NR33 teaching assignment example
NR 33 TEACHING ASSIGNMENT EXAMPLE
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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
OBJECTIVE
Describe
hypertension
and its
management
1.
2.
Define
hypertension
(HTN)
Identify signs
and symptoms
of HTN
Define
diagnosis of
HTN
3.
4.
Identify
management
of HTN
Management
of untoward
effect of
medication
1.
Describe
effects of
medication
Identify
strategies to
manage
untoward
effects
2.
Identify
strategies to
enhance
compliance
with
medication
schedule
Appropriate
follow-up to
manage HTN
Describe
tertiary
prevention for
HTN
Identify
appropriate
follow-up
3.
CONTENT OUTLINE
definition of hypertension (HTN)
a.
signs and symptoms of HTN
a. no symptoms in early disease
b. symptoms of late disease
i. cardiac
ii. neurological
iii. ophthalmologic
iv. peripheral vascular
v. renal
diagnosis of HTN
a. measurement of blood pressure
management of HTN
a. diet
i. low sodium, low fat
b. exercise
i. aerobic exercise
c. stress management
i. anxiety reduction
ii. early identification of physical stressors
d. medication
i. daily medication
describe effects of medication
a. desired effect of medication
i. decreases blood pressure by reducing fluid volume
1. works on kidneys
b. untoward effects of medication
i. electrolyte changes
1. hypokalemia
2. hyperglycemia, hyperuricemia, hypercalcemia
ii. hemodynamic changes
1. sudden shifts in plasma volume
a. orthostatic hypotension
identify strategies to manage untoward effects
a. timing of administration
i. taken in morning to prevent nocturia
b. adaptive changes in body habitus
i. dangle in bed prior to rising
c. dietary modifications
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
1. tertiary prevention to maximize wellness in clients with HTN
a. chronic and progressive nature
i. goal to achieve blood pressure measures within acceptable ranges
according to comorbitity
ii. requires frequent assessment and follow-up with PMD
2. appropriate follow-up
a. weekly to monthly follow-up until stable
b. use of a blood pressure journal
c. every three months when stable
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MATERIALS
Verbal
explanation
and
hypertension
fact sheet
Verbal
explanation
and
medication
fact sheet
Verbal
instruction,
sample blood
pressure
journal,
written
appointment
card for next
scheduled
visit.
NR33 teaching assignment example
EVALUATION OF OUTCOMES:
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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.