called hypertension, is dangerous because it makes the heart work harder to pump blood to the body and contributes to hardening of the arteries, or atherosclerosis, and to the development of heart failure. Several things contribute to high blood pressure, including: Smoking Being overweight Obese Lack of physical activity Too much salt in the diet More than 1 to 2 drinks of alcohol per day Stress Older age Genetics Family history of high blood pressure Chronic kidney disease Adrenal and thyroid disorders Signs and symptoms- High blood pressure is called the "silent killer" because many people don't realize
they have it. High blood pressure often has no warning signs or symptoms. You may have damage from high blood pressure without having any signs. Your blood pressure should be no higher than

12/80. When it gets higher than this it is causing damage in your body. It can cause heart attacks, strokes, kidney disease, and eye problems. This can lead to coronary artery disease. Coronary Artery Disease Coronary artery disease is a disease in which a waxy substance called plaque builds up inside the coronary arteries, and the arteries that supply blood to the heart muscle become hardened and narrowed. This plaque can block the blood that is being pumped to the heart either totally or partially. When this happens less oxygen gets to the heart and can cause a heart attack. This can cause permanent damage to the heart.

Diabetes Diabetes is a lifelong (chronic) disease in which there are high levels of glucose or sugar in the blood. Insulin is a hormone produced in the pancreas by special cells, called beta cells. Insulin is needed to move blood sugar (glucose) into cells. It is stored there and later used for energy. When there is too much glucose in the blood it is called hyperglycemia. What are possible causes of hyperglycemia? Hyperglycemia is caused when there is an increase in glucose in the blood. This can be caused by insulin resistance, when glucose is unable to enter the cell so it builds up in the blood. An illness can cause a lack of insulin. Stress also elevates blood glucose. The bodys response to low glucose levels (increasing insulin production) can also result in hyperglycemia. What is the normal range for glucose testing? 70-130 mg/dl

Medications
To help with medication compliance we spent some time with Mr. Tortino to review what his meds are, why hes taking each one and how to use a pill box. We focused on how and when to take them and things to report. We used laymans terms and avoided complicated medical language. Drug: Lisinopril Classification: Ace Inhibitor Mechanism of Action: Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also plasma renin levels and aldosterone levels. Net result is systemic vasodilation. Therapeutic Effects: Lowering of BP in hypertensive patients. Increased survival and decreased symptoms in patients with heart failure. Increased survival after myocardial infarction. Nursing Considerations: *Obtain BP before administering-hold typically if SBP <90 *Change position slowly-especially with elderly to prevent orthostatic changes *Monitor for decreased WBC count, hyperkalemia as well as liver function, and GFR, creatinine (metabolized by liver-excreted by kidneys) Drug: Atenolol Classification: Beta Blocker Mechanism of Action: Blocks stimulation of beta1(myocardial)-adrenergic receptors. Does not usually affect beta2 (pulmonary, vascular, uterine)-receptor sites. Therapeutic Effects: Decreased BP and heart rate. Decreased frequency of attacks of angina pectoris. Prevention of MI. Nursing Considerations: *Obtain BP and HR before administering-hold typically if SBP <90. HR <60 *Change position slowly-especially with elderly to prevent orthostatic changes *Contraindicated in worsening CHF, bradycardia of heart blockuse with caution in diabetes, liver disease Drug: Glyburide Classification: Anti-diabetics/ sulfonylureas

Mechanism of Action: Lowers blood sugar by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. May also decrease hepatic glucose production. Therapeutic Effects: Lowering of blood sugar in diabetic patients. Nursing Considerations: * Instruct the patient to take medication at same time each day. Take missed doses as soon as remembered unless almost time for next dose. Do not take if unable to eat. *Observe for signs and symptoms of hypoglycemic reactions (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety). Patients on concurrent beta-blocker therapy may have very subtle signs and symptoms of hypoglycemia. Drug: Prilosec Classification: Proton Pump Inhibitor Mechanism of Action: Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Therapeutic Effects: Diminished accumulation of acid in the gastric lumen, with lessened acid reflux. Healing of duodenal ulcers and esophagitis. Decreased acid secretion in hypersecretory conditions. Nursing Considerations: *may give w/without regards to food *assess frequently for epigastric/abd pain and blood in stool, emesis

Drug: Simvastatin Classification: Statins Mechanisms of Action: Inhibits 3-hydroxy-3-methylglutaryl- coenzyme A (HMG-CoA) reductase, an enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol. Therapeutic Effects: Lowering of total and LDL cholesterol and triglycerides. Slightly increases HDL cholesterol. Slows the progression of coronary atherosclerosis with resultant decrease in coronary heart disease-related events. Nursing Considerations: *give w/wo food *can cause liver injury/damage-watch AST-alk phos, bili levels closely *can cause muscle injury/damage. If CPK elevated DC use

Lifestyle Changes
My goal is to educate Mr. Totino on diet and lifestyle changes he should make to improve his health and eliminate contributing/risk factors from his disease (CAD). Smoking -Find out the extent of Mr. Totinos knowledge on how smoking effects the body by asking him questions focusing on what he knows about smoking. -I will share the following facts with Mr. Totino about smoking as it relates to his CAD and chest pain: It speeds up the process of atherosclerosis (plaque building in your arteries and blocking blood flow/oxygen to your heartchest pain). Smoking brings chemicals into your body that irritate and inflame your blood vessels. They then harden and thicken and block blood flow. Smoking increases his blood pressure which tightens and constricts his blood vessels, it makes them smaller and harder for blood to get through. Increases clotting of his blood which can narrow or completely block his artery. He is six times more likely to experience a heart attack.

