HTN

PATIENT COUNSELLING
Based on Disease Profile –
1. Educate the patient about the disease severity, the importance of adherence to therapy,
and the consequences of uncontrolled hypertension.
2. The patient needs to be informed about what they are, what actions to take to relieve
minor side effects, and what to do about intolerable or dangerous side effects.
Based on Drug Profile –
1. Diuretics: Monitor for muscle weakness, confusion, dizziness.
2. Diuretics should be taking with food or milk to prevent GI upset and the dosage
should not interrupt sleep due to urination.
3. Beta Blockers: Monitor for hypotension, dizziness, headache, and bradycardia.
Explain the need for dose tapering before stopping the drug.
4. ACE Inhibitors: Advise to take them 1 hour before meals and monitor for
hypotension, dizziness, cough, taste disturbances and rash.
5. Calcium Channel Blockers: Monitor for swollen gums, chest pain, swollen joints
(with nifedipine), constipation, dizziness, and light-headedness.
6. Alpha Blockers: Monitor for hypotension.
Based on Lifestyle Modification –
1. Maintain a healthy body weight
2. Engage in Regular Aerobic Physical Activity such as Brisk Walking at least 30
minutes per day, 5-7 days a week.
3. Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced
content of saturated fat.
4. Restrict Dietary Sodium Intake (2.4 gm sodium or 6 gm sodium chloride).
5. Smoking Cessation and Alcohol Abstinence.
 CONGESTIVE HEART FAILURE

PATIENT COUNSELLING
Based on Disease Profile –
1. Providing information regarding the severity of the disease.
2. Counsel the patient of what to do in the case of Emergency.
3. Educate the patient regarding possibility of nocturnal dreams, CNS problems,
hypotension, dizziness, headache, and bradycardia.
Based on Drug Profile –
1. Advised to take ACE inhibitors 1 hour before meals.
2. Diuretics should be taking with food or milk to prevent GI upset and the dosage should
not interrupt sleep due to urination.
3. Digoxin should not be discontinued during therapy
4. Avoid over the counter drugs(Antacids, cold, allergy products & diet drugs)
5. Explain the need for dose tapering before stopping the drug.
Based on Lifestyle Modification –
1. Maintain a healthy body weight.
2. Regular physical activity (e.g. brisk walking) at least 30 minutes per day.
3. Restrict Dietary Sodium Intake and adopt a diet rich in fruits and vegetables.
4. Smoking Cessation and Alcohol Abstinence.
 ISCHEMIC HEART DISEASE

PATIENT COUNSELLING
Based on Disease Profile –
1. Patients should be encouraged if they experience chest pain that is more than an
angina, to call for an Ambulance.
2. Patients also need up-to-date advice when faced with difficult choices regarding
medical treatment, angiographic procedures or surgery.
Based on Drug Profile –
1. Statins: Educate the patient to take these drugs after food. It is advisable to take these
medications during night (except for atorvastatin). Ask the patient to report to the
doctor if any signs of muscle pain appear and not to worry in the case of urine
discoloration.
2. Nitrates: Sublingual administration, sublingual tablets should not be chewed or
crushed, use of transdermal patches, do not stand up immediately while using this
medication.Monitor for bluish colored lips, fingernails or palms.
3. Fibrates: Take with or immediately after food to lessen stomach upset. Monitor for
blood in urine, chest pain, and shortness of breath, stomach pain.
4. Anion Exchange Resins: This medicine should never be taken in dry form. Mix the
medicine with beverage or drinks.
5. Nicotinic Acid Derivatives: Do not crush, break or chew the extended release
medication. Monitor for darkening of urine, loss of appetite, severe stomach pain, and
yellow eyes.
Based on Lifestyle Modification –
1. Regular physical activity (e.g., brisk walking) at least 30 minutes per day, 5-7 days a
week.
2. Eliminate Trans Fat Food like fried, oily food or baked food.
3. Restricted Dietary Sodium Intake.
4. Smoking Cessation and Alcohol Abstinence.
 MYCOCARDIAL INFRACTION
PATIENT COUNSELLING
Based on Disease Profile –
1. Patients should be encouraged if they experience chest pain that is more than an
angina, to call for an Ambulance.
2. Patients also need up-to-date advice when faced with difficult choices regarding
medical treatment, angiographic procedures or surgery.
Based on Drug Profile –
1. Nitrates: Sublingual administration, sublingual tablets should not be chewed or
crushed, use of transdermal patches, do not stand up immediately while using this
medication.Monitor for bluish colored lips, fingernails or palms.
2. Statins: Educate the patient to take these drugs after food. It is advisable to take these
medications during night (except for atorvastatin). Ask the patient to report to the
doctor if any signs of muscle pain appear and not to worry in the case of urine
discoloration.
3. Anticoagulant Therapy: Stop all sports and dangerous activities, soft –bristled
toothbrushes should be used, and electric razors can replace razors blades. Proper
monitoring of INR should be done, and if beyond 2.5- 3.5 inform to the physician.
4. Fibrates: Take with or immediately after food to lessen stomach upset. Monitor for
blood in urine, chest pain, and shortness of breath, stomach pain.
5. Beta Blockers: Monitor for hypotension, dizziness, headache, and bradycardia.
Explain the need for dose tapering before stopping the drug.
Based on Lifestyle Modification –
1. Regular physical activity (e.g., brisk walking) at least 30 minutes per day, 5-7 days a
week.
2. Eliminate Trans Fat Food like fried, oily food or baked food.
3. Cocaine, Amphetamine use, and excessive caffeine intake should all be avoided.
4. Regularly monitor Blood Pressure, and Hematological Parameters.
5. Restricted Dietary Sodium Intake.
6. Smoking Cessation and Alcohol Abstinence.
 ASTHMA

