Miscellaneous-Teaching

PAIN

Pain I

SN instructed patient/caregiver to take pain medication before pain becomes severe to achieve better pain control. Always refill your meds before you run out of them. SN instructed patient on nonpharmacologic pain relief measures, including relaxation techniques, positioning, etc. SN instructed to report to physician if experiencing pain level not acceptable, pain level greater than 6/10, pain medications not effective, unable to tolerate pain medications, and pain affecting ability to perform normal activities

Nonpharmacologic Pain

SN instructed patient/caregiver on nonpharmacologic pain relief measures, including relaxation techniques, massage, stretching, positioning, and hot/cold packs. SN instructed patient to report to physician if patient experiences pain level greater than 6, pain medications not effective, patient unable to tolerate pain medications, pain affecting ability to perform patient’s normal activities.

Pain Management I

SN instructed patient/caregiver on importance of pain management. Take pain medication as ordered. Do not wait for pain to become severe. If your pain is not controlled and you are taking your medication as prescribed contact your doctor or nurse. Do not take your medication more often than prescribed without talking with your physician. Patient verbalized instruction.

Pain Management II

SN instructed patient/caregiver on pain management. Acute pain such as occurs with trauma, often has a reversible cause and may require only transient measures and correction of under lying problem. In contrast, chronic pain often results from conditions that are difficult to diagnose and treat.

Pain and Exercise

SN instructed patient/caregiver about Pain and Exercise. Although resting for short periods can alleviate pain, too much rest may actually increase pain and put you at greater risk of injury when you again attempt movement. Research has shown that regular exercise can diminish pain in the long term by improving muscle tone, strength, and flexibility. Exercise may also cause a release of endorphins, the body’s natural painkillers. Some exercises are easier for certain chronic pain sufferers to perform than others.

Pain is experiential

SN educated patient/caregiver that Each person experiences and expresses pain in an individual manner using a variety of sociocultural adaptation techniques. The important issues is expressing pain before it becomes unmanageable.

Pain is subjective

SN educated patient/caregiver that Pain is a subjective experience and must be described by the Pt in order to plan effective treatment plan to reduce pain as much as possible using a verity of techniques.

Pain management

SN educated patient/caregiver on pain management: pain med must be taken before pain becomes too intense; also, it may be taken before an activity that is expected to induce pain, in order to minimize the pain; instructed the caregiver to observe Pt very carefully for over-sedation.

Pain Non-Pharm Techs

SN educated patient/caregiver that the use of non-pharmacologic techniques (e.g., relaxation, guided imagery, music therapy, distraction, and massage) before, after, and if possible during painful activities; before pain occurs or increases; and along with other pain relief measures.

Pain Opioids & Constipation

SN educated patient/caregiver that Constipation is a common side effect of opioid narcotics. That if permitted increases water consumption, fresh fruits and vegetables and exercise will help to alleviate this problem.

Pain and DM

SN educated patient/caregiver about Pain and DM. Diabetes can destroy small blood vessels, which in turn can damage the nervous system, and these damaged nerves can cause pain. The pain arises from the nerves that are injured or malfunctioning that can be from the tip of the toe to the brain. Diabetes pain usually strikes first in the hands and feet.

IV LINE

Central Catheter Problems

SN instructed patient/caregiver on signs of central catheter problems. The signs of catheter infection and problems are similar for all types of central venous catheters. If you have any sign of infection or catheter problem, call your doctor immediately. In addition, signs of infection, clotting, or other problems include: Redness, tenderness, drainage, warmth, or odor around the catheter site Fever of 100.5F (38 C) or greater, or chills, swelling of the face, neck, chest, or arm on the side where your catheter is inserted, leakage of blood or fluid at the catheter site or the cap, inability to flush the catheter, or resistance to flushing the catheter, displacement or lengthening of the catheter.

Thrombophlebitis

SN instructed patient/caregiver watch for these problems: a hole in the skin where the IV is — medicine or fluid can go into the tissue around the vein. This could harm the skin or tissue. Swelling of the vein — this can lead to a blood clot (called thrombophlebitis).

Phlebitis I

SN instructed patient/caregiver about Phlebitis. This is inflammation of the vein. It is a common complication associated with intravenous therapy. It may occur up to 48 hours after catheter removal.

Phlebitis II

SN instructed patient/caregiver about Phlebitis, or an inflammation of the vein, may occur when receiving IV antibiotics which can be irritating to smaller veins. Symptoms of phlebitis include redness, tenderness and swelling. Education about recognition of these complications allows the patient to be involved and can help reduce the risk of further complications related to IV therapy.

Extravasation I

SN instructed patient/caregiver about Extravasation that occurs when the catheter dislodges from the vein and a vesicant solution or medication is administered into the surrounding tissue, leading to tissue necrosis.

Extravasation II

SN instructed patient/caregiver on IV complications. One of these complications is infiltration, or fluid leaks into the tissue surrounding the vein. This may be accompanied by swelling, burning, and discomfort. Extravasation occurs when a vesicant drug, such as those used in chemotherapy, leaks into the surrounding tissue, with similar signs and symptoms to infiltration. In this case, however, the vesicant may destroy the surrounding tissue making it extremely important to catch and treat this early.

DRAINS

Jackson Pratt Care I

SN instructed patient/caregiver about Jackson Pratt care. The JP drain removes fluids by creating suction in the tube. The bulb is squeezed flat and connected to the tube that sticks out of your body. The bulb expands as it fills with fluid. SN instructed patient use soap and water or saline (saltwater) solution to clean your JP drain site. Dip a cotton swab or gauze pad in the solution and gently clean your skin.

