NUR 602 Module 8 Patient Education Example

One Morning a Week, Done Right: Teaching Alendronate to a 69-Year-Old Woman Who Also Takes Levothyroxine

[Student Name]

Southern New Hampshire University

NUR 602: Advanced Pharmacology Across the Life Span

Module Eight Patient Education

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

One Morning a Week, Done Right: Teaching Alendronate to a 69-Year-Old Woman Who Also Takes Levothyroxine

Alendronate is one of the best studied drugs in primary care, and one of the most often taken incorrectly or not at all. Fewer than half of the women in a large claims analysis took enough of their bisphosphonate to be considered adherent, and those who did had fewer fractures (Siris et al., 2006). Most failures are not refusals; they come from dosing rules that seem arbitrary and fears that are never addressed. This paper plans education for a woman starting weekly alendronate. It argues that teaching the reason behind each rule, fitting the rules into her existing routine and answering her fears with real numbers will do more for her bones than a longer list of instructions.

The Patient and Her Learning Needs

Mrs. Lan Tran is 69, a retired seamstress who lives with her daughter's family. She broke her left wrist falling on an icy step two years ago. A bone density scan now shows a femoral neck T-score of -2.7. She takes levothyroxine 75 mcg each morning at 6 a.m., waits for breakfast as she was taught and takes a calcium tablet with dinner. Her creatinine clearance is 62 mL/min, her 25-hydroxyvitamin D level is 34 ng/mL and she had a dental checkup last month. She speaks Vietnamese at home and reads English at a basic level, so teaching will use a professional medical interpreter rather than her daughter. She told the nurse that a friend at her temple stopped a bone pill because she heard it could rot the jaw.

Why Treatment Is Worth the Effort

Mrs. Tran needs to know what the drug can do before she will follow its rules. In the Fracture Intervention Trial, among women who already had a vertebral fracture, 8.0% of those taking alendronate had a new vertebral fracture over three years, compared with 15.0% of those on placebo, and hip fractures were roughly halved (Black et al., 1996). For a woman with a prior fracture and osteoporosis, the Endocrine Society guideline recommends a bisphosphonate as initial therapy (Eastell et al., 2019). In plain words for her: taking this pill correctly once a week makes another broken bone about half as likely.

Teaching the Rules Through Their Reasons

Each rule becomes easier to follow once its purpose is clear. Alendronate is very poorly absorbed; less than 1% of an oral dose reaches the blood even under ideal conditions, and food, coffee, juice, mineral water or calcium can reduce that to almost nothing. That is why she must take it with a full glass of plain water on an empty stomach and let a full half hour pass before breakfast, a second drink of any kind or another tablet. The tablet can also irritate the esophagus if it lodges there, so she must swallow it whole with the full glass of water and stay upright, sitting or standing, for those 30 minutes.

Her levothyroxine is the practical problem, since it also needs an empty stomach. The simplest plan is to choose one day, Sunday, when she takes alendronate at 6 a.m. instead of her thyroid pill, stays upright and waits 30 minutes, then takes her levothyroxine and waits another 30 minutes before breakfast. If a full hour before breakfast is too long, she can move that day's levothyroxine to bedtime, provided dinner was three or more hours earlier. Her calcium stays with dinner. If she forgets her Sunday dose, she takes it Monday morning and returns to Sunday the following week, never two tablets in one day.

Answering Her Fears With Numbers

Her friend's warning deserves a direct answer. Osteonecrosis of the jaw is rare in people taking oral bisphosphonates for osteoporosis, with estimates in the range of about 1 in 10,000 to 1 in 100,000 patient-years, far lower than in people receiving high-dose intravenous treatment for cancer (Khan et al., 2015). Good dental care is the main protection, and her recent checkup is reassuring. Atypical thigh fractures are also rare. In a large cohort, the risk rose with years of use and was higher in Asian women, but in the first several years, the fractures prevented far outnumbered the atypical fractures caused (Black et al., 2020). Because of that finding, her need for continued therapy will be reviewed at five years, and she should report new aching in the thigh or groin at any time.

Teaching Method

The session will take 20 minutes with the interpreter present. The nurse practitioner will demonstrate with a real tablet and a full glass of water, then ask Mrs. Tran to explain in her own words when she will take the pill, what she will drink and how long she will wait, correcting and asking again until her answer is complete. Her daughter will be invited to hear the plan but not to interpret. The handout below will be given in Vietnamese and English, and a phone check will follow in two weeks, after her first two doses.

The Handout

The handout aims at a reader in the sixth grade, one idea to a line. Its text reads as follows.

Table 1. Handout Text: Your Bone Pill, Once a Week

Note. The Vietnamese version is translated by a certified medical translator and checked with the interpreter.

Evaluation

Teaching will be judged successful if, at the two-week call, Mrs. Tran can state her Sunday routine correctly, reports no heartburn or pain on swallowing and has taken both doses. Pharmacy refill records at three and six months will show whether she continues. Her thyroid-stimulating hormone level will be checked in six to eight weeks to confirm that the Sunday adjustment has not changed her thyroid control.

Conclusion

Alendronate works only when it is taken correctly and taken for years. For Mrs. Tran, that means a Sunday routine built around her thyroid pill, reasons she understands for each rule, an honest answer to the fear she heard at her temple and teaching in her own language.

References

Black, D. M., Cummings, S. R., Karpf, D. B., Cauley, J. A., Thompson, D. E., Nevitt, M. C., Bauer, D. C., Genant, H. K., Haskell, W. L., Marcus, R., Ott, S. M., Torner, J. C., Quandt, S. A., Reiss, T. F., & Ensrud, K. E. (1996). Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. The Lancet, 348(9041), 1535-1541. https://doi.org/10.1016/S0140-6736(96)07088-2

Black, D. M., Geiger, E. J., Eastell, R., Vittinghoff, E., Li, B. H., Ryan, D. S., Dell, R. M., & Adams, A. L. (2020). Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. New England Journal of Medicine, 383(8), 743-753. https://doi.org/10.1056/NEJMoa1916525

Eastell, R., Rosen, C. J., Black, D. M., Cheung, A. M., Murad, M. H., & Shoback, D. (2019). Pharmacological management of osteoporosis in postmenopausal women: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 104(5), 1595-1622. https://doi.org/10.1210/jc.2019-00221

Khan, A. A., Morrison, A., Hanley, D. A., Felsenberg, D., McCauley, L. K., O'Ryan, F., Reid, I. R., Ruggiero, S. L., Taguchi, A., Tetradis, S., Watts, N. B., Brandi, M. L., Peters, E., Guise, T., Eastell, R., Cheung, A. M., Morin, S. N., Masri, B., Cooper, C., . . . Compston, J. (2015). Diagnosis and management of osteonecrosis of the jaw: A systematic review and international consensus. Journal of Bone and Mineral Research, 30(1), 3-23. https://doi.org/10.1002/jbmr.2405

Siris, E. S., Harris, S. T., Rosen, C. J., Barr, C. E., Arvesen, J. N., Abbott, T. A., & Silverman, S. (2006). Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: Relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clinic Proceedings, 81(8), 1013-1022. https://doi.org/10.4065/81.8.1013