PATIENT COUNSELLING
Based on Disease Profile –
1. Providing information regarding the site and severity of the disease based on
Pulmonary Function Test results.

2. The patient should be able to monitor symptoms, peak flow measurements, drug
usuage and knowing how to deal with fluctuations in severity of asthma.

3. Counselling should lead to increase patient confidence in the ability to self manage to
asthma, decrease hospital admission rates.

Based on Drug Profile –

1. Provide information regarding the action of each of the medicines they use.

2. The appropriate choice of inhalation devices should be made and the patient should be
educated to use them correctly.

3. An individualized self management plan should be developed for each patient.

4. Specific counselling on drugs used to relieve symptoms, drugs used to prevent the
asthma attacks and drugs which are given only as a reserve treatment for severe
attacks.

5. A self-management plan would also include details of when to increase the dose of
inhaled steroid, when to take oral corticosteroids and when to use a nebulizer.

Inhalation Technique Counselling for Dry Powder Inhalers (DPI):

1. Hold inhaler upright or level.

2. Take a rotacap capsule from its container. Insert the rotacap transparent end first, into
the raised square hole of the rotahaler.

3. Load inhaler with one dose. Press the rotacap firmly such that the top end of rota cap
is level within the top of the hole.

4. Holding the mouth piece firmly with one hand, rotate the base. Exhale gently as
much as comfortable.
 5. Place mouthpiece in mouth and close lips around it. Inhale slowly, forcefully and
deeply through inhaler and releases a dose.

6. Removes inhaler and hold breathe for at least for 5sec then breathe out slowly, if a
second dose is prescribed, wait for 1min before repeating the above steps, rinse
mouth and replace dust cap.

Inhalation Technique Counselling for Metered Dose Inhalers (MDI):

1. Remove dust cap, shake inhaler well and hold inhaler upright or level.

2. Load inhaler with one dose, exhale gently as much as comfortable, place mouthpiece
in mouth and close lips around it.

3. Inhale slowly, forcefully and deeply through inhaler and release a dose.

4. Remove inhaler and hold breathe for at least for 5sec then breathe out slowly, if a
second dose is prescribed, wait for 1min before repeating the above steps.

5. Rinse, gargle the mouth and replace the cap.

Based on Lifestyle Modification –

1. Avoid environment that may be a reason for the Asthma attack and use protectants
according to the nature like Umbrella, Rain Coat, Sweater, Cap etc.

2. Take food at proper timings and must be rich in protein.

3. Perform exercises like walking and yoga.

4. Avoid any kind of Emotional Stress, Mental Tension, Anxiety or Excitement which
may trigger Asthma attacks.

5. Explain the importance of Smoking Cessation and technique for it.

6. Sleep only 2 hrs after any meal.

 7. Monitor PFT bi- annually and visit the doctor on exact review dates.

COPD
PATIENT COUNSELLING
Based on Disease Profile –
1. Explain the patient about the site, severity and progressiveness of the disease.
2. Inform about the emergency management in the case of Exacerbation.
Based on Drug Profile –
1. Use of Inhaled Therapy: The incorrect use of any inhaler will lead sub therapeutic
dosing.
2. Home Nebulizer Therapy: Patients are prescribed nebulizer therapy for use at home
should be counselled appropriately.
3. Domiciliary Oxygen Therapy: Portable oxygen cylinders can be used to increase
exercise tolerance during walking.
Based on Lifestyle Modification –
1. Pulmonary Rehabilitation: Advice and support on stopping smoking, nutritional
assessment aerobic exercise training to increase capacity and endurance for exercise,
breathing retraining.
2. Smoking Cessation: Members of the health care team can educate smokers about the
dangers and actively encourage and motivate those who want to give up.

