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
The focus of this assignment is identifying patient’s 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 total of 100 points.
Directions: 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.
Type your answers on this form. Click “Save as” and save the file with the assignment name and your last name, e.g., “NR305_Discharge_Teaching_ Plan_Form_Smith” 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.
Look 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.
Assessment area
Need(s) identified.
Teaching technique or approach to problem identified.
Describe content.
Rationale for choosing this technique/approach.
Example:
Special/age related needs
These are some ideas, there may be others that you identify.
· Age, lives alone, is non-compliant with diet.
· Expected aging changes such as decreased hearing, visual difficulties.
· Red appears to not understand his glucose numbers and how that relates to his diet and insulin administration.
· Home health nurse to assist Red and family in proper insulin management and administration
· Red reports “difficulty sleeping” which may be related to depression and conditions such as obstructive sleep apnea that commonly affect the elderly
· Slower response time due normal aging process affects new learning
· Age related physical changes may be causing Red to experience incontinence
Ideas for teaching methods/approach based on the scenario and problems noted. You may have identified others.
· Teach importance of diet and insulin management to Red and family and how to better manage his diabetes.
· 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.
· 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
· Collaborate with the physician regarding the possibility of a sleep study
· Instruct to limit fluid intake before bedtime, daily coffee intake, alcohol abstinence, use of bedside commode
Provide a brief rationale on why you chose these particular technique/approaches.
· 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.
· Non-benzodiazepines and melatonin receptor agonist may be used to aid older adults in falling asleep.
· Control of symptoms can help one continue to complete activities of daily living and live independently
Cognitive issues
· Alert and Oriented x’s 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
· Red appears to have depression and anxiety from life losses (spouse, health and purpose in life)
· Risk for dementia from alcohol over use
· An assessment of Red reading ability would be helpful
· 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).
· 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.
· “Mini-Cog tests the persons executive function, including the ability to plan, manage time, organize activities, and manage working memory” (Jarvis, 2012, pg 76). Identifying deficits will help further address the type assistance required.
· 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).
Physical barriers
· Healthcare services are not close by since her lives in a rural area and may cause a serious problem in an emergency
· Red’s has a tendency to be socially isolated by living in a rural area
· Elderly and now with impaired walking complicated by neuropathy
· Red may have problems reading his medications instruction including insulin syringe due to effects uncontrolled diabetes
· Offer resources medic alert bracelet, encourage use of caregiver, family involvement and tele-health
· Encourage keeping contact with Veterans and other social support systems
· Assist in scheduling an ophthalmology apportionment for possible need for corrective lenses and requesting large print labels on medicine bottles
Utilizing these resources can help prevent health disparities from living in a rural environment
Medications
Red needs to understand what is causing his blood sugars to be elevated even when he does not eat.
The importance of insulin to keep his blood sugars within a certain range,
How his antibiotic will help his foot ulcer
If he takes sleeping medication or uses Benadryl, the use of alcohol can be dangerous
· 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
Nutrition
· Diabetic teaching, diet restriction for weight loss as Red is considered obese with BMI of 32.5
· Need help in alcohol abstinence and alternatives to eating empty calorie foods such as sweets and alcohol
· Needs family, caregiver or service delivery of meals that adhere to his diet
· Encourage Red and family to attend diabetes classes and weight management
· Refer Red and family to a nutritionist to help formulate menu plan with limits on caloric intake
Roles and Relationships
· Red needs to utilize his identified support system to help him live to continue living in his own home
· Incorporate current support systems (his son, daughter in law and friends) in his plan of care
Self-concept
· 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
· Perform the CAGE test and or SMAST-G screening test
· Screen for depression
· Emphasize patients strength such as going to church, his friends and family support
· Patient perception of his drinking problem is an important step in recovery
Wound care
· 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
· Teach Red, his family (son and daughter in law), caregivers that will be involved in his care
· Teach toperform daily dressing changes, to inspect for signs of infection (redness, swelling drainage), other areas for
· skin breakdown daily
· Emphasize the importance of keeping feet covered with well and comfortable fitting shoes that don’t cause redness, cuts, red spots and blistering
· Teach to keep feet clean and dry, away from heating devices, hot water by first checking temperature
· Teach how to improve circulation by wearing compression stockings
· Teach Red, his family, and other caregivers with return verbaliztion of understanding
· Include meeting with the podiatrist nurse that would include visual and written instructions for wound care that include regularly scheduled appointment to his podiatrist
· Early assessment and intervention help prevent serious problems from developing (Nursing interventions and rationales, Impaired skin integrity2013)
Resources/ referrals needed
· Home Health RN, PT, SW
· Home Health aide covered by VN
· Housekeeper
· Meal delivery
· AA and Support groups for DM
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