Nursing Plan

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Discharge Teaching Plan Case Study

Sherman “Red” Yoder

Directions

This case study provides information you will need to know to complete the Discharge Teaching Plan Assignment. Please see the guidelines in Doc Sharing for more details and grading rubrics for this assignment. After you read the case study, obtain the Discharge Teaching Plan form from Doc Sharing and document your teaching plan for Mr. Yoder.

Case Study

Continuing our story of Mr. Red Yoder, our elderly diabetic patient:

Two weeks later, Red misses his Monday morning coffee at the local VFW. He has also missed church for the past four Sundays. He usually has a few whiskey sours a day and needs to take something for sleep (Benadryl). Jon (Red’s son) gets “irritated with me over my beer and whiskey habits and yells pretty loud” at times. His friends “worry about him.” “I know it’s only 20 miles to the VFW, but I just haven’t felt like eating the last couple of days; maybe I’ve got the flu that’s going around.”

Red does not like to cook and usually picks up whatever is convenient, such as cake and donuts and some fast food. He also loves bacon! The home health nurse wanted to make sure he didn’t get an infection in that toe and now she is back to change the bandage. Red relates to the home health nurse “I’m not sure if I should take my insulin because I’m not eating, but my blood sugar was 203 when I poked my finger this morning. How can my sugar be that high when I’m not eating much? I just took off my sock to check on my sore and my whole foot is red and big. I haven’t looked at it for a few days; it was just a little pink the last time I checked it. I should have paid closer attention to those pills I was supposed to take, that antibiotic. “

Red requires admission to the hospital for sepsis of the wound.

Admission notes:

Today’s Date: [assume it is today]

Brief Description of Client:

Name: Sherman “Red” Yoder

Gender: Male      Age: 80       Race: Caucasian

Weight: 109 kg (240 pounds)

Height: 183cm (72 inches)

Religion: Protestant

Major Support: Jon (son)     Phone: 869-555-3452

Allergies: no known allergies

Immunizations: Influenza last fall; tetanus 4 years ago

Attending Physician/Team: Dr. Frank Baker

Past Medical History: Diabetes Type 2 diagnosed June 2 (last year).

History of Present illness:

Patient developed an ulcer on his big toe that was treated at home for 2 weeks. Son brought patient to ER 6 days ago and patient was treated for sepsis with IV antibiotics.

Social History:

Widower; son (Jon) lives nearby

Primary Medical Diagnosis:

Sepsis

Surgeries/Procedures & Dates:

L4-5 laminectomy – 25 years ago;

Transurethral resection of the prostate – 6 years ago

Nursing Diagnoses:

  • Impaired Walking;
  • Impaired Skin Integrity;
  • Ineffective Health Maintenance;
  • Ineffective Self Health Management

One week later, Red is being discharged home with home health for wound care. Please prepare a discharge teaching plan for Mr. Yoder and his care takers.

Discharge Teaching Plan Form

Your Name:                                                                        Date:

Your Instructor’s Name:

Purpose: 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

 

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.
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.

Cognitive issues
Physical barriers
Medications
Nutrition
Roles and Relationships
Self-concept
Wound care
Resources/ referrals needed

 

Discharge Teaching Plan:

Guidelines and Grading Rubric

Purpose

In addition to the information presented in the week 2 introduction threaded discussion for Red Yoder, our elderly patient male patient, the student will read an assigned case study and write a discharge teaching plan utilizing the information gained from both sources.

Course Outcomes

This assignment enables the student to meet the following course outcomes:

CO #1: Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO #1)

CO #3: Utilize effective communication when performing a health assessment. (PO #3)

CO #4: Identify teaching/learning needs from the health history of an individual. (PO #2)

CO #5: Explore the professional responsibilities involved in conducting a comprehensive health assessment and providing appropriate documentation. (PO #6)

Points

This assignment is worth a total of 100 points.

Due Date

The completed Discharge Teaching Plan form is to be submitted to the Dropbox by 11:59 p.m. MT Sunday of Week 2. Post questions to the weekly Q & A Forum. Contact your instructor if you need additional assistance. See the Course Policies regarding late assignments. Failure to submit your assignment to the Dropbox on time may result in a deduction of points.

Directions

  1. Review the initial information presented regarding Mr. Red Yoder, whom you met in week 2 threaded discussion. Read the Discharge Teaching Plan Case Study located in Doc Sharing. Take notes and highlight important points that are important to consider when developing a discharge teaching plan.
  2. Use Microsoft Word 2010 (or later) to fill in the Discharge Teaching Plan form, which is located in Doc Sharing. This assignment is to be completed with a maximum of 6 pages. You may bullet point your responses.
  3. Use scholarly writing including correct English grammar, syntax and sentence structure when writing in complete sentences.
  4. Submit the assignment to the Discharge Teaching Plan Dropbox by Sunday, 11:59 p.m. MT, by the end of Week 2. Please post questions about this assignment to the weekly Q & A Forums so that the entire class may view the answers.