Additionally use a visual so he can actually see what smoking is doing to his blood vessels

Use the following visual from the CDC website to show him the benefits to quitting smoking cessation

-I will show him the following plan from the CDC site on how to begin the quitting process: Start your stop smoking plan with START S = Set a quit date. Choose a date within the next 2 weeks, so you have enough time to prepare without losing your motivation to quit. If you mainly smoke at work, quit on the weekend, so you have a few days to adjust to the change. T = Tell family, friends, and co-workers that you plan to quit. Let your friends and family in on your plan to quit smoking and tell them you need their support and encouragement to stop. Look for a quit buddy who wants to stop smoking as well. You can help each other get through the rough times. A = Anticipate and plan for the challenges you'll face while quitting. Most people who begin smoking again do so within the first 3 months. You can help yourself make it through by preparing ahead for common challenges, such as nicotine withdrawal and cigarette cravings. R = Remove cigarettes and other tobacco products from your home, car, and work.

Throw away all of your cigarettes (no emergency pack!), lighters, ashtrays, and matches. Wash your clothes and freshen up anything that smells like smoke. Shampoo your car, clean your drapes and carpet, and steam your furniture. T = Talk to your doctor about getting help to quit. Your doctor can prescribe medication to help with withdrawal and suggest other alternatives. If you can't see a doctor, you can get many products over the counter at your local pharmacy or grocery store, including the nicotine patch, nicotine lozenges, and nicotine gum.

Emphasize the importance of a healthy diet and what it includes. Make a sample daily meal plan with him to give him the idea of what his meals should consist of. -Fats from natural/healthy sources (avacados, olive oil, peanut butter, nuts) - His carbohydrates should come from vegetables/fruits and whole grains -Get plenty of protein (chicken, beans, fish) -No artificial/processed sugary foods
Here is a sample menu for healthy meals I will give Mr. Totino to try Option 1: Oatmeal topped with berries and chopped nuts Fat-free milk Option 1: Black bean soup Grilled chicken breast on a roll with lettuce, tomato, grilled vegetables, and mustard Low-fat or fat-free frozen yogurt with fresh fruit Option 1: Steamed edamame, pineapple and melon chunks, or gingersnap cookies Option 1: Miso soup Stir-fried tofu and assorted vegetables Brown rice Fresh spinach salad with sesame dressing Option 2: Whole grain toast with peanut butter Sliced banana Hot cocoa or latte made with fat-free milk Option 2: Whole wheat pita with hummus (chickpea spread), lettuce, tomato, diced cucumber, and olives Carrot and celery sticks Grapes Option 2: Low-fat or fat-free yogurt, fresh fruit salad, or graham crackers Option 2: Grilled salmon topped with salsa Baked potato with soft margarine spread Broccoli cooked with garlic and olive oil Small roll Option 2: Fat-free milk Almonds

Breakfast

Lunch

Afternoon Snack

Dinner

Evening Snack

Option 1: Low-fat or fat-free yogurt Peanuts

Skills Necessary for Self-Care

We identified several things Mr. Tatino needed some additional help with in order to be successful in managing his health. Blood pressure monitoring was something that he had been told to do, but he didnt really have a plan, or equipment and didnt think it was very important, until now. We did the following: o Helped Mr. Totino decide on an arm cuff that he could purchase from the pharmacy that was in his price range. o Set up a monitoring schedule that he would remember and followed his doctors orders. o Taught him how to read and record the measurements. o Directed him to take it at times when he had been doing quiet activity, and that measurements over time are most important. He expressed an understanding that if he took the measurement right after running around, it would be high, and to repeat it after sitting quietly for a more accurate baseline. Glucose self checks were an area that we reviewed: o We talked about his monitor, and he demonstrated proper technique for its use. o We helped him plan checks according to his doctors schedule. o We reinforced the benefit of recording his results o We reviewed sick day insulin protocol Insulin Administration: o We had Mr. Totino demonstrate; and found him able to read the sliding scale and draw up and self administer his insulin competently. o We did some additional teaching about site rotation Tracking weight: o We reviewed the importance of checking weight as a measure of overall health and to monitor for side effects of medications or illness, such as fluid retension. o We instructed him to check his weight every other day while adjusting medications and as his doctor orders Weight should be checked at the same time of day each time Clothing worn should be similar each time

When to call the doctor

Call a doctor immediately if you have high blood pressure and: Your blood pressure is much higher than normal (such as180/110 or higher). You think high blood pressure is causing symptoms such as: o Severe headache, especially pulsating headaches behind the eyes. o Blurry vision. o Nausea or vomiting. These are symptoms of malignant high blood pressure or hypertensive crisis. Call a doctor if: Your blood pressure is 140/90 or higher on two or more occasions. You think you may be having side effects from your blood pressure medicine. Your blood pressure is usually normal and well controlled, but it goes above the normal range on more than one occasion.

Finally, we included stress management techniques

Set priorities. Focus on whats important. Let the other stuff go. Identify tasks that you can share or delegate, then ask for help.

Get organized. Disorder can make things confusing and hard to remember. Set short-term goals you can reach. Reward yourself for meeting them! Say no -- gracefully -- to taking on more obligations.

Focus on the positive. Choose to look for the good in others and yourself. Laugh! Look for humor in your everyday life or watch a funny video. Listen to music. Choose tunes that relax or revive you. Talk to a counselor or a friend.

Remember, things don't have to be perfect. Sometimes good enough is just fine. Take a time-out for yoga, meditation, or some deep breaths.

Get regular exercise. Find something you like doing that you can work into your schedule. Set aside 5 to 10 minutes for yourself each day