The focus of this assignment is identifying patient\u2019s needs and analysis and synthesis of details within the written client record and planning an appropriate discharge plan with necessary patient teaching of the disease process.
\nPoints: This assignment is worth a total of 100 points.
\nDirections: Please refer to the Discharge Teaching Plan Guidelines found in Doc Sharing for details about how to complete this form. Remember there is a 6 page maximum limit on this assignment.
\nType your answers on this form. Click \u201cSave as\u201d and save the file with the assignment name and your last name, e.g., \u201cNR305_Discharge_Teaching_ Plan_Form_Smith\u201d When you are finished, submit the form to the Teaching Plan Dropbox by the deadline indicated in your guidelines. Post questions in the Q&A Forum or contact your instructor if you have questions about this assignment.
\nLook at the EXAMPLE in the first assessment area. This is NOT an all-inclusive response and you will need to add your responses as well. Please be sure to review your guidelines.<\/p>\n
Assessment area
\nNeed(s) identified.
\nTeaching technique or approach to problem identified.
\nDescribe content.
\nRationale for choosing this technique\/approach.
\nExample:<\/p>\n
Special\/age related needs
\nThese are some ideas, there may be others that you identify.
\n\u00b7 Age, lives alone, is non-compliant with diet.
\n\u00b7 Expected aging changes such as decreased hearing, visual difficulties.
\n\u00b7 Red appears to not understand his glucose numbers and how that relates to his diet and insulin administration.
\n\u00b7 Home health nurse to assist Red and family in proper insulin management and administration
\n\u00b7 Red reports \u201cdifficulty sleeping\u201d which may be related to depression and conditions such as obstructive sleep apnea that commonly affect the elderly
\n\u00b7 Slower response time due normal aging process affects new learning
\n\u00b7 Age related physical changes may be causing Red to experience incontinence
\nIdeas for teaching methods\/approach based on the scenario and problems noted. You may have identified others.
\n\u00b7 Teach importance of diet and insulin management to Red and family and how to better manage his diabetes.
\n\u00b7 Use videos, audio and teach back methods. It may even be helpful to assure proper reading of the glucometer and administration of the insulin by Red or his family.
\n\u00b7 Collaborate with the physician and pharmacist for their recommendations on sleep aids such as melatonin receptor agonist, and non-benzodiazepine along with behavioral interventions such as a set schedule bed time each night
\n\u00b7 Collaborate with the physician regarding the possibility of a sleep study
\n\u00b7 Instruct to limit fluid intake before bedtime, daily coffee intake, alcohol abstinence, use of bedside commode
\nProvide a brief rationale on why you chose these particular technique\/approaches.<\/p>\n
\u00b7 For example, Red may have poor eyesight due to the diabetes and needs audio and demonstration with return demonstration. He may not be able to see the lines on the insulin syringe.<\/p>\n
\u00b7 Non-benzodiazepines and melatonin receptor agonist may be used to aid older adults in falling asleep.<\/p>\n
\u00b7 Control of symptoms can help one continue to complete activities of daily living and live independently
\nCognitive issues
\n\u00b7 Alert and Oriented x\u2019s 3, with some signs of being forgetful and or impaired recall as he forget to check his insulin, take his medications as directed and does not know how to manage his diabetes
\n\u00b7 Red appears to have depression and anxiety from life losses (spouse, health and purpose in life)
\n\u00b7 Risk for dementia from alcohol over use
\n\u00b7 An assessment of Red reading ability would be helpful
\n\u00b7 Recommend the mini mental state exam. (The supplemental mini-cog can only be utilized due to copy right restrictions of the MMSE). Instruct to repeat three works after me, then draw a clock with numbers on the front,next draw hand on the clock of a time of day specified, last have the three words repeated (Jarvis, 2012, p 76).<\/p>\n
\u00b7 Screen for depression and for alcohol use disorder Identification test. If abnormal utilize the expertise of social worker for counseling and psychiatrist for treatment of depression. Encourage the alcohol abstinence to prevent loss of independence.
\n\u00b7 \u201cMini-Cog tests the persons executive function, including the ability to plan, manage time, organize activities, and manage working memory\u201d (Jarvis, 2012, pg 76). Identifying deficits will help further address the type assistance required.
\n\u00b7 The incidence of dementia is fivefold among the elderly who abuse alcohol compared to non-abusers. Older adults were shown to benefit from rehab than younger adults (Jarvis, p 89 substance abuse).
