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Posted: March 17th, 2022
Evidence-based discharge teaching is critical in promoting health and impacting readmissions. You will address Tina Jones’ diagnoses; asthma, dehydration, and wound infection, providing education that will support adherence and prevent readmission. Provide clear guidance for wound care, infection control, medications, diet, blood sugar monitoring, activity, and follow-up that will optimize her health.
Discharge teaching on Tina Jones on the following:
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Diabetics
Addresses all areas of the diagnosis, including pathophysiology, risk factors, and health promotion using current EBP in a patient centered manner demonstrating caring behaviors with use of therapeutic communication.
ASTHMA
Addresses all areas of the diagnosis, including pathophysiology, risk factors, and health promotion using current EBP in a patient centered manner demonstrating caring behaviors with use of therapeutic communication.
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DEHYDRATION
Addresses all areas of the diagnosis, including pathophysiology, risk factors, and health promotion
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nursing current EBP in a patient centered manner demonstrating caring behaviors with use of therapeutic communication
INFECTION
Addresses all areas of the diagnosis, including pathophysiology, risk factors, and health promotion using current EBP in a patientcentered manner demonstrating caring behaviors with use of therapeutic communication.
WOUND CARE
Thorough instruction on asepsis, wound care and equipment using current EBP in a patient-centered manner demonstrating caring behaviors with use of therapeutic communication
MEDICATION
Thorough instruction on medications, including indication, dosing, adverse effects, adherence, and administration using EBP in a patient-centered manner demonstrating caring behaviors with use of therapeutic communication.
ACTIVITY
Thorough instruction on activity, including bathing, equipment, and safety using EBP in a patientcentered manner demonstrating caring behaviors with use of therapeutic communication
DIET
Thorough instruction on proper diet for diabetes management, including counting carbohydrates, hypo- and hyperglycemia, and lifestyle changes using EBP in a patient-centered manner demonstrating caring behaviors with use of therapeutic communication
FOLLOW UP
Thorough instruction on instructions on follow-up plan, including appointments and warning signs of potential problems using EBP in a patient-centered manner demonstrating caring behaviors with use of therapeutic communication.
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3-4 pages
Diabetes:
Diabetes is a chronic condition where the pancreas does not produce enough insulin or the body does not properly use the insulin it produces, resulting in high blood sugar levels. Over time, high blood sugar can lead to serious complications affecting the eyes, kidneys, nerves, heart, and blood vessels. Tina needs to monitor her blood sugar levels regularly through finger pricks using a glucometer. Her target blood sugar range provided by her endocrinologist is 80-130 mg/dL. She should check her blood sugar before meals and at bedtime. If her levels are high, she needs to follow up with her primary care provider for medication adjustments.
Some key things for Tina to manage her diabetes include:
Eating a balanced diet with the right amount of carbohydrates, proteins, healthy fats, fruits and vegetables at each meal to keep blood sugar stable. She received education on carbohydrate counting and how to estimate portions.
Being physically active on most days of the week to help control blood sugar and weight. Short walks after meals are recommended.
Taking her diabetes medications as prescribed, which includes metformin twice daily. She needs to report any side effects.
Checking her feet daily for any wounds, blisters or changes in color or temperature and see her podiatrist every 6 months.
Having an annual eye exam with her ophthalmologist to check for any retinal damage.
Maintaining normal blood pressure and cholesterol levels through diet and medication adherence.
Avoiding tobacco and limiting alcohol intake.
Managing stress through relaxation techniques.
Seeing her endocrinologist every 3-6 months for adjustments in her diabetes care plan.
Asthma:
Asthma is a chronic lung disease characterized by inflammation and narrowing of the airways. Tina experiences symptoms like wheezing, chest tightness, shortness of breath and coughing, especially during or after exercise or exposure to allergens or irritants like smoke. Her asthma is currently well controlled with an inhaled corticosteroid, fluticasone, twice daily and an albuterol inhaler for rescue as needed. Proper use of her inhalers and adherence to her medications is key to preventing exacerbations.
