Many people in the US, particularly the elderly, take more than one prescribed medication. CDC (2014) reported that between 2009 and 2012 nearly 48% of persons asked used at least one prescription drug, 22% used three or more prescription drugs, and nearly 11% used five or more.

In a recent study published by the Mayo Clinic, seven out of 10 Americans take at least one prescription drug. The most commonly prescribed drug is antibiotics — taken by 17 percent of Americans — followed by antidepressants and opioids — each taken by 13 percent of Americans. In addition, findings showed that:

• Even more staggering than the CDC findings, currently more than half of Americans take two prescription medications, and 20 percent of Americans are on at least five prescription medications.
• More women than men receive prescription medications.
• Antidepressant prescriptions are more common among women than men and are most common among women ages 50 to 64.

When people take multiple medications, there is a greater risk for confusion about which medications are taken, when they are taken, and what they are being taken for. There is also a higher risk of drug interactions and increased side effects and adverse reactions.

Sometimes because of the sheer number of medications being prescribed, they may be forgotten, become too much of a bother, or a financial burden that can significantly impact client compliance and lead to poor health outcomes.

In this written assignment, you will be conducting an interview of a client who is taking multiple prescribed medications (three or more) and submitting a written paper describing the findings from the interview. You will then develop a Client Teaching Plan. Your instructor will assist you in the selection of the client. You must achieve a “pass” in this assignment to satisfactorily fulfill the requirements for the Pharmacology course.

The three parts of this assignment are:

Conduct an interview with a client who is taking multiple medications (polypharmacy). You must prepare the client before the interview by explaining why you are conducting the interview. You can say “my assignment is to find out about the medications you are taking so I can determine if you need more information about what you are taking”. You must always get permission from the client to conduct the interview and you must tell the client how the information will be used. You can say, “I will not be using your name in the information I share and I will be submitting it to my instructor only for this student assignment”. If there is important information that needs to be communicated to you, your doctor, family, or nurse, my instructor will assist me in following up on this”. Tell the client you will take no more than 30-45 minutes for the interview.

There may be a family member or significant another present during the interview. That is fine. Be sure to identify who answered a question and if possible always have the client answer first. Always thank the client (and others) when you complete the interview.

Do not use recording equipment for this interview. Have a notepad and pencil or pen and explain that you will be taking notes. When the interview is over, go to a quiet place and take some time to fill in any information you did not jot down. If you wait, you will not remember.

When setting the environment for the interview, make sure the client (and others) is comfortable and you are comfortably seated facing the client. If possible, do the interview in a quiet place.

Ask questions slowly giving the client time to answer. Pay attention to the client’s hearing and ability to respond to the questions. Be sure your non-verbal communication demonstrates you are calm and relaxed.

Use the following interview question guidelines when conducting the interview. Be aware that the client may not be able to answer each of the questions with detailed information. Collect as much information as the client is able and willing to give you. Remember you are the interviewer so you will be collecting information and not making any comments about the information shared by the client except to ask for further clarification if you are not sure what was said or need more detail if it is available.

1. What medications are you taking?
   (Before the interview research each of the medications. In your paper include the reason for each medication, the drug classification, the route of administration, the dose, and possible side effects/adverse reactions).

   For the following questions, paraphrase the client’s answers for your written paper.

2. How long have you taken each of these medications?
3. Do you know why you are taking these medications?
4. Who told you about the medications and why you need to take them? Were you able to ask any questions about the medications and if so were they answered so you understood what was said?
5. How do you feel about taking these medications?
6. Are you taking other medication purchased “over the counter” such as in a drug store? If so, what is it, and why are you taking it.
7. How and when do you take your medications?
8. Do you have any difficulty taking the medications? If so, what happens and how do you deal with any difficulties.
9. Have you ever felt any uncomfortable feelings and/or body reactions to taking these medications? If so, what were they and how were they handled?
10. If you had the above reaction, did they take you off the medication and/or replace it with another medication? Were you told why this happened?
11. Do you have any reason not to take the medications?
12. Have you ever not taken the medication? If so, what was the reason?

Ask a final question about whether the client would like to tell you anything further about their medications.

