Running Head: TEACHING PLAN 1

Norquest College

NFDN 1002

Assignment 1: Teaching Plan

Fauziya Ali

October 8, 2015

Wanda Scott

0263031
Teaching Plan 2

Teaching Plan

The client for this teaching project is a 72 year old female that presently is in moderate

health. The teaching focus ultimately is to improve her quality of life, increase mobility and

maintain medication compliance. With a achievable, specific plan with instructions on

medication, increasing mobility and improving diet will hopefully result in a improved state of

overall health and wellness.

This clients past medical history is vast: arthritis, hypertension, ankylosing spondylosis,

cerebral aneurysm (with repair), and more recently COPD, macular degeneration, obesity and

cellulitis (lower right leg). She has a smoking history (30 years), but quit approximately 7 years

ago prior to her brain aneurysm surgery. This focus will concentrate on lack of regular exercise,

mild exercise intolerance, shortness of breath and medication avoidance.

Assessment Data

This client is in her retirement years, starting retirement early because of her ankylosing

spondylosis and spinal correction surgery. Her income is adequate and sometimes lean, leaving

her a merger retirement. She has grown, raised her adopted child, worked and retired all in a

small coastal town in the Sunshine Coast of British Columbia. This has allowed her a vast

support system including life long friends since grade school. This group provides grocery and

home support when needed, ill or times of great stress (divorce or bereavement) as well as

weekly social outings. This client has had a moderate life with not much extravagance, some

traveling and visits to family inn her younger years.

Education basics were achieved through the public school system having received a

Grade 12 diploma. Work experience was on the job at the local City Office or provided by small

courses through weekend retreats. This population hailed from a small town in Italy, therefore

the people retained their heritage and language, both spoken and written.

This client has struggled with weight gain and loss for the better part of her midlife. She

has belonged to two weekly weight loss groups for the better part of twenty years. These groups

both meet weekly to which she is a regular attendance participant. This participation in weight

loss groups has given her the education abut exercise and nutrition for weight loss, which will

aid and reinforce some of the principles of this teaching plan.

At present she is struggling with the decreased activity level because of her shortness of

breath which is resulting in additional weight gain. She is eager to try this teaching plan, not only

for a structured approach to activity, but ultimately some weight loss. The only barrier to

learning, might be memory loss, so the information about her medication and walking schedule

will be provided in a written format. This is be easily accessed for reinforcement and schedule

maintenance.

Chronic pain is difficult to handle as well as the medications prescribed to treat. This

client has had a long history with difficult and increasing back/neck pain and is treated with

many anti-inflammatories and narcotic based analgesics. “Many elderly patients suffer cognitive

impairment, confusion or memory loss, either from pathology or medication, which can be

compounded by sight and hearing impairment.” (Potter and Perry, 2014, p. 1023)
Teaching Plan 4

Although this patient has an extensive health history and a long standing relationship

with her current physician, she remains non-compliant with her COPD medication, specifically

Combivent and Simbacort MDI. This is one focus area for teaching and implementation.

Goal Setting

This goal setting session is initiated as a one-on-one setting in her home, which fits well

with the clients learning style. Instructional material includes font samples, two example of style

and documentation options and medication information both on computer access and typed index

cards.

This client is a visual learner and prefers a written schedule that she can refer to and

“check” when completed. This will help with the memory and evaluation of this teaching plan.

She would prefer a one page reference that she could mount to her fridge as a reminder.

Headings and check boxes with be in 20 New Times Roman Font and in bold for ease of reading.

“Bold type or underlining emphasizing important information”, as stated in Critical Thinking in

Nursing, (Lipe and Beasley, 2004, p, 177). The client also prefers the typed index cards instead

of “favouriting” the medication information page on her computer. Reese (2202) stated that

visual verbal learners preferred the written language - pictures and charts charts.

There are no cultural beliefs or restrictions to goal setting. In fact a plump “Nona” figure

is quite prominent in the Italian stereotype. This client is seeking change to improve her wellness

and her ability to continue an active lifestyle, because she is facing real restrictions because of

her shortness of breath.

This client has much education on this subject and chooses her eating pattern more based

on a social need as compared to a nutritional one. A elderly women on her own, eating and

cooking have been replaced with evening get togethers with other widowed or single friends.

This is fulfilling her social need and therefore will not be altered at this time. She is adamant that

she remain in charge of her eating habits and does not wish to alter her food choices at this time.

As she states “this is one pleasure I have left”.

The client is only interested in participating in exercise that is indoors. The weather there

is temperamental so a indoor place that can be safe for seniors to walk is at the local mall.

“Patients with known cardiac disease and those with multiple risk factors should be cautioned to

avoid exertion incl. weather…can precipitate chest pain and bronchospasm.” (Potter, 2014, p.