Grading Criteria

(Bulleted points you will need to address in your responses)

Category Points % Description
Special/ age related needs 10 10%
  • Are there any special needs regarding Mr. Yoder’s case?
  • Does Mr. Yoder’s age present a problem?
  • What are the risks of a readmission for Mr. Yoder?
  • What measures might be put into place in an attempt to prevent a readmission?
Cognitive issues 12 12%
  • What is Mr. Yoder’s cognitive status in your opinion?
  • What available assessment tool might you use to assess Mr. Yoder’s cognitive ability?
  • Does the fact that Mr. Yoder mentioned: “I have not checked the bandage in a few days” concern you?
Physical barriers 10 10%
  • Why does the fact Mr. Yoder lives in a farmhouse alone, 20 miles from town present as a barrier?
  • How is Mr. Yoder’s eyesight a possible barrier for him, given his age? What problems will this present?
Medications 12 12%
  • What medication teaching does Mr. Yoder need prior to discharge?
  • Describe teaching material/techniques to help Mr. Yoder understand his diabetes as it relates to his blood sugar and necessity for insulin injection.
Nutrition 12 12%
  • What measures are needed to ensure Mr. Yoder follows a diabetic diet?
  • Will he be able to prepare his own meals and if not, how will he get the nutrition he needs for wound healing and to keep his blood sugar under control?
Roles and Relationships 8 8%
  • Who are the closest family members to Mr. Yoder and what is the state of that relationship?
  • His friends “worry about him.” Do you believe his friends could be a support system for Mr. Yoder and help him be more compliant in his own care?
Self-concept 8 8%
  • Given the scenario and Mr. Yoder’s non-compliant behavior, what would you expect his self-concept to be?
Wound care 12 12%
  • What are some important teaching points to make in regard to Mr. Yoder and his foot wound? Name 3 teaching points.
Resources/ Referrals needed 10 10%
  • What are some community resources that may be available for Mr. Yoder?
  • Will there be challenges because of the location in which he lives?
Clarity writing 6 6%
  • Content is organized logically and clearly understandable. Writing is free of spelling, grammar and syntax errors.
Total 100 100% A quality paper will meet or exceed all of the above requirements.

 

Grading Rubric

Assignment Criteria A
(92-100%)
Outstanding or highest level of performance
B
(84-91%)
Very good or high level of performance
C
(76-83%)
Competent or satisfactory level of performance
F
(0-75%)
Poor or failing or unsatisfactory level of performance
Special/age related needs

(10) points

Discusses full and complete list of special or age-related needs. Suggests teaching methods/approach and provides rationale. Identifies risks of readmission and poses measures to prevent readmission to the hospital.

(9-10 points)

Discusses partial list of special or age-related needs. Suggests teaching methods/approach and provides rationale. Identifies risks of readmission and poses measures to prevent readmission to the hospital.

(8 points)

Discusses minimal list of special or age-related needs. Barely addresses teaching methods/approach and rationale. Identifies risks of readmission but does not address measures to prevent readmission to the hospital.

(7 points)

Barely address special or age related needs.

Does not address teaching methods/approach and rationale. Fails to identify risks of readmission and does not address measures to prevent readmission to the hospital.

(0-6 points)

Cognitive issues

(12) points

Provides an accurate assessment of Mr. Yoder’s cognitive ability and utilizes and explains an appropriate geriatric assessment tool. Provides rationale.

(11-12 points)

Provides an accurate assessment of Mr. Yoder’s cognitive ability and utilizes but does not explain an appropriate geriatric assessment tool used. Provides rationale.

(10 points)

Provides an accurate assessment of Mr. Yoder’s cognitive ability but fails to utilize or explain an appropriate geriatric assessment tool which could be used. No rationale provided.

(9 points)

Barely addresses an assessment of Mr. Yoder’s cognitive ability and does not utilize or explain an appropriate geriatric assessment tool which could be used. No rationale provided.

(0-8 points)

Physical barriers

(10) points

Describes physical barriers that may impede Mr. Yoder’s continuity of care. Offers suggestions to remedy. Provides rationale.

(9-10 points)

Describes physical barriers that may impede Mr. Yoder’s continuity of care. Offers suggestions to remedy. Does not provide rationale.

(8 points)

Provides minimal description of physical barriers that may impede Mr. Yoder’s continuity of care. Fails to offer suggestions to remedy. Does not provide rationale.

(7 points)

Barely address physical barriers that may impede Mr. Yoder’s continuity of care. Does not offer any suggestions to remedy.

