Treating Patients with COPD
Instructions: Interview a patient with a chronic pulmonary health condition who is on at least two medications.
In a 1,300-1,400-word paper, discuss the following:
- Obtain a complete health history.
- Obtain a complete medication history, including prescription and over-the-counter drugs or supplements.
- Analyze the client’s current knowledge level of medications and compliance with the prescribed dosing and administration.
- For each medication, identify the pharmacokinetics, pharmacodynamics, dose, route of administration, side effects, adverse reactions, any drug interactions, potential safety issues, and the impact on the client’s health status.
- Formulate possible interventions related to lack of drug efficacy, lack of client knowledge, or client compliance issues as identified during the interview.
Prepare this assignment according to the APA guidelines. An abstract is not required.
Solution
Treating Patients with COPD
- Complete health history.
Past surgical and medical history
- Had a heart failure after a myocardial infarction while aged 68 years.
- Had COPD ( was on 2 L of home oxygen
- Appendectomy
- Hypertension
Family history
- Father passed on with myocardial infarction at the age of 59 years (smoker, diabetes, hypertension)
- Mother alive (heart failure, atrial fibrillation)
- Siblings are healthy
Social history
- Married with three children
- History of 30 pack year smoking (quit after MI)
- Has worked on a farm
- No illicit drugs or alcohol use
Allergies/ Medications
- Takes 20 mg of lisinopril twice daily
- Takes 50 mg metroprolol twice daily
- Takes 25 mg spironolactone daily
- 40 mg of furosemide daily
- Fluticasone/salmeterol 50/500 dry powder inhaler (DPI)one puff twice a day
- One cap of tiotropium inhaled daily
- Ipratropium/albuterol solution for nebulization or metered dose inhaler for every six hours as required.
- Two puffs of levalbuterol MDI every 4 to 6 hours as needed.
- Home oxygen.
(COPD, 2009)
The patient is confused about the medication he takes and when to take them.
Has no known allergies
Past record review (availed by the wife)
- Echocardiogram with EF of 25%
- Spirometry with an FEVI predicted of 35% which does not significant change after inhaled bronchodilator
- Complete medication history
The wife revealed that he had five exacerbations in the past that were treated with oral steroids and antibiotics.
- Doxycycline x1 course, Amoxilin x2 courses
- The most recent course was two years ago
- Has not been hospitalized in the past six months
Based on this information and chest x-ray findings, the patient is treated for community acquired pneumonia.
During hospitalization, the patient receives the following treatments.
- Nebulized ipratropium/albuterol every four hours as required
- 60 mg Prednisone daily per month.
- Gm. of IV ceftriaxone plus 50 mg oral azithromycin daily
- Maintain PO2> 60 mmHg with oxygen
Preparation for discharge
- The patient significantly improved over 3 days and was weaned back to the home oxygen regime.
- Takes the ipratropium/albuterol nebulized treatments every 6 hours. Is also ready to switch back to bronchodilators through inhaler devices.
- Determine the treatment and dose for oral corticosteroids after prescribing antibiotics for a total of 7 days (Abramovitz, n.d.).
- Patient knowledge of level of medications
The patient admits not knowing some of the prescribed medications and their uses. He takes a lot of pills during a single day and claims not to remember each of them. Therefore, this has led to him choosing the drugs to take and the ones to avoid taking. By his own admittance, he is not able to fully adhere to complete dosage prescribes.
Older patients have high adherence to medication. Their age is also associated with polypharmacy and comorbid conditions (Barnes, 2014). Furthermore, advanced age is associated with cognitive decline. Polypharmacy means that the patient has different prescriptions for different possible ailments. Therefore, keeping tabs on which drugs to take and when to take them presents a challenge to the patient. This is even made worse by the decline in cognition through his advanced age.
- Effects and reactions to administered drugs
For maintaining the treatment of bronchospasm which is associated with COPD, Atrovet HFA Inhalation Aerosol is used. The usual dosage is two inhalations four times a day. These should not exceed 12 inhalations within 24 hours (Flens & Kollaard, 2009). Atrovent HFA solution does not require shaking but like other metered dose inhalers requires coordination in actuating the canister and inhaling the medication.
