February 8, 2023

Hi my name is christine briggs and i will be the student nurse for today i’m going to be teaching my patient about how to take their own blood pressure and how to take their own pulse and how basically how to just take their new medication safely and their new medication is metoprolol so the patient came into the hospital having chest pain this was a missed

Opportunity patient teaching for me and so the patient came into the hospital having chest pain and the patient was confirmed by blood work that he was having an mi so a cabbage was done to treat the still blocked arteries and four days post-op is when is the day i had him during care and he developed hypertension so he was put on a new medication to treat the

Hypertension which was metoprolol and that’s what i’m going to be doing this p patient teaching on today so when the type of environment you want to set up for this patient is so he had glasses so you want to make sure his glasses are on so he can be able to read and he can see you better um he doesn’t have hearing aids so that’s not a barrier of communication a

Patient can only read at eighth grade level so it needs to be more direct and simple in teaching make sure the tv is off and have patience wife at the bedside while doing the teaching so she can learn as well in order to be able to help him at home um provide privacy while doing the teaching so like shutting the door having the door closed so there’s no distractions

Like outside noises um this during my day of care my patient didn’t have a roommate so if they did have a roommate and it was a noisy roommate then kind of like provide privacy like either could find another room possibly to teach them in or you know close the curtain or you know something like that and you want to have the patient’s phone turned off because if

You don’t like if they get the notification he might want to you know look at his phone so make sure that’s off um the patient’s preferred language is english so you want to make sure you’re teaching your patient in the language they prefer and you want to assess his pain level because if the patient’s in pain he may not want to like he might not take in as much

Information as he could if he wasn’t in pain and you want to sit at eye level so this is like a picture of what a level you could look a level you could look at like sitting like you want to sit eye level and you’re not like standing over them and stuff like that okay so the types of required materials that you would want to have in order to teach this patient

About the medication is you want to make sure you have a watch with a seconds hand because that will help with taking the pulse because i’m going to be teaching the patient how to do his own pulse and then you want to have a stethoscope and a blood pressure cuff and you want to see if the patient has access or can afford a medication box like this because it will

Help a lot better with keeping track of when he has taken the medication so he knows when he took it and what next time when he needs to take it so so i’ll backtrack so the first thing that i will be teaching him is about taking your pulse so this is something i would have given the patient that day to take home with like a required material so you want to make

Sure you help the patient find his own pulse so you want to feel the wrist you could do radial you could do apical but in this case metoprol you want to do an apical pulse so that’s a little bit easier when you have a stethoscope so you would listen to the heart listen for the blub dub and you would count the heartbeat for 30 seconds so when you so you have the

Watch in front of you and then you will count 30 seconds well you’ll watch the clock for 30 seconds you’ll be counting your heartbeat and once you get that number and the 30 seconds is up so say he counted 30 beats per minute on his heart rate so then you would multiply that by two so 30 multiplied by 2 is 60. so 60 would be his overall heart rate in one minute

And with metoprolol you want to make sure his you want to make sure your pulse rate is over 60 beats per minute and if it isn’t you would withhold the medication because the metoprol lowers blood pressure so if you have to at least make sure your blood your pulse is over 60 beats per minute so you would mis he would he would withhold the medication and call

His doctor and then with the blood pressure so i would also provide him with this printout for how to do his blood pressure it’s like a simple little thing of showing like where his blood pressure is normal and what numbers it would be to have to um if it shows him if it’s elevated and if it’s high so metoprolol you you don’t want to give this medication when

The blood pressure is lo the systolic or diastolic or yeah the systolic when the it’s under 90 so it’s this diastolic so if the diastolic is under 90 then you want to withhold this medication because it it decreases your blood pressure and if your blood pressure is already under 90 then it could cause hypotension so you would want to teach him that you would want

To withhold this medication so i would also teach him how to do the blood pressure so you would want to wrap this around your arm so the artery line there’s an artery line on the cuff and you also want to make sure he can afford this these materials because some patients can’t afford them and if he can’t afford them then he you could refer him to case management

And they could help him with that and maybe insurance could cover it too so that he could work that out so he’d be able to get one of these so he would wrap it so he would line up the artery line on the arm at the right spot where you feel the brachial pulse and then he would turn the knob tight and then you would pump up and when you pump up you would watch

