Instructing patients

ISONIAZID. Severe and sometimes fatal hepatitis may occur with isoniazid therapy. The nurse must carefully monitor all patients at least monthly for any evidence of liver dysfunction. It is important to instruct patients to report any of tlie following symptoms anorexia, nausea, vomiting, fatigue, weakness, yellowing of Hie skin or eyes, darkening of Hie urine, or numbness in the hands and feet. 

The nurse instructs patients to report any symptoms of infection such as an elevated temperature (even a slight elevation), sore throat, difficulty breathing, weakness, or lethargy. The patient must be aware of possible signs of pancreatitis (nausea, vomiting, abdominal pain, jaundice [yellow discoloration of the skin or eyes]) and peripheral neuritis (tingling, burning, numbness, or pain in the hands or feet). Any indication of pancreatitis or peripheral neuritis must be reported at once. 

Educating the Patient and Famiiy The nurse instructs patients under treatment for narcotic addiction to wear or carry identification indicating that they are receiving naltrexone If the patient is taking naltrexone and requires hospitalization, it is important that all medical personnel be aware of therapy with this drug. Narcotics administered to these patients have no effect and therefore do not relieve pain. Fhtients receiving naltrexone may pose a problem if they experience acute pain. The primary health care provider must decide what methods must be used to control pain in these patients. 

Instruct patients to rise slowly from a sitting or lying position. 

Provide assistance for the patient getting out of a bed or a chair if symptoms of postural hypotension are severe. Place the call light nearby and instruct patients to ask for assistance each time they get in and out of a bed or a chair. 

Instructs patient to insert applicator into vagina, angling it toward the tailbone and advancing it about 2 inches. 

Monitor for acute and chronic adverse effects of AEDs. Acute adverse effects are best detected by a thorough neurologic examination at clinic visits. Instruct patients to report sedation, ataxia, rash, or other problems immediately. Monitor for chronic adverse effects including a loss of bone mineral density, which should be measured every 2 years in patients taking phenytoin, phenobarbital, carbamazepine, and valproate. 

Instruct patients, family members, and caregivers on first aid for seizures. First aid for seizures consists primarily of keeping the patients from hurting themselves. They should be placed on the floor, if possible, and their heads cushioned. First responders to a seizure should never attempt to restrain them or force an item into their mouth. If a seizure lasts longer than 5 to 10 minutes, emergency medical assistance should be called. 

Clinicians should instruct patients to use crushed ice or ice chips because the area will cool more evenly than with large pieces of ice. Patients should not apply ice directly to the affected area or leave it on for longer than the recommended 20 minutes because frostbite may occur.12 A thin sheet or napkin will protect the skin and also allow for better cold transfer than thicker material such as a towel. Alternatively, soaking the area for 20 minutes in a cool bath (55°F or 13°C) provides effective cooling. 

Instruct patients over the phone to irrigate the eye immediately with water or saline continuously for at least 15 minutes before seeking a clinician. Irrigation dilutes and removes the chemical agent, and is the best way to decrease ocular tissue damage. Patients should then seek immediate care from an ophthalmologist or emergency facility.7... 

Instruct patients receiving phenytoin about the symptoms of elevated serum concentrations (e.g., nystagmus, blurred vision, dizziness, drowsiness, and lethargy). 

The primary outcome is the prevention of extravasation events using proper administration techniques. Instruct patients to promptly report any symptoms of extravasation. If extravasation occurs, select the proper antidote and thermal application for immediate administration. Promptly refer the patient for plastic surgery if pain persists or ulceration develops. 

It s generally wise to instruct patients to take a test dose of the beta blocker in the safety of their homes before the performance situation, to be certain that they can tolerate any side effects, especially potential dizziness. 

In order to prevent transfer to another person, instruct patients to wear clothing to cover the application sites. If direct skin-to-skin contact with another person is anticipated, the application sites must be washed thoroughly with soap and water. 

In order to maintain serum testosterone levels in the normal range, instruct patients not to wash the sites of application for at least 2 hours after application. TESTOSTERONE, BUCCAL The recommended dosing schedule is the application of 1 buccal system (30 mg) to the gum region twice daily, morning and evening (about 12 hours apart). Testosterone buccal should be placed in a comfortable position just above the incisor tooth on either side of the mouth. With each application, testosterone should be rotated to alternate sides of the mouth. 

Gl irritation/disorders Bisphosphonates cause local irritation of the upper Gl mucosa. Alert physicians to any signs or symptoms signaling a possible esophageal reaction and instruct patients to discontinue bisphosphonates and seek medical attention if they develop dysphagia, odynophagia, retrosternal pain, or new or worsening heartburn. 

Infection Instruct patients treated with succimer to report promptly any signs of infection. If infection is suspected, immediately conduct the above laboratory tests. Pregnancy Category C. 

When beginning treatment with formoterol, instruct patients who have been taking inhaled, short-acting 2-agonists on a regular basis (eg, 4 times/day) to... 

