During a clinical rotation we come into contact with many patients, from many different backgrounds, with many different disease processes which effect their systems. Each patient has their own manifestations, of signs and symptoms, along with courses of action which are taken to best meet their individual needs. One of the tools used when caring for a patient is education. CDC.gov states “A well-informed patient is more likely to cooperate if the patient understands” (Centers for Disease Control and Prevention, 2011). Educating a patient allows a patient to be more involved in their care, and there is a greater possibility for compliance once the patient knows what to do, and why. As student nurses one of the ways we educate our patients is through use of a Patient teaching plan. The teaching plan incorporates general knowledge of the patient’s diagnosis, disease process, medication, and treatment.
One of the patients I had the opportunity to care for was a 64 year old female which went by the initials E,M who was diagnosed with multiple system atrophy, anoxic brain injury, hypertension, dysphagia, hypothyroidism, and clostridium difficile. When looking into the condition of the patient, we find that the reason she presented with many of the signs and symptoms that she did is because of her medical diagnosis, and the disease process. With manifestations such as loose foul smelling stool, and hyperactive bowel sounds for clostridium difficile; comatose state, along with quadriparesis, apraxia, and rigidity for anoxic brain injury. While other parts of her medical diagnosis may be associated with, or related to another existing diagnosis. For example one of the symptoms of multiple system atrophy is difficulty swallowing, which is known as dysphagia which she has been diagnosed with as a medical diagnosis. An important aspect of the teaching plan is to also educate the patient on medication, and treatment of the disease.
It is important to emphasize to the patient that some of the medications they are taking may not be curative, but used as prophylaxis, and for symptom management. Some of the medications my patient is currently prescribed are; Midodrine, Famotidine, Levothyroxine, Vancomycin, Clonazepam, and Psyllium. Each of these medications have a specific purpose in managing the disease process and symptoms that my patient exhibits. When we look at Vancomycin we know that the patient is taking this medicine for treatment for their clostridium difficile. With this drug there are many facts that the patient needs to know; such as being aware of dosing, associated risks like issues with hearing, and toxicity to the body. While drugs like Levothyroxine have a series of side effects which differ from the others, ranging in severity.
It is associated with weight loss, hair loss, irregular breathing, to signs of over dose; like change or loss in consciousness, sudden slurring of speech, and sudden loss of coordination. It can be said that all drugs have side effects, but it is of utmost importance to teach the patient about things which can alter their lifestyle, or leave them debilitated, or dead. In order to have an effective teaching plan, one must look at the patient as a complete being, and not by just their disease process.
Religion, and culture must be considered when developing the teaching plan, if things such as diet, or practices work contrary to their personal beliefs. Other aspects such as the patient’s education level, and cognitive ability are important things that must be considered; if not considered you can be wasting a lot of time and energy, using ineffective methods because the patient may not be able to understand you, or they may even speak a foreign language. Family is another part to be considered during teaching, they can be an added help or hindrance causing noncompliance especially when it comes to other factors; such as age, and if the person is independent for decision making.
Although every teaching plan is different, and received by each patient in their own way, they are important for getting precise information across, and give patient’s information that is needed to empower themselves, and be better caregivers to themselves.
Data: (1 point)
Demographics: Age: 66 Sex: F Education:
High School Religion: Catholic Culture: New Mexican / Hispanic Occupation: Housewife Educational Needs: (2 points)
What does the client know? She knows that she is sick, and in the hospital, and experiencing many different signs, and symptoms associated with her disease, such as diarrhea. She also knows she is taking a medicine to help her with that. She also knows that her blood pressure has periods of it dropping. What does the client need to know? The client needs know that the name of the medicine she is taking for clostridium difficile is Vancomycin 250mg capsule four times a day. She also needs to know that she has to follow the protocol when taking this medication.
Meaning she has to take it as directed by the Doctor; not missing a dose, and to complete the medication. Not completing the medication, and taking it as directed, can cause resistance of the organism to the medication. She also needs to know that she will need to have labs done to check if therapeutic levels have been obtained, or toxic levels. What does the client need to know? She also needs to know that she is on midodrine for hypotentsion, even though she has a diagnosis of hypertension. She needs to be aware that midodrine can cause hypertension, and headaches, fainting, and dizziness, and that she should notify the doctor if she has any of those symptoms. Teaching Plan: (3 points)
Teaching objectives: Teach patient about importance of taking medicine, and completing it. Teach that she may be taking medication long term Content: Medication, How it should be taken, side effects, what to do if side effects occur Time Frame: The patient will be able to tell me the medication she is taking, and how she is supposed to take it by the end of the teaching lesson. The patient will be on the Vancomycin x14 days as per M.D, then will be tested upon completion of medication to see if it works. Stool samples will be collected for testing, to know if she is now positive or negative for clostridium difficile. The patient will start midodrine 10mg as needed, up to three doses a day for hypotension. Teaching Strategies: (2 points)
Who is involved: The Nurse is involved doing the teaching, to the patient and her husband, since her husband helps her with care. When: This will be done before discharge, and upon starting medication. The optimal time for this will be in the morning so that this information cause be fresh in her mind Where: This will take place at the patient’s bedside.
How: This will be done in a private way with the family of the patient present for support. Instruction, and demonstration will Evaluation: (2 points) Client response or feedback: I understand that I am taking Vancomycin to counter my c-diff. I also understand that once the medication is started, that I need to keep taking it until I complete it. I am aware that I will need to be tested to make sure I am free of this infection. I will inform my Doctor if I experience any kind of alleregic reaction, or if I begin to get redness all over my body.
I will report any headache, blurred vision, or dizziness when taking midodrine. I will also purchase a blood pressure machine to check before I take this medication. Were objectives met? Describe. Yes. The patient is clearly able to state why she is taking the medication. She also understands side effects of the medications, and voices that the M.D must be called. What is the next step / new plan? I will teach the patient the importance of washing hands to prevent the spread of infection.
Centers For Disease Control And Prevention 2011 EFFECTIVE TB Interviewing for Contact Investigation: Self-Study ModulesCenters For Disease Control And Prevention (2011, May 4). EFFECTIVE TB Interviewing for Contact Investigation: Self-Study Modules. Retrieved May 30, 2015, from http://www.cdc.gov/tb/publications/guidestoolkits/interviewing/selfstudy/module2/2_2.htm 201505302116391203383684
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