Teaching Plan for Client in the Medical-Surgical Unit of MountainView Hospital in Clark County, Nevada
Topic for Educational Need
The topic of education for this patient is postoperative care for hip replacement surgery. This topic was chosen because the patient underwent a total right hip arthroplasty procedure on September 16, 2019. The patient will need guidance and instruction on all aspects of recovery to achieve the best outcome of the joint replacement surgery (John’s Hopkins, 2017). Being knowledgeable about how to self-care, what to expect, and what resources will be needed will assist the patient obtain and maintain the best possible function and quality of life after the procedure (Cleveland Clinic, 2015).
Relevant Medical and Surgical History. Chronic progressive right hip pain; limited in ambulation to about 100 yards without stopping because of pain. Back pain, herniated disc, lumbar fusion 1981, motor vehicle accident in 1983, numbness and tingling from hip area down to legs.
September 16, 2019. Temperature 98.6F, blood pressure 105/71 mmHg, pulse 74 bpm, respirations18 breaths/min, O2 sat 97% on 2.0L/min nasal cannula.
September 17, 2019: 0730. Temperature 98.8F, blood pressure 92/58 mmHg, pulse 78 bpm, respirations 18 breaths/min, O2 sat 98% 2.0L/min nasal cannula, pain level 7 out of 10.
September 17, 2019: 1130. Temperature 98.8F, blood pressure 93/59 mmHg, pulse 79 bpm, respirations 18 breaths/min, O2 sat 97% on 2.0L/min nasal cannula, pain level 9 out of 10.
Assessment of Patient
The patient was alert and oriented x4 throughout the clinical day on September 17, 2019. The patient 54 years old, a native English speaker, and high school educated. The patient is unemployed, divorced with three children, lives alone, and on disability from a motor vehicle accident in 1983. The patient has chronic hip pain with numbness and tingling from the hip area down to the legs and has managed the pain throughout the years since the MVA with physical therapy and the use of baclofen and clonazepam for muscle spasms. The patient is accustomed to applying self-care to manage her physical condition. The patient’s plan after discharge from the hospital will be to live at one of her adult daughter’s home which is a one-story unit so the patient will not have the burden of going up and down flights of stairs. The patient’s health goal is to be independent as soon as possible and is motivated to apply all suggested therapeutic interventions. The patient’s current emotional state ranges from willingness to make a rapid recovery as well as some anxiety surrounding the management of pain which ranged from 7 to 9 out of 10 during the clinical day.
Method of Implementation
The patient’s learning style is visual and motor so printed handouts and physical demonstration were chosen as the method of teaching. A hands-on approach where the patient gets to perform a procedure with your guidance is often the best method (Lippincott, 2017). The patient’s style is to keep it simple and get the facts with a simple checklist. The patient does not have hearing or learning impairments so there will not be limitations as to what the patient understands. The patient’s daughter is supportive and will be informed by the patient on how to be cared for so the patient will receive assistance with health care management. The patient has access to a computer and the internet at home and is willing to seek further instruction from reliable sources such as the “Patient Handbook for Total hip Replacement” by Kaiser Permanente for more details on how to perform activities of daily living after surgery.
The tools that will be implemented for teaching will be printed handouts and physical demonstrations of how to use adaptive equipment. The printed handouts outline the physical movements and positions that the patient will practice that will reduce pain and improve function. These movements include not bending the hip past 90 degrees, not crossing legs while sitting or standing, not pivoting foot and toes inward (medially), and how to use a walker.
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The patient will also be educated on how to perform activities of daily living such as showering, dressing and toileting. For showering, a shower chair or stool should be utilized for safety as well a long-handled brush or sponge to assist with washing. Dressing aids such as a long-handled shoe horn and tongs will assist with dressing. For toileting, a raised seat should be used and rails should be installed if possible to provide support.
The printed handouts were chosen because it shows simple illustrations on what to do and what not to do that will be easy to follow. The patient will be able to glance at the handout be reminded of what movements and positions are recommended and what should be avoided without having to read lengthy paragraphs. In-person physical demonstrations on how to use adaptive equipment will allow the patient to practice utilizing each item before going home to it is familiar once the patient is home and will be using the equipment independently.
The patient demonstrated that learning occurred by return demonstrating the movements and positions that were shown on how to go from sit to stand and to bed. The patient verbally repeated the instructions given regarding what to do and what not to do when performing activities of daily living. The patient acknowledged the adaptive equipment that were in the room to take home upon discharge. An example of a question asked of the patient is, “what is the angle that you should avoid sitting or bending?” and “what should you never do with your legs while sitting or standing?”. The criteria that would show the patient understood the material is if the patient responded with the answers, “Do not sit or bend more than 90 degrees”, and “Do not cross legs while sitting or standing” to the questions aforementioned, respectively. Possible revisions to this plan would be to provide a DVD for the patient to take home to be viewed periodically as a refresher to maintain the best practice for physical therapy exercises and the how to’s for activities of daily living.
- Cleveland Clinic Foundation. (2015). A patient’s guide to total joint replacement and complete care. Retrieved from https://my.clevelandclinic.org/ccf/media/Files/Ortho/patient-education/total-joint-replacement-patient-guide.pdf?la=en
- John’s Hopkins Medicine. (2017) Patient education: Hip replacement surgery. Retrieved from https://www.hopkinsmedicine.org/johns_hopkins_bayview/_docs/medical_services/orthopaedic_surgery/hip_replacement_surgery_patient_education_guide.pdf
- Kaiser Permanente. (2015). Total hip replacement: Patient handbook. Retrieved from https://thrive.kaiserpermanente.org/care-near-you/northern-california/santarosa/wp-content/uploads/sites/15/2015/09/Total-Hip-Replacement-Booklet.09416-085-3-10_tcm75-244262.pdf
- Lippincott Solutions. (August 22, 2017). 5 Strategies for Providing Effective Patient Education. Retrieved from http://lippincottsolutions.lww.com/blog.entry.html/2017/08/22/5_strategies_forpro-kDDq.html
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