3. Take food at proper timings and must be rich in protein.

4. Perform exercises like walking and yoga.

5. Avoid any kind of Emotional Stress, Mental Tension, Anxiety or Excitement which
may trigger Asthma attacks.

6. Sleep only 2 hrs after any meal.

Monitor PFT bi- annually and visit the doctor on exact review dates.
 DIABETES MELLITUS
PATIENT COUNSELLING
Based on Disease Profile -
1. The severity of the lifelong disease, its progression and complications like
Neuropathy, Nephropathy and Retinopathy.
2. The signs and symptoms of the disease.
3. Futher complications which includes Ketoacidosis and other Infections.
4. Hyperglycemia and Hypoglycemia - Signs and Symptoms and Treatment.

Based on Drug Profile –

POSSIBLE
ADMINISTRATION DOSING
DRUGS SIDE COMMENTS
TIME SCHEDULE
EFFECTS
Interacts with
Taken with meals or
Usually taken Hypoglycemia, Oral
Glibenclamide 15- 30 mins before
in 1 – 2 doses Obesity Anticoagulant
food
Action
Interacts with
Usually taken Oral
Glimiperide Taken with meals Hypoglycemia
in single dose Anticoagulant
Action
Interacts with
Usually taken Oral
Glicazide Taken with meals Hypoglycemia
in 1 – 2 doses Anticoagulant
Action
Interacts with
Usually taken Oral
Glipizide Taken with meals Hypoglycemia
in 1 – 2 doses Anticoagulant
Action
Should be
stopped before
Taken during or
Surgery or any
immediately after a Usually taken GI
Metformin Radiological
meal to minimize GI in 1 – 3 doses Disturbances
Procedures
effects
using Contrast
Media
Acarbose Swallow whole with Usually taken GI Should be
liquid before meal or in 1 – 3 doses Disturbances stopped before
chew with first Surgery or any
mouthfuls of meal Radiological
Procedures
 using Contrast
Media
Usually taken
Repaglinide Taken with meals Hypoglycemia _
3 times a day
Usually taken
Pioglitazone Taken with meals Hypoglycemia _
in single dose

INSULIN:
STEPS COUNSELLING TIPS
 Draw air into the Insulin syringe corresponding to the
amount to be taken and inject into vial.
Drawing of Insulin  Rotate the vial in the palm.
from the Vial  Invert the vial, draw up Insulin vertically from eye
level, inject excess Insulin back into the vial and pull
out the needle.
 Best sites for self injection are front and outer thighs
Site of self Injection
and abdomen.
 Clean injection site with spirit, insert the needle at 45
Technique of Injections degrees angle into subcutaneous tissue.
 Inject Insulin slowly.
 Insulin preparations should be taken 30 mins. Before
Time of Administration
food.
 Insulin should be stored at 2- 80C.
 If there is no refrigerator then place Insulin in a glass
Storage of Insulin of water.
 It is also adviced to carry Thermostat Bags which
retains the stability of the preparations.
 Patient should be monitored for Allergic Reactions
ADR (Bovine or Porcine preparation).
 Hypoglycemia.
 Insulin Pen has several advantages (easy to carry, less
Specialized Devices in pain, and accurate dose administration).
Administering Insulin  Suitable patients should be isolated and adviced by the
pharmacist.
Based on Lifestyle Modifications -
1. Exercise – benefits and effect on blood glucose control.
2. Dietary control is the mainstay of treatment in type 2 diabetes and an integral part in
type-1 diabetes.
3. Diabetes patient should limit their sugar intake.
4. Since there is an increased risk of death from coronary artery disease in diabetics, it is
wise to restrict saturated fats and to substitute them with unsaturated fats.
5. Dietary fibre has two useful properties. Firstly it is physically bulky and increases
satiety. Secondly, fiber delays the digestion and absorption of complex carbohydrates,
thereby minimizing hyperglycemia.
6. Home Blood Glucose Testing – Technique and Interpretation.
7. Foot Care.