901) There is additional walking support, because she enjoys walking with a shopping cart. Her

height (5”2’) is easily supported by a cart and she finds it comfortable, something that she

already does and enjoys. The client suggests this as a place for exercise because of the increasing

fear of falls and inclement weather.

The two learning goals for this teaching plan are COPD medication compliance and a

regular exercise program. “ Dyspnea is difficult to quantify and to treat. Treatment modalities

need to be individualized….and more than one therapy is usually implemented.” (Potter and

Perry, 2014, p. 901) The merit of both will vastly improve quality of life and aid in ease of daily

activities. “Exercise is the key factor in promoting and maintaining a healthy heart and lungs.

Patients should be encouraged to exercise 3-4 times a week for 20 - 30 min.” (Potter and Perry,

2014, p. 901).
Teaching Plan 6

A cognitive goal with this client is to provide background information about her

medications and the rational why she is to take as prescribed. A demonstration of how to

administer MDI. medications with a spacer will be provided and then the client will display the

correct administration of the MDI. She will define her medication schedule and the expectations.

Teaching Strategies and Rationale

The teaching strategies for this client are taking from page 175 of Critical Thinking in

Nursing. They state for a client of this age group, this plan will follow using visual aids placed

on the fridge where there is adequate light and no glare. It is also suggested to have large font

black print on plain white paper. Phone calls will reinforce with verbal instruction and provide

feedback for a better chance of behaviour modification again as suggest. This will help establish

and maintain independence, which is a underlying fear. Written instructions are provided on a

calendar based information sheet, along with medication instructions and reminder check boxes.

Teaching Plan

First week: MDI’s (both) taken 20 minutes prior to walking activity at the mall

Ten minutes of continuous walking with a shopping cart for support (timed with a watch).

This is repeated three times a week - Monday, Wednesday and Friday. (Days chooses by client so

that she could remember).

Second week: MDI’s (both) taken 20 minutes prior to walking activity at the mall.

Thirteen minutes of walking with a shopping cart for support (timed). Repeated three times a

week.
Teaching Plan 7

Third week:MDI’s (both) taken 20 minutes prior to walking activity at the mall. Fifteen

minutes of walking at the mall with a shopping cart for support (timed). Repeated three days per

week.

Fourth week: MDI’s (both) taken 20 minutes prior to walking activity at the mall.

Seventeen minutes of walking at the mall with a shopping cart for support (timed). Repeated

three days per week.

Evaluation includes reviewing the compliance “check box” on working calendar form,

overall wellbeing on scale of 1 -10 and evaluation of shortness of breath with walking again

using the scale of 1 -10 and times client had to stop walking to catch her breath.

Expected outcome: Client does all assigned exercise as planned, MDI with spacer will be

taken daily as prescribed, wellness scores are five or greater and shortness of breath while

exercising is measured seven or above. Reports of colds, flu or chest pain will cause immediate

reduction of activity in plan.

Initial assessment indicates that client states a 2/10 for shortness of breath while walking

during a shopping experience. and average stopping is approximately 2-4 times per experience

(usually noted by inability to talk). Overall client feels 1 - as poor and 10 as very well or no

complaints, she states an average feeling day is approximately a 6/10. MDI compliance is noted

by check marks indicating that the medication was taken daily as directed.

One month evaluation will measure the shortness of breath while exercising is reported as

6/10 (probably inaccurate), overall wellness on scale 1 - 10 and the determination self

administered the MDI with spacer daily. Daily MDI with spacer administration was adhered to
Teaching Plan 8

and exercise was completed one to two times a week, which is a increase in mobility and

exercise than previously.

Evaluation of Teaching Plan

The teaching plan strengths are the daily monitoring of medication administration, it is

easy to follow and acts as a reminder for the client. This client is now medication compliance

with her COPD MDI medications.

The exercise program provided a good place for exercise and socialization for the elderly.

However, three days a week were too ambitious only obtaining one to two exercises periods per

week at most. the client prefers one to two days as for after the one month teaching plan.

Timing the exercise was useful, but not accurate with a hand based watch. Increasing the

time by two minutes was achievable by the client, but only if they participated two times per

week, otherwise no increase was tolerated.

Evaluation of well being using the scale 1- 10 did not evaluate as well as expected.

Instead a sticker based system (face profiles) would have been a better indicator of overall health

and well being. Client felt that this was too hard to determine and then abandoned completely.

Evaluation of shortness of breath using the scale 1 -10 was too difficult for the client to

use. Instead a scale of mild, moderate and severe would have been a better choice to monitor.