Before using the first time spray, patients should actuate Atrovent HFA by releasing two sprays into the air and away from the face. In the event that the inhaler has not been in use for the past three days, then the test should occur twice in the air and away from the face. The patient should not spray the solutions to their eyes. Every inhaler provides medication sufficient for 200 actuations and should be discarded once used. At the point of discard, the amount of actuations cannot be assured though the canister is not completely empty (Kon, Hansel, & Barnes, 2008).
Atrovent HFA is provided in a stainless steel pressurized container as a metered doze with a white clear mouth piece cover, a colorless sleeve, and a green protective cap. The pressurized aerosol unit contains 12.9g solution of ipratropium bromide which is sufficient for 200 actuations. Each actuation delivers 21 mcg of ipratropium bromide from the valve and 17 mcg of ipratropium bromide delivered through the mouthpiece.
However, Atrovent HFA should not be delivered under the following conditions: hypersensitivity to Atrovent HFA components or ipratropium bromide; and hypersensitivity to atropine and its derivatives. Further, the treatment is associated with COPD and is not advisable for acute bronchospasm episodes which require rapid responses. Also, hypersensitive reactions such as angioedema, bronchospasm, urticarial, or pharyngeal edema and anaphylaxis may occur after administration. In post market experience with products containing ipratropium and in clinical trials, hypersensitive reactions such as pruritus, skin rush, laryngospasm, angioedema of the face, lips and tongue, anaphylactic reactions and urticarial have been reported. Under such circumstances, therapy using Atrovent HFA should be stopped and alternative methods of treatment sought.
Finally, the use of Atrovent HFA may cause intraocular pressure to rise since it is anticholinergic. Such may cause the worsening or precipitation of the narrow-angle glaucoma. Hence, the treatment should be used carefully wit those patients. Further, patients should not spray the chemical in their eyes as it may cause the temporary blurring of vision, eye discomfort or pains, visual halos, mydriasis or corneal congestion. If the symptoms occur then the patient should immediately consult a physician.
- Possible interventions related to lack of drug efficacy, lack of client knowledge, or client compliance issues
Non-adherence to regimes and medications is common in the handling of COPD. The more complicated and lengthier the regime, the greater lower the adherence levels. The greatest factor inversely affecting adherence is frequency of dosing. COPD patients are usually older and therefore require medication for other ailments. Another factor affecting adherence is polypharmacy. The patients take more than five prescriptions with a number having more than two prescription providers. Therefore, such patients become frustrated with such complicated dosing regimens and may miss some doses (Rennard, 2012).
The solution to this often involves charting the regimes for the elderly patients. For instance, a care-giver may decide to color-code the way in which the patient is supposed to take their medicine. An example includes yellow-green-yellow-white in the morning and yellow-green-white in the afternoon. Therefore, the patient is always aware of the color sequence to follow at different times of the day. Once this becomes a habit, then it is easy for the patient to remember their regimes.
Also, caregivers can develop a regime chart for the ailing patients. Such a chart clearly outlines the day, the medication, specific quantities and how to take them. The charts are placed next to areas that the patients access daily such as washroom sinks or on the doors of the refrigerator. The patient therefore is aware daily of their regime and can stick to it (Flens & Kollaard, 2009).
Also important are other regime factors and medication. Medications that do not have direct implications to the symptoms attract the lowest adherence levels. Drugs that induce unpleasant side effects also face low levels of adherence. Even if drugs clinically improve their condition, a patient may decide to discontinue with a drug just to avoid its discomforting side effects. Therefore, the regime in this case includes the use of alternative drugs that do not react negatively with the patient. The drugs inducing the negative effects are replaced by their equal alternatives.
Thus, the best regime for the COPD
patient should be patient centered. The patient knows which drugs to take and
in what quantities through color coding. Further, charting allows the patient
to assess the regime daily and reminds them of the time, type, and quantity of
medication they should take. Finally, patients do not like drug with unpleasant
effects. They would rather ignore the drug than to take it and suffer
unpleasant consequences. Therefore, patient may decide against continuing with
the treatment than suffer the accompanying discomforts.
References
Abramovitz, M. COPD.
Barnes, P. (2014). COPD. Elsevier Health Sciences.
COPD. (2009).
Flens, C. & Kollaard, S. (2009). COPD. Amsterdam: Stichting September.
Kon, O., Hansel, T., & Barnes, P. (2008). Chronic obstructive pulmonary disease. Oxford: Oxford University Press.
Rennard, S. (2012). COPD. Elsevier Health Sciences.