Instructed on some signs/symptoms of Congestive Heart Failure (CHF), such as: increased fatigue and shortness of breath, among others.

Instructed on some factors that may increase the risk of developing/exacerbating Osteoporosis, such as: high intake of caffeine and certain medications, among others.

SN teaching about Gastroesophageal reflux disease ( GERD ). Examples of things to reduce or steer clear of in your diet include: high fat foods, caffeine products, chocolate, onions, peppermint, carbonated beverages, citrus and tomato products. Do not lie down immediately after eating, avoid late evening snacks, avoid tight clothing and bending over after eating. Elevate the head of the bed six to eight inches to prevent reflux when sleeping. Extra pillows, by themselves, are not very helpful.

Make sure the skin remains clean and dry. Examine the skin daily. Inspect pressure areas gently. Make sure the bed linens remain dry and free of wrinkles. Pat the skin dry, do not rub

SN instructed patient about Tramadol. SN instructed that it is an opiate pain medication used to treat moderate to moderately severe pain. SN Taught that the most common adverse effects of tramadol include nausea, dizziness, dry mouth, indigestion, abdominal pain, vertigo, vomiting, constipation, drowsiness and headache. SN Instructed patient to take pain medication before pain becomes severe to achieve better pain control.

Instructed patient about how when suffering from osteoarthritis the weight-bearing larger joints, including those of the hips, knees, neck and lower spine are the most commonly affected. The small finger joints can be involved too.

SN instructed patient / caregiver regarding medication Digoxin. Explained that Digoxin helps make the heart beat stronger and with a more regular rhythm to treat A - fib. Explained that the side effects may include mild nausea, vomiting, diarrhea and headache. SN instructed patient / caregiver to avoid becoming overheated or dehydrated during exercise, in hot weather or by not drinking enough fluids, because Digoxin overdose can occur more easily if dehydrated, and to call 911 if overdose is suspected. Explained that the overdose symptoms may include severe nausea, severe vomiting or diarrhea, loss of appetite, blurred vision, seeing halos around lights or objects, severe skin rash, fast / slow or uneven heartbeats, and feeling like passing out. SN instructed patient / caregiver to notify physician ( MD ) if experiencing persistent side effects or adverse effects.

Sn instructed patient on managing hyperlipidemia means controlling cholesterol and triglycerides. Read food labels and choose foods with low cholesterol and saturated trans fat. For people who would benefit from lowering their cholesterol, the American Heart Association recommends aiming for a dietary pattern that limits saturated fat to 5 to 6 percent of daily calories and reduces the percent of calories from trans fat.

Instructed patient to immediately report to MD when having suicidal thoughts.

Instructed in new medication Glucovance to improve glycemic control in patients with type-two diabetes whose hyperglycemia cannot be controlled with diet and exercise alone. In addition, warned of possible S/E such as headache, dizziness, diarrhea, nausea, vomiting, abdominal pain, hypoglycemia, lactic acidosis, or upper respiratory tract infection. Instructed to take one daily with breakfast and, if twice daily, then at breakfast and dinner. Stop drug and tell prescriber of unexplained hyperventilation, myalgia, malaise, unusual somnolence, or other symptoms of early lactic acidosis. GI symptoms are common with initial drug therapy but GI symptoms that occur after prolonged therapy may be related to lactic acidosis or other serious disease and should be reported promptly. Instructed not to take any other drugs, including OTC drugs, without checking with prescriber.