A fridge based calendar, with easy check boxes worked well for this client. It was a daily

reminder for medications and exercise and the client liked the visual cues and ease of use.
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Conclusion

This teaching plan was a partial success. In reviewing the nursing diagnosis, this plan did

educate the client about her COPD medications and the importance of taking them daily and as

prescribed. The clients activity tolerance did increase with daily medication administration and

activity planning and execution. Activity was decreased to one to two walking exercises for 15

min after the four weeks of the teaching program.

The activity and monitoring calendar on the fridge was enjoyed by the client. She could

follow it with ease. She found it easy to read and she used it as a reminder for her medication

administration.

Altering the teaching plan for future teaching will aid in the success. Relying on a more

simplistic evaluation process will lower the confusion for the client and provide a better

assessment tool. Sticker with the face representation instead of a scale would be easier to use for

the wellness determination. Changing the evaluation of shortness of breath would have lessoned

the frustration, descriptions (cannot speak while walking, have to stop to catch breath, or able to

speak whole sentences while walking) for determination in a legend on the side would help

maintain the consistency.

There was no cost involved in the implementation of this teaching plan and follow up

was done via phone calls. Personal follow up or having another connected person follow up in

could have reenforced the program and the continuation of exercise. A older persons activity

program in which a nurse could organize, tract, supervise and access would have merit and show
Teaching Plan 10

a better evaluation and outcome for clients. This enforces the need for face-to-face evaluation

and the support of personal care program for the older client.
Teaching Plan 11

Nursing Care Plan

Nursing Diagnosis

1) At risk for activity intolerance, related of her COPD, AEB non-compliant medication

administration and SOB while walking.

2) Readiness for enhanced knowledge, related to her COPD, AEB interest and asking for

aids/help.

3) Risk for ineffective activity planning, related to her COPD, AEB shortness of breath

with mild exertion.

Assessment:

Ask client how long she has been short of breath while walking (Shopping).

Ask client why they are reluctant to take the MDI medication for her COPD.

Observe resting and exhertional breathing rates.

Auscultate apecies and bases bilaterally

Findings:

Client states “ For a year or more”.

Client states “That I only take them when I feel really short of breath and never carry them in my

purse”.
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Client is free from shortness of breath during a sitting assessment and is able to speak full

sentences.

Bases are clear on auscultation, fine wheezes to species bilaterally.

Planning

Client will administer with a spacer both MDI twice per day as directed.

Client will administer her Ventolin MDI as needed for shortness of breath and wheezes.

Client will be able increase her ability to walk without stopping because of shortness of breath.

Expected Outcomes

Administration of MDI will be tracked on calendar.

Compliance use of Ventolin for shortness of breath in addition to regular doses.

Walking assessment will have a respiratory rate of 12-20, not cough and able to speak at least

6-10 words together.

Clients lungs will be clear on auscultation

Interventions

Written instruction of medication routine/schedule.

Teaching rational for medication compliance.

Exercise to maintain heart and lung health.

Rational

“Visual-non-verbal learners prefer pictures….charts and diagrams.” (Reese, 2002)

For the older adult: “Provide written instructions for reinforcement.” (Lipe, 2004, p. 175)

Basic medication theory, medication administration simulation and client administration. “…a

patient performs the activity following the course of lessons, summative evaluation

determines whether the education truly altered patient behaviour.” (Lipe, 2004, p. 181)

“Exercise is the key factor in promoting and maintaining a healthy heart and lungs. Patients

should be encouraged to exercise 3-4 times a week for 20 - 30 min.” (Potter and Perry,

2014, p. 901).

Evaluation

Ask Client to evaluate speaking while walking and at rest.

Assess lung sounds by auscultation.

Assess respiratory rate walking and at rest.

Assess MDI compliance on chart.

Patient Response and Findings

Client able to speak full sentences at rest, 4-6 words while walking.

Clear on auscultation.

Respiratory rate walking: 24-26.

Respiratory rate at rest: 16-18.

Partial MDI compliance - No additional use of Ventolin for shortness of breath and 4 days

missed regular dosage.

Achieved Outcome

Chest auscultation is clear.

Client able to speak full sentences while at rest.

Improved MDI compliance.

References

Lipe, S. and Beasley, S. (2004). Critical Thinking in Nursing. Philadelphia, PA, Lippincott

Williams &Williams

Herman, T. H., Kamitsuru, S. (Eds.). (2014) NANDA International nursing diagnoses:

definitions & classifications, 2015-2017. Oxford: Wiley Blackwell.

Potter. P. A., Perry, A. G., Stockert, P.A., Hall, A. M., Ross-Kerr, J. C., Wood, M. J., Astle, B. J.,

Duggleby, W. (Eds.), (2014). Canadian fundamentals of nursing (5th ed.). Toronto, ON:

Mosby/Elsevier Canada.

Reese, S. (2002). Understanding our differences. Techniques, 77(1), 10-23