This dial and you want to listen as you pump up the and as you listen you’ll be hearing the heart beat as it pumps so when you pump higher you want to pump hot where the last beat you hear while you’re pumping it up you want to pump it at least 10 to 20 uh merc millimeters of mercury higher than what the last one you heard and then you’ll see he would teach

Him to slowly turn this backwards so turn it backwards to deflate the cuff so then when he listens the first beat you hear is the top number and then he’ll keep hearing the beat go lowering as the dial goes down and keep and he has to keep track of where the dot the line is at and the last one that he hears is the bottom number so if it stops so say he hears

A heartbeat pumping up to 120 so he would pump up the cuff to about 140 and then you turn the knob and listen so then the first b heat the first beat that he hears is at 120. so the top number would be 120. and then it keeps beating and then so you keep watching it until you hear the last beat and whatever the last beat is that it’s on is the bottom number so

Say it’s 80 so it’d be 120 over 80 is the blood pressure so that’s something you would want to teach him also um you want to teach him what is considered to be high and what is considered to be a low blood pressure so that’s what this helps with this little chart that i just showed you um and also with the medication it is helpful to have one of these boxes

Because um so say he’s taking metoprolol every eight hours so then every eight hours is three times a day so he can get a pill organizer where it’ll say like so like one takes at one time and then eight hours later the next time is in the next box in the same day and then he knows to take one so then he knows when he has taken one and if he missed one and if

Like if he missed one then he’d know that he wouldn’t he missed one because that’s he missed he saw it in the pill organizer that he missed it so it’s really helpful to have one of those kind of medication boxes but if he doesn’t have one and he has enough doesn’t have say he doesn’t have enough money for one you could also get like an egg carton it’s like a

Creative kind of way you can take an egg carton and like separate them out and in that order or in that way i mean and another thing you would want to teach this patient is when to call the doctor so like when they’re si when he has any signs and symptoms of excessive fatigue or dizziness appear if he’s going to be taking any over the counters he should contact

His doctor before doing that because it could affect the metoprolol that one that he’s taking also um you want to make sure you teach him not to double dose if there is a missed dose because double dosing would just decrease your blood pressure even more and he could develop hypotension which is not a good thing and activities you want to avoid until response is

To the medication is established so like maybe driving you want to make sure he doesn’t drive for a whole day what to let his body get used to taking the metoprolol so he knows what effect the pill has on his body and you also want to teach him to keep a log book so like take a piece of paper and you write like write a little table out so he could write the date

And then he can write his pulse in and write his blood pressure and every single day every time he like every time before he takes the motopr law he can write it down and then he could give it to his doctor when he goes for a follow-up on the metoprolol and you want to have this patient teach back the information that you presented so i would have him show me

How to take his own pulse and have him show me how to do his blood pressure like have him demonstrate it back to me so i know that he knows how to do it himself so i don’t just send him home and he didn’t know and he didn’t ask a question so i want to make sure that he knows how to take his blood pressure and i want to make sure he knows how to take his own pulse

And and if the wife is also there it would be a good idea to probably teach her how to do this as well so then he could help him at home like she could possibly do his blood pressure sometimes or you know she could take the pulse so it’s a good it’s just a good thing to have his wife in there just so she knows about the teaching as well and then she could help him

Do the blood pressure and do the pulse so you could have the wife even demonstrate it back to you so she understands it as well um so observation of the patient demonstrating the learned materials back so that’s why i just said and if the patient has any problems or questions he can call his doctor about it to ask so at the end of the teaching session patient and his

Wife should have a good understanding of how to take blood pressure and pulse before taking metoprolol how to organize metoprol for times it should be taken if whether it’s being taken every six hours or every eight hours just make sure he knows how to organize it in the right medication spot like boxes if he has a medication box or in the egg carton if he doesn’t

Have a medication box and when to call the doctor and most importantly how to safely take metoprolol and after my teaching i would make sure have them teach it back to me to make sure that they they understand the material that was taught and then i would have the bed and lowe’s position call bell and reach you know personal items in reach and then i would go document and that’s it

Transcribed from video
Metoprolol patient teaching project By Christine Briggs