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Pharmacology Patient Teaching Project
Jessica L. Wilborn
University of Missouri Kansas City
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My teaching project consisted of information about ciprofloxacin. My patient was
receiving this medication because he had a prostatectomy. The physician prescribed 500mg
tablet by mouth every 12 hours for the prevention of infection after the prostatectomy.
Ciproxfloxacin is the generic name. Cipro is the brand name. Cipro is an antibiotic
(floraquinolones) used to fight bacteria in the body (Cerner Multum, 2012, p.1). Cipro interferes
with the DNA replication in susceptible bacteria preventing cell reproduction (Karch, 2013,
p.287). I began the patient teaching by telling the patient he should not take the medication if he
had a history of head injury, allergic reaction to an antibiotic, diabetes, kidney or liver disease,
muscle weakness, trouble breathing, low potassium levels, epilepsy or seizures. He denied
having any of these illnesses. Ciprofloxacin should be taken with a full 8 oz. glass of water
(Cerner Multum, 2012, p.2). While taking this medication consuming several glasses water a day
is encouraged. Food can be consumed with or without Cipro but it must be taken the same time
each day.
After reviewing the patient’s current diet I explained which foods are not recommended
with concurrent use of the medication. “Ciprofloxacin should not be taken with dairy products
such as milk, yogurt, or calcium-fortified juice because these foods make the drug less effective”
(Cerner Multum, 2012, p.2). These foods are acceptable to eat or drink during regular meals but
not alone with Cipro. I preceded to tell the patient to avoid taking this medication with tizanidine
(Zanaflex) because the combination causes drowsiness, low blood pressure, confusion, slurred
speech, and weakness. The patient was not taking herbal drugs or supplemental drugs. However,
I told the patient if he needs to take medication after leaving the hospital to contact his physician.
The following drugs will affect ciprofloxacin are: Coumadin, clozapine, cyclosporine, glyburide,
methotrexate, metoclopramide, phenytoin, probenecid, ropinirole or theophylline, an
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NSAID(Advil, Motrin), or steroid medication (prednisone) (Cerner Multum, 2012, p.4)
Ciprofloxacin needs to be taken 6 hours before or 2 hours after antacids (Tums, Rolaids,
Mylanta), ulcer medicine (Carafate), Videx, and vitamin or mineral supplement containing
calcium, iron, or zinc because they make the drug less effective if taken simultaneously (Cerner
Multum, 2012, p.3).
A considerable amount of the patient teaching focused on the schedule of drug
administration and storage with the patient and his wife. Ciprofloxacin must be stored at a room
temperature and away from heat and moisture. I explained the bathroom should be avoided for
storage and the medicine should be out of the reach of children. If a dose is missed, it should be
taken as soon as the patient remembers. However, skip the missed dose if it is near the next
scheduled dose. The patient should not take extra medicine to replace the missed dose (Cerner
Multum, 2012, p.3). I suggested to the patient setting his cell phone to alarm at the scheduled
time to maintain the dosing schedule. The couple and I reviewed his daily schedule to determine
what time of day he is most alert to remember to take his medication. The patient decided this
morning was the best time. I stressed to the patient the importance of taking the medication the
same time everyday for effectiveness and taking it even if he does not experience symptoms of
infection. “This medication must be taken for the full prescribed length of time even if symptoms
improve in order to completely clear the infection” (Cerner Multum, 2012, p.3). I told the couple
to look for the symptoms of overdose such as weakness, urination problems, or blue lips with
pale skin (Cerner Multum, 2012, p.3).
I insisted on discussing the most serious side effects and emergency situations with the
patient and briefly reviewing the lesser side effects. Allergic reactions that need to be reported
immediately are: difficulty breathing and swelling of the tongue and throat. Serious side effects
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include: pounding heartbeats, sudden pain in any of the joints, diarrhea that is bloody or watery,
pale of yellowed skin, and skin reactions mild or severe (Cerner Multum, 2012, p.4). I asked the
patient if he had contact information in case of an emergency and he did. After the patient
teaching, I quickly hit the important points: taking the medication for the full prescribed time,
storing medication in a dry place, avoiding dairy products ten with Cipro, drinking plenty of
fluids, serious side effects, and monitoring stools for diarrhea.
I used a printed drug information leaflet accessed through North Kansas City Hospital to
teach the patient. The teaching tool was appropriate for my patient because he received
medication to be taken by mouth. Demonstration was not necessary because did not have to
administer a shot to himself or insert or operate a device. The SMOG formula for the information
leaflet is: the square root of 48 is 6.9 (6.9 +3=9.9). The reading level of this article is 9.9 grade
level. According to Continuing Education, “the average adult in the United States can’t read
above the 8th grade level” (Winslow, 2001, p.34). The reading level of the content was
appropriate for my patient because his occupation is a compute programmer. However, this
information might be challenging for other patients due to the generic and brand name drugs
listed. If I was teaching another patient with a lower reading level I would have to pronounce the
drug name and explain how each drug works. His spouse was present and also had a high school
education. She was able to understand the scheduling, administration, and side effects of the
medication.
