With the scenario given, the nurse's considerations or actions regarding the client’s refusal to restart his blood pressure medication would be to elicit the patient’s perspective. First, the nurse must ask why the client is refusing the medication. The nurse must take the patient seriously and thoroughly listen to the client’s perspective (Arnold, 2020). After finding out why they are refusing, the nurse must take action by providing the client with information about the medication he is taking, which is hydrochlorothiazide and metoprolol. The information they must include would be the proper use and the potential risks, complications, and benefits. After explaining this information, the nurse must consider any concerns the client might have. For example, after the client had taken hydrochlorothiazide, he began to have shortness of breath and chest pain, and after he had taken metoprolol, he had suffered a fall. These are considerable concerns for the client that must be addressed. Addressing their concerns, it will make the client feel heard and appreciated, leading to trust. If all of these actions and considerations are taken, and the client still refuses, the nurse must consider the principle of autonomy and document all the information given and that the client refused (Arnold, 2020). 

           To prevent the client’s fall, the health care team should have considered the client’s medications and past medical history. With the client already being on hydrochlorothiazide, the healthcare team should have looked at this before prescribing him the second medication of metoprolol. Although together they do not have an adverse relationship, it is crucial for the healthcare team to consider polypharmacy risks. Another consideration that the healthcare team should have taken is explaining the side effects of each medication. For example, hydrochlorothiazide and metoprolol have possible side effects of chest pain, fainting, and slow heartbeat (Mayo Clinic, 2021). With this information, the client would have been informed of these side effects, which would have helped prevent his fall. Another consideration that would have helped the healthcare team to prevent the client’s fall was the patient’s age and history of blurred vision. With these considerations, the healthcare team would have known he is already at fall risk and communicated fall prevention interventions to eliminate this risk.

References:

Arnold, J. (2020). Informed Refusal-What You Need to Know. Duke Health Referring Physicians. https://physicians.dukehealth.org/articles/informed-refusal-what-you-need-know.

Mayo Clinic. (2021, May 1). Metoprolol And Hydrochlorothiazide (Oral Route) Side Effects. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/metoprolol-and-hydrochlorothiazide-oral-route/side-effects/drg-20071224?p=1

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