Write a paper describing your research and findings about the medications being taken and the results of the interview. Report your findings in a 3-5 page written paper. In your paper include the reason for each medication, the drug classification, the route of administration, the dose, and possible side effects/adverse reactions.

Use accurate and appropriate spelling and grammar and APA Editorial Format for sources used in your written paper.

Develop a teaching plan for this client based on your findings. Based on the findings from the interview, develop a 2-3 page teaching plan to include the following:

1. List one goal for this teaching plan
2. Describe two to three teaching resources that might be used
3. Identify two teaching strategies that can be used based on the client interviewed
4. List specific client instructions regarding the medications and what adverse reactions they should be aware of/and what to do
5. Identify at least one factor that may negatively influence adherence to the medications and how it can be overcome
6. If, appropriate, describe how the family might be involved in ensuring the client is on a proper and safe medication regime

Submit your completed assignments by following the directions linked below. Please check the Course Calendar for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.)

 

Competency

Explain principles of care for clients with oncological disorders.

Scenario

Anna is a 45-year-old female that presented to her physician’s office for her annual check-up. Anna has a history of diabetes, obesity, and noncompliance with diet and medications to control her diabetes. She a single mother of three teenagers and smokes regularly. During the history review, Anna shares with you that she has not been feeling like herself for the past six months, she has been unusually tired and thought that she felt a lump in her right breast during a self-breast exam around that same time. She stated, “I am very busy with my children; I haven’t had time to get it checked out.” She has recently been experiencing right nipple pain. Anna has a positive family history of breast cancer; both her mother and grandmother have been treated for breast cancer. Anna has never had a mammogram. During the breast examination, the practitioner palpated a lump in Anna’s right breast. No discharge from the nipple was observed. Anna’s right breast was tender upon palpation. No abnormalities were found in the left breast. Based on the physical findings Anna will undergo a diagnostic mammogram.

Instructions

In a 2-page paper, describe the care that Anna would require and address the questions below.

1. What risk factors does Anna have that could predispose her to the development of cancer?
2. What signs and symptoms could indicate that Anna has developed cancer?
3. Based on Anna’s risk factors and presenting problems, identify three care strategies that you would use to provide quality care to Anna. Provide rationale to explain why you chose these strategies.

The benchmark assesses the following competency:

4.2 Communicate therapeutically with patients.

The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.

Note:  The teaching plan proposal developed in this assignment will be used to develop your Community Teaching Plan: Community Presentation due in Topic 5. You are strongly encouraged to begin working on your presentation once you have received and submitted this proposal.

Select one of the following as the focus for the teaching plan:

1. Primary Prevention/Health Promotion
2. Secondary Prevention/Screenings for a Vulnerable Population
3. Bioterrorism/Disaster
4. Environmental Issues

Use the “Community Teaching Work Plan Proposal” resource to complete this assignment. This will help you organize your plan and create an outline for the written assignment.

1. After completing the teaching proposal, review the teaching plan proposal with a community health and public health provider in your local community.
2. Request feedback (strengths and opportunities for improvement) from the provider.
3. Complete the “Community Teaching Experience” form with the provider. You will submit this form in Topic 5.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

 

Anna is a 45-year-old female that presented to her physician’s office for her annual check-up. Anna has a history of diabetes, obesity, and noncompliance with diet and medications to control her diabetes. She a single mother of three teenagers and smokes regularly. During the history review, Anna shares with you that she has not been feeling like herself for the past six months, she has been unusually tired and thought that she felt a lump in her right breast during a self-breast exam around that same time. She stated, “I am very busy with my children; I haven’t had time to get it checked out.” She has recently been experiencing right nipple pain. Anna has a positive family history of breast cancer; both her mother and grandmother have been treated for breast cancer. Anna has never had a mammogram. During the breast examination, the practitioner palpated a lump in Anna’s right breast. No discharge from the nipple was observed. Anna’s right breast was tender upon palpation. No abnormalities were found in the left breast. Based on the physical findings Anna will undergo a diagnostic mammogram.

Instructions

In a 2-page paper, describe the care that Anna would require and address the questions below.