Some things Tina needs to do include:
Using her preventer inhaler, fluticasone, as prescribed even when feeling well to control inflammation in her airways.
Using her rescue inhaler, albuterol, as needed for symptoms and before exercise. She was shown proper inhaler technique.
Avoiding triggers like smoke, pets, and pollens by limiting outdoor activity when pollen counts are high.
Having a written asthma action plan from her pulmonologist to recognize worsening symptoms and how to respond.
Seeing her pulmonologist every 3-6 months for lung function testing and medication adjustments.
Getting an annual flu shot to prevent respiratory infections.
Quitting smoking and avoiding secondhand smoke exposure.
Dehydration:
Dehydration occurs when the body does not have as much water and fluids as it needs. It can be caused by vomiting, diarrhea, excessive sweating, not drinking enough fluids, or a combination of factors. For Tina, her vomiting and diarrhea from her stomach virus led to fluid loss and dehydration. It is important for her to rehydrate by slowly drinking water, electrolyte beverages, broths and oral rehydration solutions over the next few days. She should avoid caffeinated, alcoholic and sugary drinks which can further dehydrate. Signs she needs to watch out for and report include dizziness, lightheadedness, decreased urine output and dark urine.
Wound Infection:
Tina had a minor wound infection on her lower leg from an insect bite. Wound infections are common and occur when bacteria enters through a break in the skin. Hers was treated with a 7-day course of antibiotics which she needs to finish and take as prescribed to clear the infection. Some things she needs to do include:
Keeping the wound clean and dry, and covered with a sterile bandage until healed. The nurse showed her how to change the dressing.
Watching for signs of infection like increased pain, swelling, redness or pus and contacting her provider if these occur.
Practicing good hand hygiene, especially before and after touching the wound to prevent spread of germs.
Avoiding scratching or picking at the wound until fully healed.
Wound Care:
For her leg wound, Tina needs to follow these steps:
Wash hands thoroughly with soap and water before and after dressing changes.
Inspect the wound daily and watch for signs of infection.
Gently cleanse the wound with saline solution or water and pat dry. Avoid soaking.
Apply a thin layer of antibiotic ointment like mupirocin.
Cover with a sterile non-adhesive dressing and secure with tape.
Elevate the leg when sitting or lying down to reduce swelling.
Contact her primary care provider with any concerns.
Medications:
Tina's discharge medications include:
Metformin 500mg twice daily for diabetes
Fluticasone inhaler (110mcg) twice daily and albuterol inhaler as needed for asthma
Amoxicillin 500mg three times daily for 7 days to complete treatment of her wound infection.
Ibuprofen for pain as needed.
She was counseled on proper administration, storage, side effects to watch out for, importance of adherence and not stopping medications early without consulting her providers. She has a two week supply and follow up appointments scheduled.
Diet:
Tina received education on following a balanced, nutritious diet focused on whole grains, lean proteins, fruits and vegetables to aid in managing her diabetes and recovery. She should drink plenty of water and avoid sugary drinks. Small, frequent meals are recommended over large ones to keep blood sugar stable. She was provided examples of healthy meal plans and snacks.
Activity:
Light activity as tolerated is advised during recovery. Once feeling better, Tina should aim for 30 minutes of walking or other aerobic exercise most days. She can start with short 5-10 minute sessions and slowly increase duration. Exercise helps control blood sugar and asthma symptoms. Proper rest is also important to allow her body to heal.
Follow Up:
Tina has follow up appointments scheduled with her:
Primary care care care provider in 2 weeks
Endocrinologist in 4 weeks
Pulmonologist in 6 weeks
Podiatrist in 6 months
She understands the importance of keeping these and contacting any provider sooner with concerns regarding her conditions, medications, or if symptoms worsen.
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