NR 226 Week 7 Pneumonia Discharge Teaching Plan Example

Discharge Teaching Plan: Five Things Mr. W. Must Do at Home After Pneumonia, Who Does Each One, and What Sends Him Back

Student Name

College of Nursing, Chamberlain University

NR 226: Fundamentals: Patient Care

Instructor Name

Month Day, Year

Discharge Teaching Plan: Five Things Mr. W. Must Do at Home After Pneumonia, Who Does Each One, and What Sends Him Back

Only What Leaves the Building

Mr. W., 81, goes home on day six of his admission for pneumonia. His saturation is 94% on room air, his cough is stronger, the sacral wound has not grown, and he walks 30 meters with a walker. He goes home to the two-story house he shares with his wife, Joan, 79, who uses a walker herself. Their daughter lives 20 minutes away and has taken two days off work. A home health nurse will visit twice a week. Details are composite.

The plan teaches only what he or his family must do at home, and each item traces to a problem in the care plan: airway clearance, skin integrity and falls, plus the antibiotic that continues his treatment. It leaves out nearly everything about pneumonia itself, because nothing in the textbook's explanation of pneumonia is something he has to do.

The Person Who Does the Task

Mr. W. does most of the tasks himself, and the plan is written to him. Two tasks need someone else. The sacral dressing is changed by the home health nurse, not by Joan, who cannot kneel or bend safely. And the bedroom setup, moving a bed downstairs so he does not climb the stairs at night, is done by his daughter before he arrives home. Teaching was given to Mr. W. with Joan and their daughter present, and each person was taught only the part they will do.

Actions With a Time or a Trigger

1. The antibiotic. Amoxicillin-clavulanate, one tablet at 0800 and 2000 with food, until the last tablet on Sunday evening. Keep taking it even when you feel better. (Traces to the treatment of his infection.)

2. Deep breaths and coughing. Every two hours while awake, sitting up: three slow deep breaths, then a cough while hugging a pillow. Use the kitchen timer. (Traces to airway clearance.)

3. Getting up. Before you stand, sit up with your feet on the floor and count slowly to sixty, stand with the walker, and use it every time you walk, including at night. The bed is downstairs; the bathroom is eight steps away; the night light stays on. (Traces to falls.)

4. Off your back. In bed or in the recliner, lie on your side or tilt with a pillow behind you, and do not sit in one position more than two hours. Let the home health nurse look at the dressing on Tuesday and Friday. (Traces to skin.)

5. Eating and drinking. A small meal or snack six times a day, including the shakes the dietitian recommended, and at least six glasses of fluid a day, one each time the breathing timer goes off during the day. (Traces to skin and to the fatigue behind all three problems.)

Confirmation You Can Watch

Each item was confirmed by watching, not by asking whether he understood. Mr. W. explained the antibiotic schedule to me, including the day it ends, without looking at the sheet. He showed me three deep breaths and a cough with a pillow. He stood from the bed, paused, and walked with the walker to the door and back. Joan and their daughter told me when the home health nurse would come and what the dressing is for. A systematic review of the teach-back method in chronic disease education found improvements in disease-specific knowledge, adherence and self-efficacy, with a positive but inconsistent trend in readmission rates (Ha Dinh et al., 2016). The evidence is not perfect, but asking him to show or tell me each item revealed one misunderstanding: he thought he could stop the antibiotic once his cough was gone. That was corrected before he left.

What Was Left Out, and Why

Several things a textbook discharge plan would include were deliberately left out. The explanation of how pneumonia develops was left out, because he asked no questions about it and it changes nothing he does. Advice about vaccines against pneumonia and influenza was given to his daughter in writing for the follow-up visit, because it is a question for his primary care provider next month, not a task for this week. And a long list of antibiotic side effects was reduced to the one he is most likely to have, diarrhea, and what to do about it.

The sheet he took home fits on one side of a page, in large print, with the five actions at the top and the warning signs at the bottom. His daughter asked for a second copy for the refrigerator, and that request is the best sign I have that the sheet will be used rather than filed. A plan is only useful at home if it can be found at home, at the moment a question comes up.

Warning Signs With an Action Attached

Call 911: severe trouble breathing, lips or face turning gray or blue, chest pain, or if he cannot be woken easily.

Call the doctor's office the same day: fever of 38.3 C (101 F) or higher after being fever-free; breathing harder when resting; coughing up more sputum, or sputum that is darker or bloody; new confusion; the dressing soaked through, or the area around it red, hot or smelling bad; a fall, even without injury.

Tell the home health nurse at the next visit: not eating more than half of meals for two days; the antibiotic causing diarrhea.

Barriers Treated as Constraints

Four barriers were treated as fixed facts the plan had to fit, not as problems to lecture about. Joan cannot bend, lift or walk far, so no task was assigned to her that requires any of those; her role is to remind him of the timer and to call if something on the list happens. The stairs cannot be removed, so the bed moved downstairs. Mr. W. does not like to bother people, so the plan tells him plainly that calling the office about a warning sign is expected, and the office number is on the refrigerator in large print. And food still tastes metallic to him, so the plan relies on cold, sweet shakes and small meals rather than asking him to eat full meals he does not want.

His daughter's two days off end on Wednesday. After that, the home health visits are the family's main support, and the plan asks the home health nurse, on the first visit, to check whether the daily routine is working now that the daughter has gone back to work.

References

Ha Dinh, T. T., Bonner, A., Clark, R., Ramsbotham, J., & Hines, S. (2016). The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 14(1), 210-247. https://doi.org/10.11124/jbisrir-2016-2296