44 X.V Health Teaching Plan Medication 1.

Generic name: Losartan potassium Exercise Exercise plays its part in the treatment of lupus. It is very important to keep Brand name: Cozaar muscles & joints active for a variety of reasons. C: Anti-hypertensive Muscles need to be drug toned in order to function adequately. The H: Lowers high blood size of the muscle & its pressure blood circulation depend on its function (where E: Not affected by meals. the muscle is & what it It is given once a day does). Physical therapy (OD). is very beneficial to the patient who is trying to C: Tell patient to avoid maintain muscle salt substitutes; these integrity & tone. Joints products may contain depend on tendons & the potassium, which can calcification of bones. cause high potassium These in turn depend on level. continued movement. Significant bone loss K: Monitor patients through osteoporosis blood pressure to evaluate occurs when bones are effectives of drug therapy. not used regularly. When used alone, drug Encourage significant has less of an effect on other to do passive blood pressure ROM (Range of motion) exercises for the client. 2. Generic Name: Treatment Angina medications Nitrates: Commonly known as nitroglycerin, nitrates are the most commonly prescribed drugs to treat angina. Nitrates dilate blood vessels, which allow more blood to flow past blockages. Nitrates also decrease the resistance the heart faces when pumping blood to the rest of the body, which in turn can decrease the stress (workload) on the heart. Beta-blockers: Beta-blockers slow the heart rate and decrease the force of heart muscle contraction, thereby reducing the stress on the heart. Hygiene Every external part of the body demands a basic amount of attention on a regular basis. Here are some grooming routines: 1. Taking a bath everyday 2. Keep nails short and trimmed to prevent excoriation. A healthy body ensures healthy nails. Brittle or discoloured nails show up deficiencies or disease conditions. Outpatient The best way to prevent angina is to lower your risk for coronary heart disease: Avoid or reduce stress as much as you can. Control your blood pressure, diabetes, and cholesterol. Eat well-balanced meals that are low in fat and cholesterol and include several daily servings of fruits and vegetables. Diet Dietary guidelines for those who have angina include: Control calories: Eat just enough calories to achieve and maintain a healthy weight. Eat quality fats: Use virgin olive oil and other unsaturated, lowcholesterol fats. Eat foods that are rich in omega-3 fatty acids Eat the right amount of fats, carbohydrates and protein: Limit your fat intake to 20 or 30 percent, but don't substitute simple carbohydrates for fat. Less than 7% of the day's total calories from saturated fat. Up to 10% of the day's total calories from polyunsaturated fat. Up to 20% of the day's total calories from monounsaturated fat Avoid fad diets:

Get regular exercise. If your weight is normal, 3. Keep hair clean and get at least 30 minutes of moisturized. Wash your exercise every day. hair at least once a However, talk to your week using soap or doctor before starting mild shampoo. Avoid exercise or increasing shampoos with borax your activity level. or alkalis. Calcium channel Lose weight if you blockers: 4. Provide or encourage are overweight. Calcium channel blockers oral hygiene cause blood vessels to Stop smoking

