NR33 teaching assignment example page 1 NR 33 TEACHING ASSIGNMENT EXAMPLE

SCENARIO: 3-4 SENTENCES DESCRIBING PT SITUATION

MP is a 78 y/o AA female who presents to the PMD for follow-up of management of hypertension. Her blood pressure is 160/102, 78, 16, 98.2. Hgt 5’4” ,wgt 110lbs. Office is known to be busy and the PMD reports that there is “never enough time to give adequate teaching.” Client is confused about how to take her medication and asks “what is hypertension any way?” There are pills left in her bottle that should have been taken by now. She states that she feels fine and doesn’t think she needs to take her pills. She reports that she gets dizzy and has to get up at night to urinate when taking the medication. Her mother died of a stroke at age 78 years and she is frightened that that will happen to her.

SUPPORTING DATA FOR LEARNING NEED:

PERTINENT POSITIVE S/O DATA HTN by history on medication BP 160/102 on follow-up visit after initiation of medication to manage HTN Diagnosed in busy office, there is “never enough time to give adequate teaching.” Client is confused about how to take her medication and asks “what is hypertension any way?” Pills left in her bottle States that she feels fine and doesn’t think she needs to take her pills. Reports that she gets dizzy and has to get up at night to urinate when taking the medication. Possible denial and fear of diagnosis: Her mother died of a stroke at age 78 years and she is frightened that that will happen to her. PERTINENT NEGATIVE S/O DATA 5’4”, 110 lbs. (uncontrolled obesity not contributing to HTN) VS: 78, 16, 98.2. (No indication of other physical causes of HTN that could blunt response to therapy)

NURSING DIAGNOSIS

Noncompliance related to lack of knowledge about disease, experience of adverse effects of therapy and possible denial and fear of diagnosis as evidenced by HTN by history, BP 160/102 on therapy, client verbalizations, pills left in bottle EXPECTED OUTCOMES:

Client will verbalize understanding about disease at the end of counseling session. Client will state an understanding of strategies to avoid undesirable effects of medication at end of counseling session. Client will schedule a follow-up appointment at the end of the counseling session. Client will take her medication as scheduled and report compliance at the follow-up appointment.

TEACHING TOOLS

VERBAL INSTRUCTION, WRITTEN MATERIAL ABOUT DISEASE AND MEDICATION

CONTENT OUTLINE (this sample counseling session would take 30-45minutes. Your assignment is for 10 minute demonstration for a simple topic.) NR33 teaching assignment example page 2 OBJECTIVE CONTENT OUTLINE MATERIALS Describe 1. definition of hypertension (HTN) Verbal hypertension a. explanation and its and management 2. signs and symptoms of HTN hypertension a. no symptoms in early disease fact sheet Define b. symptoms of late disease hypertension i. cardiac (HTN) ii. neurological Identify signs iii. ophthalmologic and symptoms iv. peripheral vascular of HTN v. renal Define 3. diagnosis of HTN diagnosis of a. measurement of blood pressure HTN 4. management of HTN Identify a. diet management i. low sodium, low fat of HTN b. exercise i. aerobic exercise c. stress management i. anxiety reduction ii. early identification of physical stressors d. medication i. daily medication Management 1. describe effects of medication Verbal of untoward a. desired effect of medication explanation effect of and medication i. decreases blood pressure by reducing fluid volume medication 1. works on kidneys fact sheet Describe b. untoward effects of medication effects of i. electrolyte changes medication 1. hypokalemia Identify 2. hyperglycemia, hyperuricemia, hypercalcemia strategies to ii. hemodynamic changes manage 1. sudden shifts in plasma volume untoward effects a. orthostatic hypotension 2. identify strategies to manage untoward effects Identify a. timing of administration strategies to enhance i. taken in morning to prevent nocturia compliance b. adaptive changes in body habitus with i. dangle in bed prior to rising medication c. dietary modifications schedule 3. identify strategies to enhance compliance with medication schedule a. prevention of timing and missed pill errors i. medication is taken at same time every day 1. enhances therapeutic effect 2. prevents overdosage ii. use of alarm devices 1. watch and clock timers iii. use of labeled pill boxes daily medication placed in labeled compartment Appropriate 1. tertiary prevention to maximize wellness in clients with HTN Verbal follow-up to a. chronic and progressive nature instruction, manage HTN sample blood i. goal to achieve blood pressure measures within acceptable ranges pressure Describe according to comorbitity journal, tertiary ii. requires frequent assessment and follow-up with PMD written prevention for 2. appropriate follow-up appointment HTN card for next a. weekly to monthly follow-up until stable scheduled Identify b. use of a blood pressure journal visit. appropriate c. every three months when stable follow-up NR33 teaching assignment example page 3 EVALUATION OF OUTCOMES:

Direct observed data to measure outcomes: States verbal understanding and provides return demonstration are commonly used. Can use question and answer sessions to clarify understanding. Post tests are generally reserved for academic environments. Indirect measures to evaluate outcome: Client reports improvement or resolution of physiologic/psychological stressor that precipitated the teaching diagnosis.

DOCUMENTATION OF TEACHING

Most care settings use teaching flow sheets to document nursing care. They generally adhere to nursing process format and teaching/learning principles. You will be required to write a descriptive note using nursing process for this assignment.

EXAMPLE NARRATIVE: (includes pertinent data to elicit the judgement to provide client education, the description of education provided, and the evaluation of the client’s response to the education provided.)

HTN by history on HTCZ times 2 months. BP 160/102 on follow-up visit. Other VS WNL and weight appropriate for height. Client appears confused about how to take her medication and asks “what is hypertension any way?” Pill count of medication verifies missed doses. States that she “feels fine” and doesn’t think she needs to take her pills. Reports that she gets dizzy and has to get up at night to urinate when taking the medication. Revealed that her mother died of a stroke at age 78 years and she is frightened that that will happen to her. Teaching provided regarding disease process, therapeutic effect of medication, management of untoward effect of medication and strategies to ensure compliance. Client states understanding. A follow-up appointment was scheduled for one month.