1. What risk factors does Anna have that could predispose her to the development of cancer?
2. What signs and symptoms could indicate that Anna has developed cancer?
3. Based on Anna’s risk factors and presenting problems, identify three care strategies that you would use to provide quality care to Anna. Provide rationale to explain why you chose these strategies.

  New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of a positive impact on outcomes or efficiencies.

Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

To Prepare:

• Review the Resources and reflect on the impact of      clinical systems on outcomes and efficiencies within the context of      nursing practice and healthcare delivery.
• Conduct a search for recent (within the last 5 years)      research focused on the application of clinical systems. The research      should provide evidence to support the use of one type of clinical system      to improve outcomes and/or efficiencies, such as “the use of personal      health records or portals to support patients newly diagnosed with      diabetes.”
• Identify and select 4 peer-reviewed research articles from your research.
• For information about annotated bibliographies,      visit https://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographies

The Assignment: ( 5-6 pages not including the title and reference page)

In a 5-6 page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:

• Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.
• Include an introduction explaining the purpose of the paper.
• Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
• In your conclusion, synthesize the findings from the 4      peer-reviewed research articles.
• Use APA format and include a title page.

1)  Identify the 4 peer-reviewed articles, citing each in APA format, 

2)  Summarize each study explaining:

a) improvements to outcomes,

b) efficiencies (to staff, patient, facility as a result of implementing the clinical system/clinical technology described in the article), and 

c) lessons learned from the application of the clinical system/clinical technology. Be specific AND provide examples., and

3) in your conclusion, synthesize the findings from the 4 peer-reviewed research articles. 

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

· Chapter 14, “The Electronic Health Record and Clinical Informatics” (pp. 267–287)

· Chapter 15, “Informatics Tools to Promote Patient Safety and Quality Outcomes” (pp. 293–317)

· Chapter 16, “Patient Engagement and Connected Health” (pp. 323–338)

· Chapter 17, “Using Informatics to Promote Community/Population Health” (pp. 341–355)

· Chapter 18, “Telenursing and Remote Access Telehealth” (pp. 359–388)

Dykes, P. C., Rozenblum, R., Dalal, A., Massaro, A., Chang, F., Clements, M., Collins, S. …Bates, D. W. (2017). Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Critical Care Medicine, 45(8), e806–e813. doi:10.1097/CCM.0000000000002449

HealthIT.gov. (2018c). What is an electronic health record (EHR)? Retrieved from 

https://www.healthit.gov/faq/what-electronic-health-record-ehr

Rao-Gupta, S., Kruger, D. Leak, L. D., Tieman, L. A., & Manworren, R. C. B. (2018). Leveraging interactive patient care technology to Improve pain management engagement. Pain Management Nursing, 19(3), 212–221. 

Skiba, D. (2017). Evaluation tools to appraise social media and mobile applications. Informatics, 4(3), 32–40. 

Required Media

Laureate Education (Producer). (2018). Public Health Informatics [Video file]. Baltimore, MD: Author. –Downloads– Download Video w/CC Download Audio Download Transcript 

Laureate Education (Producer). (2018). Electronic Records and Managing IT Change [Video file]. Baltimore, MD: Author.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 5, “Critically Appraising Quantitative Evidence for Clinical Decision Making” (pp. 124–188)

· Chapter 6, “Critically Appraising Qualitative Evidence for Clinical Decision Making” (pp. 189–218)

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010a). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. doi:10.1097/01.NAJ.0000383935.22721.9c

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper—examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. doi:10.1097/01.NAJ.0000388264.49427.f9

Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010c). Evidence-based practice, step by step: Critical appraisal of the evidence: Part III: The process of synthesis: Seeing similarities and differences across the body of evidence. American Journal of Nursing, 110(11), 43–51. doi: 10.1097/01.NAJ.0000390523.99066.b5

Williamson, K. M. (2009). Evidence-based practice: Critical appraisal of qualitative evidence. Journal of the American Psychiatric Nurses Association, 15(3), 202–207. doi:10.1177/1078390309338733

Laureate Education (Producer). (2018). Appraising the Research [Video file]. Baltimore, MD: Author.