45 Diazepam Brand Name: Valium C: Central nervous system drug; Anxiolytic H: It is effective if it relieved symptoms of anxiety, acute agitation, tremor, delirium tremens, and hallucination and relaxes muscle. E: Not affected by meals. It is given twice a day (BID). Tell patient to avoid alcohol while taking drug. C: Warn patient to avoid acivities that require mental alertness and good coordination until effects of drug are known. K: Monitor periodic hepatic, renal and hematopoietic function studies in patients receiving repeated or prolonged therapy. 1. Musculoskeletal activity (designed to enhance flexibility & mobility) Types of Activities: Passive ROM Exercises Duration: 10-15 minutes Frequency: Everyday, 2-4 hours 2. Stretching Exercises (to specifically target joint weakness) Types of Activities: Chin-to-chest. Raise the back of the person's head up from the bed. Gently tip his chin toward his chest. Try to rest the person's chin on his chest if possible. Head turns. Put one hand on each side of the person's face. Turn the person's head toward the right as if he were looking over his right shoulder. Then slowly dilate and blood pressure to decrease, and they also reduce the frequency and severity of angina by reducing the stress on the heart. Electrocardiogram (ECG) ECG tests monitor the electrical activity of the heart. When certain ECG findings are present, the risk of unstable angina progressing to a heart attack is significantly increased. Cardiac blood tests Since unstable angina can be a precursor for a heart attack, a physician will usually order blood tests to determine if a heart attack has occurred. The test looks for evidence that heart muscle has died. Usually, several blood tests have to be checked over a period of several hours, since evidence of a heart attack can take some time to Get enough sleep and rest. Adherence to pharmacological and non-pharmacological interventions. Stress to patient and family the importance of follow-up examinations and treatment because of changing physical status. Allowing monitoring of symptoms, disease activities, and treatment of side effects. Eat a well-rounded diet instead. Eat small, frequent meals. Avoid large and heavy meals. Limit cholesterol in diet: To less than 200 milligrams a day. Limit iron intake: Too much iron can increase atherosclerosis. Eat enough dietary fiber: Whole grains are best. Eat plenty of fresh fruit and vegetables Reduce salt in your diet Optimal: no more than 1,500 milligrams per day. Check with your doctor about supplementing your diet with B vitamins: Vitamin B1 (thiamine) Vitamin B2 (riboflavin) Vitamin B3 (niacin) Vitamin B5 (pantothenic acid) Vitamin B6 (pyridoxine) Vitamin B12 (cobalamin)

46 turn the person's head so he is looking over his left shoulder. Turn the head only far enough so that the person's nose is lined up above their shoulder. Head tilts. Put one of your hands on each side of the person's face. Tilt the head to the side, bringing the right ear toward the right shoulder. Then slowly tilt the person's head to bring the left ear toward the left shoulder. Intensity: Start with minimal stretching, gradually increasing Duration: 15-20 minutes Frequency: 2-4 times a week 3.Ankle & Foot Exercises appear in the blood. Knowing the results of these tests is important in determining the next best cardiac test or treatment to have. Cardiac catheterization and angiography Physicians may recommend cardiac catheterization and angiography, especially if significant resting ECG changes are present or cardiac blood tests are abnormal. During angiography, a catheter is inserted into an artery in the groin or arm and advanced into the heart. When the catheter is positioned near the arteries that supply blood to the heart, the physician injects a contrast dye. As the dye travels through the arteries, X-ray pictures are taken to see how well blood flows through the arteries, and if there are any blockages that indicate CAD.

3 Generic Name: Captopril Brand Name: Capoten C: Angiotensinconverting enzyme (ACE)inhibitor; Antihypertensive H: Treat CHF in patients unresponsive to conventional therapy; used with diuretics and digitalis, diabetic nephropathy and left ventricular dysfunction after MI. E Given twice a day (BID). Administer 1 hour before or 2 hours after meals. C: Tell patient to report any signs of toxicity, mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty

47 breathing. K: Monitor patient closely for fall in BP secondary to reduction in fluid volume (excessive perspiration and dehydration, vomiting, diarrhea); excessive hypotension may occur. 4 Generic Name: Potassium chloride Brand Name: Kalium durule C: Electrolyte and replacement solution H: Prevent hypokalemia E: Not affected by meals. Given twice a day (BID).. C: Teach patient signs and symptoms of hyperkalemia and tell patient to notify prescriber if they occur. K: Watch out for levels Types of Activities: How to start: Hold the right ankle with one hand. Put your other hand on the bottom of the foot. Ankle bends. Push the person's foot so his toes point up toward the ceiling. Then put your hand on top of the foot and push the foot down again. Ankle rotation. Hold the ankle with one hand. Hold the person's upper foot with your other hand. Gently turn the foot and ankle in circles. Toe bends. With your palm on top of the person's foot, curl the toes down toward the sole (bottom) of the foot. Then straighten and stretch the toes. Toe spreads. Use your fingers to spread the toes apart one at a time. Then bring them together again. Intensity: Gradually increasing