8. Cardiovascular risk factors – Smoking, Hypertension, Obesity and Hyperlipidemia.

9. Regular Medical and Ophthalmologic Examinations.
 OSTEOPOROSIS
PATIENT COUNSELLING
Based on Disease Profile -
1. Inform patient about the severity and complication of the disease.
2. Educate the patient that as age increases the Disease gets worsened.
Based on Drug Profile -
1. Take the recommended amount of Calcium and Vitamin D every day.
2. Sedatives should be discontinued or switched to short acting agents.
3. Diuretics should be given during day.
4. Orthostatic Blood Pressure problems should be resolved.
Based on Lifestyle Modification -
1. Perform Weight Bearing Exercises like Brisk Walking, Jogging, Dancing and Aerobic
Exercises on regular basis.
2. Smoking Cessation and Alcohol Abstinence.
3. Avoid Caffeinated Beverages which increases Calcium excretion.
4. Counsel the patient to monitor a Bone Mineral Density (BMD) if patient is above 65
years, on Long Term Steroid Treatment and who have gone through menopause and
have experienced a fracture.
5. Dietary Calcium Intake and Vitamin D must be increased.
 TUBERCULOSIS
PATIENT COUNSELLING
Based on Disease Profile –
1. Providing information regarding the severity of the disease.
2. Cover the mouth with separate Handkerchief while coughing or sneezing.
3. Inform the patient about isolation mainly from children and elderly people to avoid
easy spread of the disease.
Based on Drug Profile –
1. Teaching the patient about the importance of continuing the drugs even after
improving disease conditions.
2. Don’t miss any dose and strictly adhere to the drug regimen.
3. Teach the importance of Vitamin Supplementation to the patient.
4. Inform the patient about body fluids discoloration and Itching while taking these
drugs is nothing to worry about.

Based on Lifestyle Modification -

1. Diet should be rich in Raw Fruits and Vegetables
2. Avoid Caffeinated Beverages and Fried Food.
3. Alcohol Abstinence and Smoking Cessation.
4. Avoid Stress, Mental Tension and Anxiety.
5. Monitor Liver Function Tests while taking Anti- TB Drugs.
6. Perform Exercise.
 MENINGITIS
PATIENT COUNSELLING
Based on Disease Profile -
1. Begin Education during first Admission.
2. Provide Information to patient regarding the Severity and Complication of Disease.
3. Educate the patient about various symptoms of the Disease.
4. Teach Signs of Dehydration, Signs of inadequate PO Intake.
5. Notice any kind of Behavioral Changes and Seizure Activity.
6. Review who to contact for problems and reasons to call physician.
Based on Drug Profile -
1. Preventive Antibiotics are prescribed in people who are in close contact with the
patient.
2. Oral Fluids are always the preferred source of Hydration.
3. Use medicine to treat fever and headache.
Based on Lifestyle Modification -
1. Educate Families about Personnel Hygiene and Good Hand Washing.
2. If patient has Nausea and Vomiting start with Clear Liquid Diet and advance as
Tolerated to Regular Diet for Age.
3. Discourage sharing of Drinking and Eating Utensils.
4. Offer Plenty of Fluids.
 URINARY TRACT INFECTIONS

PATIENT COUNSELLING
Based on Disease Profile -
1. Provide Information to the Patient Regarding the cause and Severity of the Disease.
2. Patient should be informed to review the Physician if symptoms still persist.
3. Inform the patient about the various symptoms to report if the Infection Flares up.
Based on Drug Profile –
1. The patient should take full course of antibiotic even if he or she feels better.
2. Inform patient to take drugs only for the prescribed time period.
3. Inform patient to avoid any OTC Drugs.
Based on Lifestyle Modification -
1. Various behavioral factors, such as voiding after intercourse, direction of toilet paper
use after bowel movements, type of menstrual protection used, and method of
contraception, have all been investigated to asses their impact on the frequency of
UTI.
2. Maintain Personnel Hygiene; use Water to clean the infected area and not soap.
3. Women with a recurrent UTI should be encouraged to use a method of birth control.
4. Urination every 2 hours, taking the time to empty the bladder completely, also helps
to prevent UTI.
5. Foods that irritate the bladder include tea coffee, alcohol, cola, chocolate, and spicy
foods should be avoided.
6. Encourage the patient to Drink Extra Fluids to help clear the infection.
7. Educate the patient how to collect Midstream Urine for Routine Urine Check Up.
 RHEUMATIOD ARTHRITIS

PATIENT COUNSELLING
Based on Disease Profile -
1. Inform the Patient about the Severity and Complications of the Disease.
2. Advice the patient to inform about the medications they are taking and the presence of
any Renal Problem.