(0-6 points)

Medications

(12) points

Describes pertinent teaching needs for Mr. Yoder and offers a description of teaching techniques/approach used. Rationale provided.

(11-12 points)

Describes partial pertinent teaching needs for Mr. Yoder and offers a description of teaching techniques/approach used. Rationale provided.

(10 points)

Describes minimal pertinent teaching needs for Mr. Yoder and does not offer any examples of teaching techniques/approach used. Does not provide rationale.

(9 points)

Barely addresses pertinent teaching needs for Mr. Yoder and does not offer a description of teaching techniques/approach used.

(0-8 points)

Nutrition

(12) points

Describes measures needed to ensure Mr. Yoder follows his prescribed diet. Troubleshoots potential barriers that may prevent Mr. Yoder from accessing or complying with his prescribed diet. Offers teaching technique/approach to problem and provides rationale.

(11-12 points)

Describes partial measures needed to ensure Mr. Yoder follows his prescribed diet. Troubleshoots potential barriers that may prevent Mr. Yoder from accessing or complying with his prescribed diet. Offers teaching technique/approach to problem and provides rationale

(10 points)

Addresses minimal measures needed to ensure Mr. Yoder follows his prescribed diet. Does not address potential barriers that may prevent Mr. Yoder from accessing or complying with his prescribed diet. Provides teaching technique/approach to problem but does not provide rationale.

(9 points)

Barely describes measures needed to ensure Mr. Yoder follows his prescribed diet. Minimizes or fails to address potential barriers that may prevent Mr. Yoder from accessing or complying with his prescribed diet. Does not provide teaching technique/approach to problem and does not provide rationale.

(0-8 points)

Roles and Relationships

(8) points

Discusses how the role and relationships of Mr. Yoder’s family and friends may help him be more compliant in his own care. Offers suggestions/approach to any existing concerns with rationale.

(8 points)

Provides partial discussion of how the role and relationships of Mr. Yoder’s family and friends may help him be more compliant in his own care. Offers suggestions/approach to any existing concerns but does not provide rationale.

(7 points)

Minimal discussion of how the role and relationships of Mr. Yoder’s family and friends may help him be more compliant in his own care. Does not discuss suggestions/approach to any existing concerns and does not provide rationale.

(6 points)

Barely discusses or fails to discuss how the role and relationships of Mr. Yoder’s family and friends may help him be more compliant in his own care. Does not discuss suggestions/approach to any existing concerns and does not provide rationale.

(0-5 points)

Self-concept

(8) points

Provides insight into Mr. Yoder’s perceived self-concept and his previous non-non-compliant behaviors. Discusses ways to approach concerns with appropriate resources. Provides rationale.

(8 points)

Provides partial insight into Mr. Yoder’s perceived self-concept and his previous non-non-compliant behaviors. Discusses ways to approach concerns with appropriate resources. Does not provide rationale.

(7 points)

Provides minimal insight into Mr. Yoder’s perceived self-concept and his previous non-non-compliant behaviors. Does not discuss ways to approach concerns with appropriate resources. Does not provide rationale.

(6 points)

Fails to provide insight into Mr. Yoder’s perceived self-concept and his previous non-non-compliant behaviors. Does not discuss ways to approach concerns with appropriate resources. Does not provide rationale

(0-5 points)

Wound care

(12) points

Provides complete teaching points that are particular to Mr. Yoder’s case in addition to general teaching of wound care measures. Names 3 or more. Provides rationale.

(11-12 points)

Provides partial teaching points that are particular to Mr. Yoder’s case in addition to general teaching of wound care measures. Names 3 or more and provides rationale.

(10 points)

Provides minimal teaching points that are particular to Mr. Yoder’s case in addition to general teaching of wound care measures. Names 2 or more and provides rationale.

(9 points)

Fails to provide teaching points that are particular to Mr. Yoder’s case in addition to general teaching of wound care measures. Does not provide teaching points.

(0-8 points)

Resources/ Referrals needed

(10) points

Provides reasonable and accurate resources/ referrals for Mr. Yoder’s discharge to home and follow up needed. Explains choice of referrals and provides rationale.

(9-10 points)

Provides partial list of resources/ referrals for Mr. Yoder’s discharge to home and follow up needed. Explains choice of referrals and provides rationale.

 

(8 points)

Minimally addresses resources/ referrals for Mr. Yoder’s discharge to home and follow up needed. Explains choice of referrals and but does not provide rationale.

 

(7 points)

Does not provide reasonable and accurate resources/ referrals. No rationale provided.

(0-6 points)

Clarity and accuracy of writing

(6) points

No grammar, spelling, or syntax errors. Writes logically in complete sentences.

(6 points)

No more than 2 errors of any type.

(5 points)

2-3 errors of any type.

(4 points)

3 or more errors of any type.

(0-3 points)

Total Points Possible = 100 points