Patient Education and Drug Therapy

Question 1

A 47yr old patient with diabetes is being discharged home on insulin injections twice a day. Which of the following statements is most accurate regarding proper teaching?

a) Majority of teaching can be done with pamphlets
b) a thorough and comprehensive teaching plan designed for an 8th grade reading level should be developed
c) Teaching should begin with diagnosis and should be individualized
d) Nurse can assume because the patient in 47 he can read any information.

Answer 1

c) Teaching should begin with diagnosis and should be individualized

Question 2

Which of the following strategies about discharge teaching and medication is correct?

a) Teaching should be done right before the patient leaves the hospital of the doctor’s office.
b) teaching should be individualized and based on the patients cognitive ability
c) Teaching should be reserved for when the patient is comfortable or after narcotics are administered
d) Teaching should include videos, demonstrations, and instructions written at least at the 5th grade level.

Answer 2

b) teaching should be individualized and based on the patients cognitive ability

Question 3

A nurse is responsible for the preoperative teaching for a patient who is mildly anxious about receiving narcotics postoperatively. The nurse acknowledges that this level of anxiety may result in which of the following?

a) Impede learning because anxiety is helpful
b) Lead to major unsteadiness of emotional status
c) Result in learning by increasing the patient’s willingness to learn
d) Recognize the patient’s thoughts and leads to inadequate potential for learning

Answer 3

c) Result in learning by increasing the patient’s willingness to learn

Question 4

What action by the nurse is the best way to assess a patient’s learning needs?

a) Quiz patient daily on all medications
b) Begin with validation of the patient’s present level of knowledge
c) Assess family members’ knowledge of the medication even if they are not involved with the patient’s care
d) Question other caregivers about their level of experience with the drug regimen and assume lack of interest if no answers are given

Answer 4

b) Begin with validation of the patient’s present level of knowledge

Question 5

Which of the following techniques would be most appropriate for teaching a patient with a possible language barrier?

a) Provide only written instructions
b) Use detailed and lengthly explanations and speak slowly
c) Obtain an interpreter who can speak the patient’s native tongue for teaching sessions
d) If the nurse notes there are no questions, it can be assumed that the patient understands the information.

Answer 5

c) Obtain an interpreter who can speak the patient’s native tongue for teaching sessions

Question 6

Your patient is a 56yr old woman who is to begin treatment with insulin injections. Develop a 10min teaching plan on the basics of subcutaneous self administration of insulin.

Answer 6

1. A patient teaching plan regarding self-administration of subcutaneous insulin should include the following information and a demonstration of technique. Prior to teaching, a thorough assessment of the patient and available resources must be completed. Major areas to assess include the following:

• Baseline vital signs and any pertinent laboratory data
• Allergies
• Past and present medical history
• Any high-risk situations, such as disease processes that could interfere with the action of the medication
• Self-care ability
• Education level
• Cognitive, motor, and sensory deficits, such as hearing, vision, and motor impairments
• Support systems
• Readiness to learn
• Available resourcesOnce the information has been gathered, an appropriate teaching plan based on the individual’s specific learning needs can be formulated. Since this is an older patient, the teaching should be planned around the patient’s energy level, readiness to acquire the information, and skill in administering the insulin. In addition, the nurse should be sure to obtain syringes that the patient is able to see, in case of visual impairment. The use of an insulin pen may also be considered. A family member or caregiver may also be present for reinforcement of information. Brief explanations with pictures and a demonstration (with a return demonstration) would be most appropriate for this patient. Reinforcement of the teaching session may occur through questions and answers, a review, and more return demonstrations later in the day or before discharge. Videotapes on the topic would also be beneficial. The purpose of this critical activity is to emphasize patient teaching and concept application. (For more specific information on the steps to follow for administration of subcutaneous injections and insulin, see Chapter 10.)

Question 7

Formulate a teaching plan for a 69yr old male patient who has experienced a left side stroke, is aphasic and paralyzed on the right side. He is going to be returning home where his wife will be caring for him. Your discharge teaching will be directed to the patient and his wife, and you are to teach about safety measures for the patient, who has slight difficulty in allowing and will betaking oral medication when he returns home. he tolerates liquids, soft foods and thickened liquids fairly well.

Answer 7

2. Once again, the purpose of this Critical Thinking Activity is the development of an individualized teaching plan after careful assessment of the patient and the resources that are available to the patient. Because of this patient’s problems (although slight) with swallowing, careful evaluation by a speech pathologist and a neurologist must be done before discharge so that the patient’s status regarding aspiration potential is known and documented. Based on the information given in this scenario, the patient’s wife will also need teaching, with reinforcement through demonstration, return demonstration, pamphlets, and any audiovisual materials regarding giving medications to an individual experiencing slight difficulty in swallowing. (For more specific information on teaching plans for special situations, see Chapter 3.) Helpful rehabilitative resources may include occupational therapy for assistance with actual lifestyle changes and interventions specific to the patient’s needs, such as help with swallowing or chewing.

Question 8

Your patient does not speak english or understand any of your communication techniques thus far. Develop a plan of care that addresses the patient’s needs for medication information the heart drug cardiazem (diltiazem) and also focus on the potential for toxicity.

Answer 8

3. Most plans should reflect the use of an interpreter; more important, however, the plan of care should reflect an individualized approach to educating the patient about the toxic effects of this medication. Family members should be included also if at all possible. A simple guideline for assessment and implementation and other phases that depend on the information assessed includes the following points:

• Assessment: Evaluate prior knowledge and some of the following: adherence and the use of other drugs, ability to measure pulse rates at home, drug allergies, understanding of the materials presented, support at home, other health problems, and financial and economic needs.
• Implementation: Teach about measuring the pulse for 1 minute, journal recording, reporting adverse effects or signs and symptoms of toxicity (anorexia, nausea, vomiting, and pulse below 60), adverse effects to expect, and how to maximize the dosage by taking medication before meals and at the same time every day.