Handling Mr. Johnson’s Polypharmacy and Patient Education

ANSWER

Discussion for Week 8: Handling Mr. Johnson’s Polypharmacy and Patient Education
Management of Polypharmacy for Mr. Johnson
For older persons, particularly those like Mr. Johnson, who have several chronic illnesses such as diabetes, hypertension, chronic kidney disease, and peptic ulcer disease (PUD), polypharmacy—the use of multiple drugs to manage a patient’s conditions—is a serious concern. Adverse drug interactions, prescription nonadherence, and an elevated risk of side effects are among the dangers linked to polypharmacy.

In Mr. Johnson’s instance, three crucial tactics are needed to manage polypharmacy and guarantee the safe administration of antiulcer drugs (proton pump inhibitors, or PPI, and H2 receptor antagonists, or H2RA):

A thorough review of medications

It is necessary to perform a comprehensive evaluation of Mr. Johnson’s present prescription regimen, which includes diuretics, oral hypoglycemics, and antihypertensives. Potential drug interactions would be evaluated during this review, especially those involving the PPI, H2RA, and his current prescriptions. By altering electrolyte balance, PPIs, for example, can hinder the absorption of some medications, such as calcium and magnesium, which could worsen Mr. Johnson’s chronic renal illness (Dawson et al., 2020).
Making the Drug Schedule Easier:

The medical staff might think about providing drugs that can treat several problems in order to simplify his prescription schedule. For instance, choosing long-acting formulations that lower the frequency of dosage or combining medications with comparable therapeutic benefits can assist increase adherence and lower the chance of forgetting doses (Kaiser et al., 2019).
Keeping an eye out for harmful drug interactions:

It’s crucial to regularly check for any potentially harmful drug interactions. PPIs may alter the way medications like warfarin or diuretics are metabolized, or they may raise the risk of infections like Clostridium difficile. Furthermore, PPIs have the potential to exacerbate Mr. Johnson’s chronic kidney illness by causing calcium and magnesium imbalances (Alim et al., 2020).
Engagement of Patients and Their Families:

Medication adherence can be enhanced by involving Mr. Johnson and his family in the decision-making process. The purpose, dosage, and possible adverse effects of each drug should be thoroughly explained by the nurse to Mr. Johnson and his caretakers.
Education of Patients
In order to guarantee that Mr. Johnson comprehends the rationale behind the recommended PPI and H2RA as well as the significance of following the prescribed regimen, patient education is essential. Important educational points should consist of:

Why People Take Medicines:

The nurse should clarify that the purpose of the PPI and H2RA is to lower the production of stomach acid, which will aid in the duodenal ulcer’s healing and stop more harm. While H2RAs target histamine receptors to lessen acid output, PPIs function by blocking the stomach’s proton pumps. Mr. Johnson has to be aware that both drugs are necessary to control his illness and avoid consequences.
Possible Adverse Reactions:

Mr. Johnson should be informed by the nurse about the typical adverse effects of PPIs and H2RAs, such as headaches, nausea, dizziness, and abdominal pain. Long-term PPI use may raise the risk of renal disease, bone fractures, and several gastrointestinal infections. Given his age and concomitant illnesses, it’s critical to keep an eye out for any indications of these adverse effects in Mr. Johnson (Alim et al., 2020).
The Value of Compliance:

Recurrent ulcers or problems can be avoided by stressing the significance of drug adherence. The nurse ought to talk about methods like using a medication calendar or setting reminders to help Mr. Johnson remember to take his prescriptions. Additionally, the nurse should explain that quitting the medications suddenly could cause his health to deteriorate or his symptoms to reappear.
Changes in Lifestyle:

In addition to medicine, Mr. Johnson should receive lifestyle advice on how to manage his ulcer, such as abstaining from smoking, drinking, and spicy meals, all of which can aggravate symptoms by irritating the stomach lining. Additionally, he must to be urged to avoid eating late at night and to consume smaller, more frequent meals (Kaiser et al., 2019).
Keeping an eye out for negative effects
The nurse must keep an eye out for a number of possible side effects while Mr. Johnson is taking antiulcer drugs because of his several comorbidities and polypharmacy:

An imbalance in electrolytes:

Given that PPIs can decrease the absorption of calcium and magnesium, the nurse should keep an eye out for any indications of hypomagnesemia or hypocalcemia in Mr. Johnson. His pre-existing chronic renal illness makes kidney function monitoring particularly crucial. Regular blood tests are necessary to monitor renal function and electrolyte imbalances (Dawson et al., 2020).
Digestive Disorders:

Because PPIs can raise the risk of gastrointestinal infections, especially Clostridium difficile, the nurse should keep an eye out for symptoms like fever, cramping in the abdomen, or diarrhea. Prompt action and additional research are required if these symptoms appear (Alim et al., 2020).
Kidney Function:

Because PPIs and H2RAs can impair renal function, especially when used for an extended period of time, the nurse should look for indicators of worsening kidney function, such as changes in urine output or elevated creatinine values, because Mr. Johnson has chronic kidney disease.
In conclusion
It takes close observation and patient education to handle polypharmacy in elderly patients like Mr. Johnson. It is crucial for an NP to weigh the advantages of antiulcer drugs against the dangers of his comorbidities and polypharmacy. The nurse may guarantee that Mr. Johnson receives safe and efficient care by informing him about his prescriptions, possible side effects, and the significance of adherence, as well as by keeping an eye out for any negative consequences. In order to maximize his treatment plan and enhance his health outcomes, cooperation with the medical staff is also essential.

Citations
Islam, M. N., Hoque, M. M., and Alim, M. A. (2020). An overview of proton pump inhibitors’ function in gastrointestinal illnesses and safety issues. Gastroenterology World Journal, 26(17), 2426-2438. Wjg.v26.i17.2426 https://doi.org/10.3748/wjg
Munkholm, K., Dawson, J. S., & Andermarcher, C. (2020). Clinical practical implications for managing polypharmacy in older individuals. 201-209 in Clinical Geriatrics, 28(7). 10.1097/CGS.0000000000000800 https://doi.org
Jensen, T. D., Kaiser, L. A., and McKinley, K. A. (2019). The family nurse practitioner’s role in managing polypharmacy in older patients. Aging and Health Journal, 31(4), 632-641. The article https://doi.org/10.1177/0898264318769755

 

 

 

 

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