Educating the Patient and Family

The nurse stresses the importance of following the diet recommended by the primary health care provider because drug therapy alone will not significantly lower cholesterol and triglyceride levels. The nurse provides a copy of the recommended diet and reviews the contents of the diet with the patient and family. If necessary, the n

Patient and Family Teaching Checklist

Using Diet and Drugs to Control High Blood Cholesterol Levels

The nurse:

✓ Reviews the reasons for the drug and prescribed drug therapy, including drug name, form and method of preparation, correct dose, and frequency of administration.

✓ Emphasizes that drug therapy alone will not significantly lower blood cholesterol levels.

✓ Stresses importance of taking drug exactly as prescribed.

✓ Reinforces the importance of adhering to prescribed diet.

✓ Provides a written copy of dietary plan and reviews contents.

✓ Contacts dietitian for assistance with diet teaching.

✓ Answers questions and offers suggestions for ways to reduce dietary fat intake.

✓ Instructs in possible adverse reactions and signs and symptoms to report to primary health care provider.

✓ Reviews measures to minimize gastrointestinal upset.

✓ Explains possible need for vitamin A and D therapy and high-fiber foods if patient is receiving bile acid sequestrant.

✓ Reassures that results of therapy will be monitored by periodic laboratory and diagnostic tests and follow-up with primary health care provider.

nurse refers the patient or family member to a teaching dietitian, a dietary teaching session, or a lecture provided by a hospital or community agency (see Patient and Family Teaching Checklist: Using Diet and Drugs to Control High Blood Cholesterol Levels). The nurse develops a teaching plan to include the following information:

BILE ACID SEQUESTRANTS

• Take the drug before meals unless the primary health care provider directs otherwise.

Cholestyramine powder: The prescribed dose must be mixed in 4 to 6 fluid ounces of water or noncar-bonated beverage and shaken vigorously. The powder can also be mixed with highly fluid soups or pulpy fruits (applesauce, crushed pineapple). The powder should not be ingested in the dry form. Other drugs are taken 1 hour before or 4 to 6 hours after cholestyramine. Cholestyramine is available combined with the artificial sweetener, aspartame (Questran Light), for patients with diabetes or those who are concerned with weight gain.

• Colestipol granules: The prescribed dose must be mixed in liquids, soup, cereals, carbonated beverages, or pulpy fruits. The granules will not dissolve. Therefore, when mixing with a liquid, slowly stir the preparation until ready to drink. Take the entire drug, rinse the glass with a small amount of water, and drink.

• Colesevelam: Mix the granules in liquids, soups, cereals, or pulpy fruits. Do not take dry. Mix the prescribed amount in a glassful of liquid. Carbonated beverages should be stirred slowly in a large glass. The tablets are taken twice daily without regard to meals.

Constipation, flatulence, nausea, and heartburn may occur and may disappear with continued therapy. The primary health care provider is notified if these effects become bothersome or if unusual bleeding occurs.

HMG-CoA INHIBITORS

• Lovastatin is taken once daily, preferably with the evening meal. Fluvastatin, pravastatin, and simva-statin are taken, without regard to meals, once daily in the evening or at bedtime.

• If fluvastatin or pravastatin is prescribed with a bile acid sequestrant, take fluvastatin 2 hours after the bile acid sequestrant and pravastatin at least 4 hours afterward.

• Contact the primary health care provider as soon as possible if nausea; vomiting; muscle pain, tenderness, or weakness; fever; upper respiratory infection; rash; itching; or extreme fatigue occurs.

FIBRIC ACID DERIVATIVES

• Clofibrate: If gastrointestinal upset occurs, take the drug with food. Notify the primary health care provider if chest pain, shortness of breath, palpitations, nausea, vomiting, fever, chills, or sore throat occurs.

• Gemfibrozil: Dizziness or blurred vision may occur. Observe caution when driving or performing hazardous tasks. Notify the primary health care provider if epigastric pain, diarrhea, nausea, or vomiting occurs.

MISCELLANEOUS PREPARATION

• Nicotinic acid: Take this drug with meals. This drug may cause mild to severe facial flushing, feeling of warmth, severe itching, or headache. These symptoms usually subside with continued therapy, but contact the primary health care provider as soon as possible if symptoms are severe. The primary health care provider may prescribe aspirin (325 mg) to be taken about 30 minutes before nicotinic acid to decrease the flushing reaction. If dizziness occurs, avoid sudden changes in posture.

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