To ensure compliance with the treatment regimen, the patient must understand the importance of complying with the prescribed treatment regimen and taking the drug exactly as directed to obtain the best results from therapy. To meet this goal, the nurse develops an effective plan of patient and family teaching.
The points included in a patient and family teaching plan depend on the type and severity of the musculoskeletal disorder being treated. The nurse must carefully explain that treatment for the disorder includes drug therapy, as well as other medical management, such as diet, exercise, limitations or nonlimitations of activity, and periodic physical therapy treatments. The nurse emphasizes the importance of not taking any non-prescription drugs unless their use has been approved by the primary health care provider. The following points for specific drugs are included in the teaching plan. Information included for the patient taking a cor-ticosteroid is explained in Chapter 50.
• Toxic reactions are possible when taking gold compounds. Report adverse reactions to the primary health care provider as soon as possible.
• Contact the primary health care provider if a metallic taste is noted.
• Arthralgia (pain in the joints) may be noted for 1 or 2 days after the parenteral form is given.
• Chrysiasis may occur, especially on areas exposed to sunlight. Avoid exposure to sunlight or ultraviolet light.
DRUGS USED FOR GOUT
• Drink at least 10 glasses of water a day until the acute attack has subsided.
• Take this drug with food to minimize gastrointestinal upset.
• If drowsiness occurs, avoid driving or performing other hazardous tasks.
• Acute gout—Notify the primary health care provider if pain is not relieved in a few days.
• Colchicine for acute gout—Take this drug at the intervals prescribed by the primary health care provider and stop taking the drug when the pain is relieved or when diarrhea or vomiting occurs. If the pain is not relieved in about 12 hours, notify the primary health care provider.
• Allopurinol—Notify the primary health care provider if a skin rash occurs.
• Colchicine—Notify the primary health care provider if skin rash, sore throat, fever, unusual bleeding or bruising, unusual fatigue, or weakness occurs.
SKELETAL MUSCLE RELAXANTS
• This drug may cause drowsiness. Do not drive or perform other hazardous tasks if drowsiness occurs.
• This drug is for short-term use. Do not use the drug for longer than 2 to 3 weeks.
• Avoid alcohol or other depressants while taking this drug.
Alendronate and risedronate. These drugs are taken with 6 to 8 oz of water first thing in the morning. Do not lie down for at least 30 minutes after taking the drug and wait at least 30 minutes before taking any other food or drink. The drugs are taken exactly as prescribed. The primary care provider may prescribe alendronate as a once weekly dose or to be taken daily. Risedronate is taken daily. Take supplemental calcium and vitamin D if dietary intake is inadequate. Take all medication, including vitamin and mineral supplements, at a different time of the day to prevent interference with absorption of the drug.
Penicillamine. The primary health care provider will explain the treatment regimen and adverse reactions before therapy is started. You must know which toxic reactions require contacting the primary health care provider immediately. Take penicillamine on an empty stomach, 1 hour before or 2 hours after a meal. If other drugs are prescribed, penicillamine is taken 1 hour apart from any other drug. Observe skin areas over the elbows, shoulders, and buttocks for evidence of bruising, bleeding, or break in the skin (delayed wound healing may occur). If these occur, do not self-treat the problem, but notify the primary health care provider immediately. An alteration in taste perception may occur. Taste perception should return to normal within 2 to 3 months.
Methotrexate. Take MTX exactly as directed. If a weekly dose is prescribed, use a calendar or some other method to take the drug on the same day each week. Never increase the prescribed dose of this drug. Mistaken daily use has led to fatal toxicity. Notify the primary health care provider immediately if any of the following occur: sore mouth, sores in the mouth, diarrhea, fever, sore throat, easy bruising, rash, itching, or nausea and vomiting. Women of childbearing age should use an effective contraceptive during therapy with MTX and for 8 weeks after therapy.
Hydroxychloroquine. Take hydroxychloroquine with food or milk. Contact the primary health care provider immediately if any of the following occur: hearing or visual changes, skin rash or severe itching, hair loss, change in the color of the hair (bleaching), changes in the color of the skin, easy bruising or bleeding, fever, sore throat, muscle weakness, or mood changes. It may be several weeks before symptoms are relieved.
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