CHAPTER 6 Patient Education
I. Provide health care information regarding the prevention and treatment of diseases and medical conditions, including emergency patient care.
B. Steps in counseling patients regarding medication use
4. Ask what over-the-counter (OTC), herbals/supplements, and other prescriptions the patient is taking (patients may not fill all prescriptions at the same pharmacy). Additional medical conditions may also be considered as needed (i.e., a patient with asthma receiving a beta blocker with beta-2 action).
5. Ask the patient what they know about their medications and why they are being prescribed (i.e., the medication’s use, expected benefits, and action).
6. Discuss with the patient what their doctors told them regarding their medications, how to use them, and what to expect.
7. Open the medication container and show the patient what the medication looks like or demonstrate use; the patient may not be expecting a generic substitution, and they can also verify correct product.
10. Discuss what to do if a dose is missed (take missed dose immediately or skip the missed dose and wait until new administration time).
17. Verify the patient’s knowledge and understanding by asking the patient to repeat the given information.
C. Important patient considerations for counseling
1. New patients or those receiving a medication for the first time (including transfer prescriptions)
11. Patients receiving medication with special storage requirements, complicated directions, significant side effects, or narrow therapeutic ranges [e.g., digoxin and anti-epileptic drugs (AED)].
13. Patients receiving oral contraception regarding the risk of cardiovascular disease (CVD) if they smoke or are older than 35 years
14. Patients receiving oral contraception and select antibiotic medications (contraception failure may occur)
15. Patients receiving warfarin should be aware of the signs and symptoms of bleeding and blood clotting.
D. Other Concepts to discuss with patients and health care professionals
1. Adverse reaction concerns:
a. An adverse drug event (ADE) is any undesirable experience associated with the use of a medical product in a patient. Most potential adverse drug events can be prevented; however, an unpreventable adverse drug event is considered an adverse drug reaction.
b. Most adverse drug reactions (ADR) are common, relatively mild, and disappear when the drug is discontinued or the dose is changed. Common mild drug reactions include loss of appetite, bloating, nausea, and constipation. Serious drug reactions are those that cause death, disability or congenital anomaly or that require hospitalization. Serious ADR may require medical intervention to prevent further damage or impairment.
c. The following examples illustrate various adverse drug events:
(a) Sulfonamide antibiotics versus other sulfa-containing products (i.e., cross-sensitivity reactions rather than sulfa-allergy)
(b) Risk of Reye syndrome in children taking salicylate containing medications and with concurrent viral illness
d. Adverse events that are common that require minimal intervention (e.g., postural hypotension when starting beta blockers; constipation for opioid analgesics), and that require immediate attention (e.g., Stevens-Johnson syndrome for sulfonamide antibiotics; tendinitis/tendon rupture for quinolones).
e. True allergy (e.g., anaphylaxis) versus ADR (nausea with opioid analgesics or oral penicillins); including what reactions allow a rechallenge or desensitization of the drug
2. Examples of appropriate drug use
a. Spacing antacids and calcium containing products from certain medications (e.g., select antibiotics, such as tetracyclines, quinolones)
c. Spacing of medication administration times for peak effects or to avoid toxic effects (e.g., aspirin shortly before or long after a nonsteroidal anti-inflammatory drug)
d. Dietary restrictions for monoamine oxidase inhibitor (MAOI), warfarin, or quinolones (no tyramine-containing products [cheese, wine, red meats], do not alter the intake of the amounts of vitamin K containing products, and separate dairy intake from the time of administration, respectively)
e. Understanding “Two tabs twice daily” = 4 tablets a day total not 2 tablets each day; and similar multiplying concepts
f. Importance of finishing an antibiotic course of treatment to ensure therapeutic response and avoid recurrence of infection
h. How to use inhalers, nebulizers, injectable medications, insulin pens, blood glucose monitors, and other devices
j. Understand cautions needed with the use of medications in special populations (e.g., pediatric, geriatric, patients with organ failure, patients with immunosuppression, pregnant or lactating women)
l. Proper disposal of needles and expired medications and other safety measures such as storage that are related to accidental exposure or poison prevention
E. Emergency/non–self-care considerations
Table 6-1 Examples of Consumer Terms to be used in Patient Education
| Medical Term | Consumer Term |
|---|---|
| Analgesic | pain reliever |
| Arrhythmia | irregular heartbeat |
| Buccal | between the cheek and the gum |
| Diuretic | water pill |
| Hepatic | liver |
| Hypercholesterolemia | high cholesterol |
| Hyperglycemia | high blood sugar |
| Hypertension | high blood pressure |
| Hypoglycemia | low blood sugar |
| Inflammation | swelling |
| Metabolism | (drug) breakdown |
| Ophthalmic | for the eye |
| Otic | for the ear |
| Postural hypotension | fainting |
| Prophylaxis | preventative |
| Pruritus | itching |
| Renal | kidney |
| Saline | salt solution |
| Sublingual | under the tongue |
| Subcutaneous | under the skin |
| Topical | applied to the skin |
| Transdermal | absorbed through the skin |
II. Provide health care information regarding nutrition, lifestyle, and other nondrug measures that are effective in promoting health or preventing or minimizing the progression of a disease or medical condition
A. Patient monitoring based on drug or disease state
1. Hypertension
a. Blood pressure; note different ranges and goals for patients with compelling indications (e.g., diabetes, chronic kidney disease, stroke, heart failure, coronary artery disease, or post-myocardial infarction)
5. Antiretroviral therapy for HIV/AIDS
c. Transmission reduction (abstinence, condoms, no needle sharing), also applicable for hepatitis viruses, HBV and HCV
6. Mental disorders
d. Drug serum levels or recommended laboratory testing (e.g., antiepileptic drugs [AED], lithium, clozapine)
8. Osteoporosis
d. Take the medication first thing in the morning, at least 30 minutes before eating or drinking other substances or before taking any other medication.
III. Provide information regarding the documented uses, adverse effects, and toxicities of dietary supplements.
A. Explaining basic differences between modern medicine (allopathic) and complementary (homeopathic, Chinese medicine, etc.)
2. The term complementary and alternative medicine (CAM) is generally regarded as encompassing a broad group of healing philosophies, diagnostic approaches, and therapeutic interventions that do not belong to the dominant (conventional) Western health system.
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