Daily limit Once a successful dose has been found, instruct patients to limit consumption to 4 units/day or less. If consumption increases to more than 4 units/day, reevaluate the dose of the long-acting opioid for persistent cancer pain. 

CR tablets, 80 and 160 mg, are for use only in opioid-tolerant patients requiring daily oxycodone equivalent dosages of at least 160 mg for the 80 mg tablet and at least 320 mg for the 160 mg tablet. Take care in the prescribing of these tablet strengths. Instruct patients against use by individuals other than the patient for whom it was prescribed, as such inappropriate use may have severe medical consequences, including death. 

Orally disintegrating tablets - Administration with liquid is not necessary. The orally disintegrating tablet is packaged in a blister within an outer aluminum pouch. Instruct patients not to remove the blister from the outer pouch until just prior to dosing. The blister pack should then be peeled open with dry hands and the orally disintegrating tablet placed on the tongue, where it will dissolve and be swallowed with saliva. 

Alosetron should be discontinued immediately in patients who develop constipation or symptoms of ischemic colitis. Physicians should instruct patients to immediately report constipation or symptoms of ischemic colitis. Alosetron should not be resumed in patients who develop ischemic colitis. Physicians should instruct patients who report constipation to immediately contact them if the constipation does not resolve after discontinuation of alosetron. Patients with resolved constipation should resume alosetron only on the advice of their treating physician. 

Hazardous tasks SSRIs may cause dizziness or drowsiness. Instruct patients to observe caution while driving or performing tasks requiring alertness, coordination, or physical dexterity. 

All patients Instruct patients to take methylphenidate chewable tablets with at least 240 ml (8 ounces) of water or other fluid. Taking this product without enough liquid may cause choking. 

Oral solution Each dose of rivastigmine may be swallowed directly from the syringe or first mixed with a small glass of water, cold fruit juice, or soda. Instruct patients to stir and drink the mixture. 

Instruct patient to chew the gum slowly until it tingles, then park it between the cheek... 

NICOTINE NASAL SPRAY Instruct patients to stop smoking completely when using the product. Instruct them not to sniff, swallow, or inhale through the nose as the spray is being administered. Advise patients to administer the spray with the head tilted back slightly. 

Vitamin supplement Counsel patients to take a multivitamin supplement that contains fat-soluble vitamins to ensure adequate nutrition because orlistat reduces the absorption of some fat-soluble vitamins and beta-carotene. Instruct patients to take the supplement once a day at least 2 hours before or after the administration of orlistat, such as at bedtime. 

When valacyclovir is used as suppressive therapy in immunocompetent individuals with genital herpes, the risk of heterosexual transmission to susceptible partners is reduced. Instruct patients to use safer sex practices with suppressive therapy (see current Centers for Disease Control and Prevention Sexually Transmitted Disease Treatment Guidelines). 

Zanamivir is for administration to the respiratory tract by oral inhalation only, using the D/s/c/ a/er device provided. Instruct patients in the use of the delivery system. Include a demonstration whenever possible. If zanamivir is prescribed for children, it should be used only under adult supervision and instruction, and the supervising adult should first be instructed by a health care professional. 

The majority of rashes associated with nevirapine occur within the first 6 weeks of initiation of therapy. Instruct patients not to increase the 200 mg/day (4 mg/kg/day in children) dosage if any rash occurs during the 2-week lead-in dosing period until the rash resolves. 

Instruct patients receiving nevirapine to discontinue nursing, consistent with the recommendation by the US Public Health Service Centers for Disease Control and Prevention that HIV-infected mothers not breastfeed their infants to avoid risking postnatal transmission of HIV. 

Instruct patients to limit exposure to sunlight and UV light by wearing protective clothing and using a sunscreen with a high SPF. 

Self-administration Instruct patients in injection techniques to ensure the safe self-administration of interferon beta. 

General considerations in topical ophthalmic drug therapy Proper administration is essential to optimal therapeutic response. In many instances, health professionals may be too casual when instructing patients on proper use of ophthalmics. The administration technique used often determines drug safety and efficacy. 

Soft contact lenses The preservative in brimonidine, benzalkonium chloride, may be absorbed by soft contact lenses. Instruct patients wearing soft contact lenses to wait at least 15 minutes after instilling brimonidine to insert soft contact lenses. Renal/Hepatic function impairment Use caution when treating patients with hepatic or renal impairment. 

Contact lenses As with all ophthalmic preparations containing benzalkonium chloride, instruct patients not to wear soft contact lenses during treatment with lodoxamide. 

In one study [Mawson et al. 1982), the anti-OC effects of clomipramine were partially neutralized by instructing patients not to expose themselves to situations that would elicit OC symptoms. These antiexposure instructions contrast with the usual practice of advising patients to confront feared situations without performing compulsions. The impact of antiexposure instructions on outcome is more a theoretical than a clinical issue because most patients conduct self-exposure despite instructions to the contrary [Cottraux et al. 1989). 

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