Based on Drug Profile –

1. NSAID preparation should be taken with or after food and patients should be warned
of potential adverse effects and what to do if these occur.
2. Patients must be warned not to supplement their prescribed NSAIDS with purchased
ibuprofen or aspirin and should be careful of consuming additional ‘Hidden’
paracetamol.
3. Alopecia is likely to occur but it is reversible and encourage adequate fluid intake to
prevent hemorrhagic cystitis and to facilitate uric acid excretion with
cyclophosphamide.
4. Encourage compliance with therapy and follow up visits.
5. Explain to the Patient about the possible Side- Effects of drugs and to report if they
occur.
Based on Lifestyle Modification -
1. Avoid foods containing Furocoumarin such as Carrots, Celery, Figs and Mustard.
2. Avoid Milk, Meat and Processed Foods which may exacerbate the Disease.
3. Diet must be Low in Fat, Saturated Fats and Cholesterol.
4. Protect Skin for 8 hours after oral administration due to Photoreaction.
5. Monitor Blood and Liver Function Tests regularly due to certain Medication Toxicity.
6. Swimming and other Motion Exercises are recommended.
 GOUT
PATIENT COUNSELLING
Based on Disease Profile –
1. Patient should be advised about factors that may contribute to hyperuricemia, such as
fasting, obesity and alcohol excess.
2. Advice the patient to inform about the medications they are taking and the presence of
any Renal Problem.

Based on Drug Profile –

1. Should avoid aspirin and instead use paracetamol for analgesia.
2. Patient receiving Allopurinol should continue single daily dose, warned of potential
side effects and told to report any adverse skin reactions.
3. Patients on Corticosteroids should be informed to report any Acidity Problems,
Delayed Healing, Bone or Muscle Problems, and Night Sweats.
Based on Lifestyle Modification –
1. Renal function test should be monitored frequently.
2. Patient taking Uricosuric Agents should be with Good Fluid Intake to reduce the risk
of Renal Calculus Formation.
3. A diet free of purine is advisable to keep uric acid levels within the normal range.
4. Reduce the foods like Caffeinated Beverages, Fats and Oils, Miscellaneous
(Cinnamon, Clove, Cardamom, Cumin seeds, Chilly, Pepper, All Spicy Foods, Sugar,
Vinegar, Custard, Popcorns, and Salt).
5. Diet includes foods like Cereals, Vegetables, Fruits, Low Fat Milk, and Egg.
6. Avoid Grapefruit and Grapefruit Juice as it decreases the activity of the Uricosuric
Agents.
 ACUTE RENAL FAILURE
PATIENT COUNSELLING
Based on Disease Profile -
1. Patient should be informed about the Severity and Complication of the Disease.
2. Educate patient about the Risk Factors which could worsen the disease like Diabetes
Mellitus, Hypertension, Family History, and Age- related risk.
3. Inform patient about the symptoms of the disease getting Worsened like High Blood
Pressure, Blood in Urine, and Pain in Lower Back at about the Waistline, Swelling
especially in the Arms, and Frequent Urination at Night, Nausea and Vomiting.
Based on Drug Profile -
1. Thiazide diuretic should be taken in the morning to prevent nocturia.
2. Drug should be taken with food to minimize gastric irritation.
3. Take Vitamins and Mineral Supplements which are recommended.
Based on Lifestyle Modification –
1. Maintain the Ideal Body Weight, weigh each day in the morning and inform the
dietitian in case of losing or gaining of too much body weight.
2. Add potassium-rich food in the Diet like Banana, Spinach and other Green Leafy
Vegetables.
3. Sun screens should be used to protect from sunlight.
4. Do not need to limit the amount of fluids in the earlier stages of kidney disease.

5. Take the right amount of the protein as instructed.

6. Reduce Dietary Sodium Intake.

 PSORIASIS

PATIENT COUNSELLING
Based on Disease Profile
1. Provide complete information to the patient regarding the severity of the disease.
2. Provide the patient with information booklets

Based on Drug Profile

1. Explain the patient about the importance of adhering to the Medication for better
treatment.
2. Inform patient to apply Moisturizer, Creams, and Ointments regularly.
3. Monitor Blood and Liver Function Tests regularly due to certain Medication Toxicity.

Based on Lifestyle Modification

1. Avoid any kind of Stress or Worries which triggers Psoriasis.
2. Wake up a little early in the morning drink 2 glasses of warm water then sit cross
legged on the floor and do deep breathing and meditate.
3. Closely monitor climatic changes and adjust accordingly especially in the travelling
and always try to limit Travelling.
4. Breathe Fresh Air and Sleep Well.
5. Educate patient about the possible Photo Therapies.