However, it is possible that hypertension is an incorrect diagnosis. Normal blood pressure should be bellow 120/80, but it is also considered that the blood pressure can deviate up to 140 mmHg systolic pressure and 90 mmHg diastolic reading. Because Mrs. Chang’s blood pressure reading is lower than 140/90, her case can be considered pre-hypertension at most (Cunha, 2010). Another possibility is that Mrs. Chang’s condition has changed since her last examination, but she could not have known that because she cannot remember her last examination. She currently appears to suffer from orthostatic hypotension rather than hypertension. Both hypertension and orthostatic hypotension are considered risk factors for cardiac disorders and brain damage, so Mrs. Chang’s atrial fibrillation and mini stroke could have been caused by her blood pressure issues.
Atrial fibrillation causes faster heart contractions and irregular beating rhythm. While a healthy heart generates impulses in the sinoatrial node to stimulate myocardium contractions, a heart with atrial fibrillation generates the electrical signals in another part of the atria or in the local pulmonary veins (National Heart Lung and Blood Institute [NHLBI], 2011). People who suffer from AF usually measure between 100 and 175 beats per minute while regular rates are between 60 and 100 beats per minute (NHLBI, 2011). Although Mrs. Chang’s pulse reads 87 bpm, her medicine most likely helps regulate the process.
Mini strokes are similar to regular strokes, but they are referred to as transient ischemic attacks (TIA), and they do not cause permanent damage or destroy brain cells (Swanson, 2010). TIA can be caused by blood clots that are generated because of atherosclerosis, atrial fibrillation, hypertension, and other conditions (Wedro, 2010). It is usually a consequence of an existing medical condition, such as those conditions Mrs. Chang suffers from. Symptoms that announce the TIA are usually numbness or weakness, confusion, sight trouble, loss of balance, and loss of coordination (National Institute of Neurological Disorders and Strokes [NINDS], 2012). While aspirin is a common drug used to prevent serious strokes, anticoagulants, such as Warfarin, are prescribed to people who suffer from atrial fibrillation (NINDS, 2012).
Thiazide diuretics are the most commonly used diuretics. They inhibit the sodium-chloride transporter in the distal tube (Klabunde, 2010). Because these transporters can reabsorb around 5 percent of filtered sodium, these drugs are less effective than loop diuretics, but they are sufficient in most cases (Klabunde, 2010). Thiazide diuretics are used mainly for patients with hypertension and heart failure because they help prevent congestion and edema. Howeverm hypokalemia is the most common side-effect of Thiazide diuretics (Klabunde, 2010). Mrs. Chang does not seem to suffer from hypokalemia because her vital signs do not indicate higher blood pressure, but hypokalemia can provoke cardiac arrhythmias, so it should be considered when performing patient assessment and evaluation.
Although Mrs. Chang did not report any issues with her medication, she cannot remember her last examination. Because elderly care often deals with multiple medications, medication intake requires constant monitoring and regulation. It is evident that her medication intake was unmonitored because she displays adverse drug reactions (ADRs). Interactions between conventional medication and herbal supplements are common causes of ADRs (Cohen, 2009). Most elderly people report decline in adherence to their medication, so lack of adherence is considered a common factor for negative outcomes (George, Elliott, and Stewart, 2008). However, Mrs. Chang’s case proves that patient adherence is only one aspect of the treatment. Adherence and decision making without professional control, monitoring, and advice do not solve medical issues (Raynor and Nunney, 2002).
In addition to unmonitored pharmacological treatments, Mrs. Chang is at risk because of herbal supplements. Although several herbal drugs are acknowledged by healthcare professionals, patients are advised to seek professional opinions when using herbal medication (Gratus et al., 2009). In Mrs. Chang’s case, her daughter was the only source of information. While most people believe herbal remedies are safe and harmless, they can interfere with conventional treatments and cause ADRs (Gratus et al., 2009). Ramsay, Kenney, Davies, and Patel (2005) found that only 28 percent of patients taking complementary and alternative medicine (CAM) believed they might interfere with conventional treatments. In reality, both garlic and ginko bilboa interfere with Warfarin and increase risks of bleeding (Ramsay, Kenney, Davies, and Patel, 2005). Garlic interferes by inhibiting platelet function while ginko bilboa interferes by antagonizing the platelet activating factor.
Although it is not possible to make any judgments without detailed assessment and evaluation, conflict between various medications could have influenced her fall. Some side-effects of her medication include dizziness, fatigue, implicated coordination, implicated balance, and nausea. Most importantly, the unmonitored intake of CAM increased bleeding that could have increased those symptoms. Her medication is possibly the main factor that could have contributed to her fall.
In evaluating Mrs. Chang’s situation, I would assess her medical treatment, the necessity for continuous care, and patient education. Hiring a professional pharmacist is a common practice to improve healthcare delivery by decreasing errors in medication prescription (Flalová and Onder, 2009). I would assign a pharmacist to a multidisciplinary team working with Mrs. Chang. The main goals would be to identify and remove harmful medication from her treatment and establish appropriate medication doses (Flalová and Onder, 2009). The first step to improve Mrs. Chang’s health is to focus on correcting her current medication intake. The analysis of her condition and medication intake indicates that the prescribed medication no longer fits her medical conditions. Improving her medication intake will decrease her risk factors for ADRs, a common outcome in elderly care.
Furthermore, Mrs. Chang requires detailed patient education because improper patient education is often the main cause of unnecessary readmissions for elderly patients. Mrs. Chang must be aware that herbal supplements are not harmless and that frequent examinations are required because of her age and medical conditions. Mrs. Chang claims she has no problems with adherence, a common issue in elderly care. However, like many other elderly patients, she does not understand the hazards of decision making without advice from healthcare professionals. The main goal of her education is to refute the common assumption that herbal remedies are harmless. Another goal is to explain the importance of regular examinations for elderly patients who suffer from several disorders. If Mrs. Chang finds it physically difficult to visit her doctor frequently, I would recommend Mrs. Chang and her family to consider continuous home care. With continuous home care, a healthcare professional would monitor her drug intake and observe potential adverse drug reactions. Furthermore, because Mrs. Chang lives alone, continuous home care could assess her home for appropriate safety measures. Rather than providing Mrs. Chang with acute care frequently, palliative care is a more appropriate healthcare delivery method for elderly patients that can significantly improve their quality of living.
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