This Competency Assessment assesses the following outcome(s):
NU416-M5: Implement evidence-based interventions for managing the chronic care of patients to promote health and quality of life across the lifespan.
Co-morbid chronic illness often requires that many prescribed medications often resulting in what is referred to as “polypharmacy”. This can result in several problems. Adherence to a medication regimen is a key factor in promoting health and quality of life in those with chronic illness. Non-adherence can be attributed to a multitude of factors including cost, complexity of the medication regimen, and actual or perceived side effects (Ferdinand et al., 2017). Side effects and adverse drug reactions are other problems associated with polypharmacy. Nurses in both acute care and community or public health settings play an integral role in increasing medication regimen adherence and reducing adverse medication reactions for those with chronic illness (Shin & Haberman, 2016). For this assignment, evaluate a medication list and search for an evidence-based interventions to increase quality of life and promote health through improved medication adherence.
Consider an 80-year old patient, Mrs. X. Mrs. X has a long list of medications, both prescribed and OTC.
Altace 5 mg qd for congestive heart failure
Adalat CC 60 mg qd for hypertension
Cardizem LA 180 mg qd for coronary artery disease
Lasix 40 mg qd for edema
Hydrochlorothiazide 25 mg qd for hypertension/edema
Baby aspirin 81mg qd to prevent clots
Lipitor 10 mg qd for hypercholesterolemia
Synthroid 0.125 mcg ac qd for hypothyroidism
Tylenol 650 mg q4-6h for pain (arthritis)
Aleve 250 mg q6-8 hrs for prn for pain (arthritis)
Amrix 15 mg qd for pain/muscle spasms
Glucosamine 500 mg bid for pain
Amitriptyline 75 mg qhs for pain/sleep
Paxil 20 mg qd for depression
Oxazepam 15 mg hs for insomnia
Tylenol PM 1 tab qhs prn for insomnia
Benadryl 25 mg prn for allergy/itching
Prilosec 40 mg ac qd for gastric reflux/heartburn
Fiber laxative in water qd for constipation
Colace 50 mg bid for constipation
Multivitamin 1 qd
What are your first thoughts as you see this list? What are your impressions of Mrs. X’s health?
Read the following article: American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults as found in your reading list. Compare Mrs. X’s medication list against the Beers List Criteria for Potentially Inappropriate Medication use in Older Adults. What potential problems and concerns do you have for Mrs. X related to side effects and drug interactions? Consider the content items of the SPICES screening tool when answering.
What health promotion strategies would you use to address these concerns about side effects and drug interactions?
What evidence-based interventions would you recommend to help Mrs. X remain compliant with her medications?
This document should be no more than three pages in length. When creating this plan:
- Considers the Mrs. X’s age and level of understanding.
- Avoid medical terms Mrs. X and her family might not understand.
SPICES
An Overall Assessment Tool for Older Adults
- S = Sleep Disorders
- P = Problems with Eating or Feeding
- I = Incontinence
- C = Confusion
- E = Evidence of Falls
- S = Skin Breakdown
