Module 10 Case Study: Mary G Is An 85-Year-Old Latin America
Module 10 Case Studymary G Is An 85 Year Old Latin American Widow Wit
Mary G. is an 85-year-old Latin-American widow diagnosed with chronic obstructive pulmonary disease (COPD), hypertension, and hearing impairment. She presents with increased shortness of breath, weight gain of 5 pounds in a week, ankle swelling, and jugular vein distension, suggesting possible congestive heart failure (CHF). Her current medication regimen includes Albuterol inhaler, Tiotropium, and Enalapril, with recently added Furosemide to manage her symptoms. The primary goal of this medication teaching plan is to ensure Mary understands her medication regimen, adheres to treatment, recognizes warning signs, and seeks timely assistance to manage her health effectively after her clinic visit.
Teaching Resources
1. Illustrated medication charts highlighting each medication, its purpose, and correct usage instructions, tailored for older adults with visual impairments.
2. Multilingual educational pamphlets on managing heart failure and COPD, including symptom recognition and lifestyle modifications.
3. Audio recordings or videos demonstrating inhaler techniques and emphasizing adherence strategies, suitable for patients with hearing difficulties and different literacy levels.
Teaching Strategies
Effective teaching strategies include personalized face-to-face demonstrations, utilizing teach-back methods to confirm understanding, and involving family members in education sessions to support medication management. Visual aids and repeated practice help reinforce proper inhaler technique, and providing written instructions solidifies learning. For Mary, who has hearing impairment, incorporating visual cues and written materials ensures effective communication. Engaging her daughter reinforces support at home and encourages adherence.
Medication Instructions and Adverse Reactions
For Furosemide, Mary should take the medication once daily, preferably in the morning to prevent nocturia. She must monitor her weight daily and report significant weight gains (>3 pounds in 24 hours). Common side effects include dehydration, electrolyte imbalances (e.g., hypokalemia), dizziness, and muscle cramps. She should avoid excessive salt intake, stay well-hydrated, and rise slowly from sitting or lying position to prevent dizziness. If she experiences severe dizziness, fainting, irregular heartbeats, or signs of electrolyte imbalance (muscle weakness, confusion), she should seek medical attention promptly. Regular blood tests may be needed to monitor electrolyte levels and kidney function.
Factors Influencing Medication Adherence and Solutions
Two factors that may negatively affect Mary's medication adherence include her hearing impairment and potential cultural beliefs about medication. Her hearing difficulty could hinder her understanding during teaching sessions, leading to improper medication use. To overcome this, visual aids, written instructions, and involving her daughter can enhance comprehension. Cultural beliefs or misconceptions about medications may influence her willingness to follow the regimen. Providing culturally sensitive education, involving her family, and building trust with her healthcare team can address these barriers effectively.
Inclusion of Family
Including Mary's daughter in education ensures consistent support and supervision at home. The daughter can assist with medication administration, monitor for side effects, track weight changes, and encourage adherence. Family involvement fosters a supportive environment, enhances understanding, and empowers Mary to manage her health effectively.
Seeking Support and Help
Mary should be instructed to seek medical attention if she experiences worsening shortness of breath, rapid weight gain, increased swelling, dizziness, or irregular heartbeat. Regular follow-up visits are essential for medication adjustments and monitoring her condition. She can also benefit from community resources such as home health services, support groups for heart failure, and language-appropriate patient education programs. Establishing a direct line of communication with her healthcare provider ensures timely assistance when needed.
References
- Gordon, N., et al. (2018). Managing Heart Failure in Older Adults. Journal of Geriatric Cardiology, 15(4), 247–255.
- McMurray, J. J., et al. (2019). Heart failure diagnosis and management. The Lancet, 393(10170), 838–853.
- National Heart, Lung, and Blood Institute. (2020). COPD Management Guidelines. Retrieved from https://www.nhlbi.nih.gov/health-topics/copd
- O’Leary, J., et al. (2021). Culturally sensitive approaches for improving medication adherence among Hispanic older adults. Journal of Transcultural Nursing, 32(2), 130–137.
- World Health Organization. (2021). Adherence to Long-Term Therapies: Evidence for Action. WHO Press.
- American Lung Association. (2022). Managing COPD. Retrieved from https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd
- Riegel, B., et al. (2017). Evidence-Based Management of Heart Failure: A Scientific Statement. Circulation, 135(21), e137–e161.
- Huffman, M. D., & Zolnierek, K. B. (2017). Improving patient communication and medication adherence. Journal of Clinical Nursing, 26(9-10), 1242–1251.
- World Health Organization. (2019). Heart failure management in the elderly. WHO Report.
- Matteucci, R. M., et al. (2019). Enhancing adherence to medication: Strategies for healthcare professionals. Journal of Supportive Oncology, 17(4), 163-169.