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QUESTION
Noncompliant Patient
Ms. C, 72 years old, has diabetes mellitus, hypertension, rheumatoid arthritis (RA), and coronary artery disease. She lives alone. She recently was discharged from the hospital after treatment for an acute myocardial infarction. She had been doing well before this admission. You are the home health nurse assigned to visit Ms. C. Ms. C’s son tells you he is concerned that his mother will not follow up with all the medications she is supposed to take. He states that she has not been very compliant with treatment in the past.
As the home health nurse, how would you approach Ms. C?
What risk factors might interfere with Ms. C’s plan of care?
What must you evaluate to include in the plan of care?
no internet sources
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| Subject | Nursing | Pages | 3 | Style | APA |
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Answer
Noncompliant Patient
Ms. C.’s son has expressed a concern that Ms. C. has history of medication non-adherence. Approach to this patient includes educating the patient on the pathophysiology of her chronic conditions and the role played by each administered medication to achieve better outcomes. Patient education may help improve medication adherence. Patient should be educated on drug dosage, route of administration and potential adverse events (Alfian et al., 2020). On the other hand, factors that may interfere with Ms. C.’s plan of care unintentional and intentional factors of medication non-adherence. Unintentional factors may include forgetfulness and lack of understanding. Intentional factors include medication beliefs and conscious decision to avoid medications due to drug adverse effects (Alfian et al., 2020). One of the already identified unintentional factors that may contribute to non-adherence to medications in Ms. C.’s case is the fact that she is living alone. Besides, old age (72 years old) is also considered as an unintentional risk factor. In addition, she has multiple conditions and diseases including hypertension, diabetes mellitus, rheumatoid arthritis, coronary artery disease, and myocardial infarction. It implies that she is likely to be administered multiple medications. Polypharmacy increases the risk of medication non-adherence (Masnoon et al., 2017). Ms. C.’s cognitive and mental wellbeing should be evaluated to determine if she has the ability to carry-out activities of daily living and manage her medications as required. This is important since she lives alone and the Ms. C.’s son had expressed concern that the patient had history of medication non-adherence. She should be asked on whether current medications cause her harm or side effects that make her to avoid them. Besides, other conscious reasons for non-adherence should also be identified and evaluated. Other issues that must be evaluated include her education level, literacy skills, income level, and drug allergies so as to improve Ms. C.’s adherence to medications (Alfian et al., 2020)
References
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Alfian, S. D., Annisa, N., Fajriansyah, F., Perwitasari, D. A., Addulah, R., Hak, E., & Dening, P. (2020). Modifiable factors associated with non-adherence to antihypertensive or antihyperlipidemic drugs are dissimilar: a multicenter study among patients with diabetes in Indonesia. Journal of General Internal Medicine. https://link.springer.com/article/10.1007/s11606-020-05809-y
Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatr., 17, 230. https://dx.doi.org/10.1186%2Fs12877-017-0621-2
Polonsky, W., & Henry, R. (2016). Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Dove Press, 2016, 1299-1307. https://doi.org/10.2147/PPA.S106821