The content of this material was easily readable except for the long list of medications at
the end. Most patients might skip the list because they do not know what the drugs mean
however, the list contained vital information about drug-drug information about drug-drug
interactions. As a nurse before discharging the patient I familiarize them with the brand names
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and explain the drugs effect in simple terms. The content used simple words like, “take, shake,
chew, swallow, drink, eat” in relation to the instructions on drug administration. This is
important because the patient has more self-efficacy to follow the directions accurately. The
material implemented the usage of the second person making the material more personal
(Winslow, 2001, p.35). The measurements were spelled numbers instead of roman numerals so
patients can know the correct dosage. The information was complete, accurate, and in readable
fonts. I like how the leaflet discarded miscellaneous information and only focused on the
important information.
My teaching moment was successful. I walked into the room with a positive and
receptive attitude. First, I introduced myself to the patient and his spouse. The patient seemed
anxious so I asked him about his day before beginning to make him more comfortable and
receptive to the patient teaching. Due to his anxiety and fatigue I made teaching as concise and
informative as possible. “The average adult can remember five to seven points at a time” (Katz,
1997, p.34). The patient listened attentively to the information about the drug and highlighted
with me as we discussed each major point. Occasionally, he would stop and ask me specific
questions about the drug-food interactions and drug-drug interactions. As the teacher this shoved
me the patient was most likely retaining the information. Even though my patient could probably
understand medical terminology based on his occupational background I still used simple terms.
After being under the influence of medication and feeling fatigued it would be easy for any
patient at any reading level to easily become confused and misinterpret instructions.
The patient, his wife, and I sat down and brainstormed ideas to remind him when to take
his medication because effectiveness for this day is taking it at the same time everyday. I
suggested setting his cell phone to alarm 10 minutes prior to administration, writing down on
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post it notes the time and posting in common areas, his wife texting him reminders if she is not
near, etc. He liked setting his phone alarm. Then I used an example to clarify the time to take the
medication. So I said if you were taking this today Friday March 10, 2013 at 2 pm you would
take this pill again at 2 am Saturday March 16, 2013. Then I asked him to give a time and tell me
12 hours from then when was his next dose. Once I gave a concrete example he could easily
answer correctly. Overall, the wife and the patient verbalized understanding and a readiness to
learn about the drug and the effects on the patient. If I could do anything different in my next
patient teaching I would use more examples in relation to his needs (Katz, 1997, p.34). I would
incorporate care at the bedside because it gives the patient more time to ask questions and retain
more information (Katz, 1997, p.34). Next time I would try to find a more condensed pamphlet
on the same material so the patient does not feel overwhelmed (Katz, 1997, p35).
Overall, my first teaching moment went well however there are minor changes I would
make for next time. First, timing is crucial for the patient receptiveness to the teaching. For
example, I did my patient teaching the day he was being discharged. Besides the effects of the
medication and fatigue he probably had to see many other medical personnel prior to discharge
who also did patient teachings. “Teaching may overwhelm even the most advanced learner”
(Katz, 1997, p.34). If you know a day in advance the patient is being discharged it is probably
better to teach him or her the day before. If the patient has questions the nurse has time to
answer them, review key points, and assess for understanding. Second, instead of asking the
patient to restate and return demonstrate after the teaching I would ask randomly at different
times of the day based on his or her physical state. The patient reinforces long term memory
when they can replicate what you do. It is just as easy to copy what the nurse does yet still be
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confused. When asked to return demonstrate at different times the nurses is truly able to assess
understanding.
Third, my patient teaching like many other patient experience high emotional distress
when in the hospital (Katz, 1997, p.36). As a nurse you must assess the appropriate time for light
humor. In my case this may have helped distract him and make him feel relaxed, calm, and
receptive. In conclusion, my patient teaching project taught the teacher as well. I learned how to
be empathetic, be creative in utilizing tools for other to learn, and the responsibility to keep our
patients safe and informed.
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References
Cerner Multum, Inc. (2012). Ciprofloxacin. Denver, CO: Cerner Multum
Karch, A.M. (2013). Nursing drug guide. Rochester, NY: Lippincott & Williams & Wilkins
Katz, J.R. Back to Basics: Providing Effective Patient Teaching. (1997). The American Journal
of Nursing, 97(5), 33-36
Winslow, E.H. (2001). Patient education materials: Can patients read them, or are they ending up
in the trash? Continuing Education, 101(10), 33-38. Retrieved from
http://www.nursingcenter.com