ECG stress test In an ECG stress test, the patient exercises, usually by walking on a treadmill, while wearing an ECG monitor. If the heart is not receiving sufficient oxygen during the exercise, the ECG patterns reflect this and indicate the presence of CAD. If a person is unable to perform enough exercise to stress the heart adequately during a stress test, a drug designed to mimic the effects of exercise on the heart can be administered instead. Nuclear stress test A nuclear stress test is similar to an ECG stress test. However, during the exercise, a radioisotope (a safe radioactive compound) is injected into a vein and travels to the arteries that supply blood to the heart. After exercise, pictures of the

48 of potassium electrolyte level to prevent hyperkalemia 5. Generic Name: Isosorbide dinitrate Brand Name: Isoket C: Cardiovascular system drug; Anti-anginal H: Treatment and prevention of angina pectoris. E: Give oral preparations on an empty stomach, 1 hour before or 2 hours after meals; take with meals if severe, uncontrolled headache occurs. Given thrice a day (TID). C: Patients should be told that the anti-anginal efficacy of isosorbide dinitrate is strongly related to its dosing regimen, so the prescribed schedule of dosing should be followed carefully. from soft to moderate pressure. Duration: 2-3 Sessions, 15-20 minutes a day Frequency: 2-4 times a week. Consultation must be done first before engaging to any exercise programs. This is to ensure the safety and limitations of exercises intended for end stage renal disease patients. Encourage significant other (wife) to do ROM (range of motion) exercises on the time required to prevent immobility of the patient. Instruct significant other to perform proper stretching and warm up activities before engaging patient to a higher intensity ROM exercises. heart are taken with a special camera that can detect the radioisotope. These pictures can determine if blockages from CAD are present. Echocardiographic stress testing An echocardiographic, or echo, stress test is similar to an ECG stress test. An echo stress test uses ultrasound waves to take pictures of the heart before and after exercise, which can show changes that indicate the presence of CAD. ACTUAL

49 K: Monitor blood pressure, intensity and duration of drug response. 6. Generic name: Atorvastatin Calcium Brand name: Lipitor Antihyperlipidemic HMG-CoA reductase inhibitor C: Inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs (associated with increased risk of CAD), and increases serum HDLs (associated with decreased risk of CAD); increases hepatic LDL recapture H: >increase HDL-C E: Take the same time each day, preferably in

50 the evening; may be taken with food. C: Do not drink grape juice while taking this drug. Contraindicated with allergy to atorvastatin fungal byproducts, active hepatic disease, or unexplained and persistent elevations of transaminase levels K: Withhold atorvastatin in any acute, serious condition (severe infection, hypotension, major surgery, trauma, severe metabolic or endocrine disorder, seizures) that may suggest myopathy or serve as risk factor for development of renal failure Ensure that patient has tried cholesterol-lowering diet regimen for 3-6 months before beginning therapy Report muscle pain, weakness, tenderness;

51 malaise; fever; changes in color of urine or stool; swelling 7. Generic name: Clopidogrel Brand name: Plavix C: Adenosine diphophate (ADP) receptor antagonist antiplatelet inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets H: > prevent adverse cardiac events in coronary stent implantation E: May be taken with meals C: Avoid taking with NSAIDs K: Monitor patient carefully; increased risk of GI bleeding when

52 taken with NSAIDs Report skin rash, chest pain, fainting, severe headache, abnormal bleeding 8. Generic name: nitroglycerin Brand name: Minitran, nitrek, nitrodur, transderm-nitro C: Antianginal Nitrate Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen H: Prophylaxis of angina E: Apply to slightly different area each day. C: Remove old system before you apply a new one

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K: Administer transdermal systems to skin site free of hair and not subject to much movement. Shave areas that have a lot of hair. Do not apply to distal extremities. Change sites slightly to decrease the chance of local irritation and sensitization. Remove transdermal system before attempting defibrillation or cardioversion.