\nPhysical barriers
\n\u00b7 Healthcare services are not close by since her lives in a rural area and may cause a serious problem in an emergency
\n\u00b7 Red\u2019s has a tendency to be socially isolated by living in a rural area
\n\u00b7 Elderly and now with impaired walking complicated by neuropathy
\n\u00b7 Red may have problems reading his medications instruction including insulin syringe due to effects uncontrolled diabetes
\n\u00b7 Offer resources medic alert bracelet, encourage use of caregiver, family involvement and tele-health
\n\u00b7 Encourage keeping contact with Veterans and other social support systems
\n\u00b7 Assist in scheduling an ophthalmology apportionment for possible need for corrective lenses and requesting large print labels on medicine bottles
\nUtilizing these resources can help prevent health disparities from living in a rural environment
\nMedications
\nRed needs to understand what is causing his blood sugars to be elevated even when he does not eat.
\nThe importance of insulin to keep his blood sugars within a certain range,
\nHow his antibiotic will help his foot ulcer
\nIf he takes sleeping medication or uses Benadryl, the use of alcohol can be dangerous
\n\u00b7 Have HHRN teach a family member (son or daughter in law check blood sugars and administer insulin as needed) as well as other scheduled medication<\/p>\n
Nutrition
\n\u00b7 Diabetic teaching, diet restriction for weight loss as Red is considered obese with BMI of 32.5
\n\u00b7 Need help in alcohol abstinence and alternatives to eating empty calorie foods such as sweets and alcohol
\n\u00b7 Needs family, caregiver or service delivery of meals that adhere to his diet
\n\u00b7 Encourage Red and family to attend diabetes classes and weight management
\n\u00b7 Refer Red and family to a nutritionist to help formulate menu plan with limits on caloric intake<\/p>\n
Roles and Relationships
\n\u00b7 Red needs to utilize his identified support system to help him live to continue living in his own home
\n\u00b7 Incorporate current support systems (his son, daughter in law and friends) in his plan of care<\/p>\n
Self-concept
\n\u00b7 Red being a VFW and a farmer may not have had much education beyond high school, his Depression and denial related to loss of independence and health status. He is veteran and farmer and likely had pride in his physical abilities and independence. He is having a difficult time being vulnerable to receiving help, adjusting to his loss of independence and possibly admitting he is experiencing depression and has a problem with acohol
\n\u00b7 Perform the CAGE test and or SMAST-G screening test
\n\u00b7 Screen for depression
\n\u00b7 Emphasize patients strength such as going to church, his friends and family support
\n\u00b7 Patient perception of his drinking problem is an important step in recovery
\nWound care
\n\u00b7 Evaluate Red caregivers knowledge of how to perform daily wound care, assessment for signs of infection, and when to see his physician, how to prevent skin breakdown
\n\u00b7 Teach Red, his family (son and daughter in law), caregivers that will be involved in his care
\n\u00b7 Teach toperform daily dressing changes, to inspect for signs of infection (redness, swelling drainage), other areas for
\n\u00b7 skin breakdown daily
\n\u00b7 Emphasize the importance of keeping feet covered with well and comfortable fitting shoes that don\u2019t cause redness, cuts, red spots and blistering
\n\u00b7 Teach to keep feet clean and dry, away from heating devices, hot water by first checking temperature
\n\u00b7 Teach how to improve circulation by wearing compression stockings
\n\u00b7 Teach Red, his family, and other caregivers with return verbaliztion of understanding
\n\u00b7 Include meeting with the podiatrist nurse that would include visual and written instructions for wound care that include regularly scheduled appointment to his podiatrist<\/p>\n
\u00b7 Early assessment and intervention help prevent serious problems from developing (Nursing interventions and rationales, Impaired skin integrity2013)
\nResources\/ referrals needed
\n\u00b7 Home Health RN, PT, SW
\n\u00b7 Home Health aide covered by VN
\n\u00b7 Housekeeper
\n\u00b7 Meal delivery
\n\u00b7 AA and Support groups for DM<\/p>\n","protected":false},"excerpt":{"rendered":"
The focus of this assignment is identifying patient\u2019s needs and analysis and synthesis of details within the written client record and planning an appropriate discharge plan with necessary patient teaching of the disease process. Points: This assignment is worth a Read More …<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-237591","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/237591","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/comments?post=237591"}],"version-history":[{"count":0,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/237591\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/media?parent=237591"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/categories?post=237591"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/tags?post=237591"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}