Chinese Woman Scenario

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An 88-year-old Chinese-speaking woman is admitted for complaints of dizziness and s/p a syncopal episode while attending a local senior center program. She was brought to the emergency department. She lives with her son and his family in a two-family home, which she owns. She is independent in all activities of daily living (ADLs) and participates in a daily tai chi exercise group with her friends at the local park. She did not want to go to the emergency department, but instead wanted to go home and have some “herbal medicines.”

A medical workup reveals that she has aortic stenosis, atrial fibrillation, and hypertension. She is started on an antihypertensive, coumadin, and aspirin and discharged home with her family.

One week later she is readmitted to the hospital with rectal bleeding and bleeding from her gums. She denies taking excessive amounts of coumadin or aspirin. When you ask her son to bring in her medications, only prescribed medications are present, and he reassures you that she is taking the medications according to the physician’s orders. She reports that she has not altered her routine at all; she practices tai chi every morning and eats lots of fruits and vegetables. A colonoscopy reveals a polyp, which is removed, and she is transfused with 2 units of packed red blood cells. She is discharged home with her family 2 days later, and home health care is ordered. The home health care nurse visits her 1 day after discharge.

A Chinese-speaking nurse visits her and learns that she is taking all of her prescribed medications as ordered. However, she is taking a supplement of a Chinese herb (gingko biloba) in tablet form twice per day to maintain her memory, and she is also consuming an oriental herbal tea (containing Chinese ginseng, ginger, and garlic) three to four times per day. She states, “I take my pills just like the doctor says, but it is this tea that is making me feel better. It is made of special herbs. It is better than all of those pills.” The nurse suggests that the woman stop taking the supplement and drinking the tea until she can find out what herbs it is made of, but she is reluctant to do so because she believes it is the secret to longevity.

  1. What actions should the home health nurse take?
  2. What information should the nurse include in the medication teaching plan for the patient?
  3. Based on the information in the above scenario, do you think that her regimen is causing her rectal bleeding and bleeding gums? Why? Specifically, what elements of her regimen may be contributing to the bleeding?
The key to this is how the herbs are effecting her

symptoms and how they interact with prescribed medications.

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