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Running Head: PHARMACOLOGY PATIENT TEACHING PROJECT Pharmacology Patient Teaching Project Jessica L. Wilborn University of Missouri Kansas City 1 PHARMACOLOGY PATIENT TEACHING PROJECT 2 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 PHARMACOLOGY PATIENT TEACHING PROJECT 3 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 PHARMACOLOGY PATIENT TEACHING PROJECT 4 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 PHARMACOLOGY PATIENT TEACHING PROJECT 5 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 PHARMACOLOGY PATIENT TEACHING PROJECT 6 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 PHARMACOLOGY PATIENT TEACHING PROJECT 7 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. PHARMACOLOGY PATIENT TEACHING PROJECT 8 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