Jackson Pratt Care II

SN instructed patient/caregiver about Jackson Pratt Care. Seek immediate help if: Your JP drain breaks or comes out. You have cloudy yellow or brown drainage from your JP drain site, or the drainage smells bad.

Jackson Pratt Care III

SN instructed patient/caregiver Jackson Pratt care. Call your caregiver if: You drain less than 30 milliliters (2 tablespoons) in 24 hours. This may mean your drain can be removed. You suddenly stop draining fluid or think your JP drain is blocked. You have a fever higher than 101.5°F (38.6°C).

Jackson Pratt Care IV

SN instructed patient/caregiver when should I contact my healthcare provider. You drain less than 30 milliliters (2 tablespoons) in 24 hours. This may mean your drain can be removed. You suddenly stop draining fluid or think your JP drain is blocked. You have a fever higher than 101.5°F (38.6°C). You have increased pain, redness, or swelling around the drain site. If you have questions about your JP drain care contact your physician.

Jackson Pratt Care V

SN instructed patient/caregiver about the risks of having a Jackson Pratt drain. The JP drain site may be painful. You may have trouble lying on the side with your JP drain. Your JP drain site may leak. The JP drain may be pulled out by accident. The tubing may get blocked, crack, or break. The tubing may damage your tissue. You may have a scar. The JP drain site may get infected. This infection could spread inside your body.

Jackson Pratt Care VI

SN instructed patient/caregiver about Jackson Pratt Care. It recommended that your safety pin the drainage bottle to your clothing during the day and to your clothes during the night. Allow enough slack to Prevent the tube from being pulled do up or from pulling on the drain sutures.

Percutaneous Drain Care

SN instructed patient/caregiver on percutaneous drain care (Nephrostomy, Biliary or Abscess). Call your doctor/SN right away if you notice any of the following: increasing pain, chills, catheter becomes dislodged or broken, leaking from the catheter, blood in or around the catheter, fever of 101 degrees or higher, output decreases by 1/2 within 24 hours

INJECTION

Injection Procedure

SN instructed patient/caregiver that any injection procedure, infection at the site of injection is a possibility. Signs of infection at the injection site include: severe pain, redness, swelling, warmth or drainage. These symptoms should be reported to your physician immediately.

Safe Disposal

SN instructed patient/caregiver about safe disposal of needles/syringes is important whether you are at home, work, school or traveling. If you are using needles/syringes, it is your responsibility to make sure that you dispose of them properly in a puncture-resistant sharps container.

Never to Do

SN instructed patient/caregiver that remember to NEVER: reuse needles or recap needles on a syringe, throw loose needles/syringes in the garbage, flush loose needles/syringes down the toilet, place loose needles/syringes in recycling bins/containers. Instead, immediately put them in a puncture-resistant, sharps container.

Proper Depth

SN instructed patient/caregiver on injecting at the proper depth is an important part of good injection technique. Insulin be injected in the subcutaneous fat, which is the layer of fat just below the skin. If injected too deep, the insulin could go into muscle, where it’s absorbed faster but might not last so long.

REPRODUCTIVE

Hysterectomy Radical to Care

SN instructed patient/caregiver about the Hysterectomy radical to care for the incision with general hygiene and daily bathing. The patient was advised to evade constipation by taking mild laxatives and stool softeners. The patient was taught to care of the suprapubic catheter. The patient was reviewed that no interaction tampons, douching, or tub baths. The patient was explained that menstruation will no longer happen.

Ovarian Cancer

SN instructed patient/caregiver in ovarian cancer in the need to care for the incision with general hygiene and daily bathing. The patient was advised to evade constipation by taking mild laxatives and stool softeners. The patient was taught to care of the suprapubic catheter. The patient was reviewed that no interaction tampons, douching, or tub baths. The patient was explained that menstruation will no longer happen.

Mastectomy I

SN instructed patient/caregiver in the breast surgery that if the axillary nodes are removed, the affected arm may inflate and is less able to fight infection. The patient was advised on daily arm exercises. The patient was taught to change dressing, evaluate appearance of the incision and drain site. The patient was encouraged not to abduct the affected arm or raise the arm or elbow above the shoulder until drains are removed. The patient was instructed to avoid use of deodorants, to avoid wearing constricting clothing or jewelry on the affected arm and to carry her handbag on the unaffected arm.

Mastectomy II

SN instructed patient/caregiver with bilateral mastectomy with strips with moderate serosanguinous drainage, and two Jackson-Pratt skilled nurse performed JP Drain Care, the JP drain removes fluids by creating suction in the tube. JP#1 drain 30 ml and JP#2 drain 25 Ml serosanguinous drainage. The bulb is squeezed flat and connected to the tube that sticks out of your body. The bulb expands as it fills with fluid.

TRAUMA

Orthopedic Boot

SN instructed patient and caregiver on how to put the boot on patient properly first make sure patient has on sock, place heel in back of boot where calf of leg fits into the foam insertion site, place the hard front section on front of leg making sure the foam section in on ankle, bring soft side sections around and covers the hard area, secure with the Velcro straps. When boot is applied properly, using inflation device, inflate boot until firm. Patient must always wear boot if out of bed, may only remove to sleep.

Cast care I

SN educated patient/caregiver to report to doctor immediately if any of the following happen: The cast gets wet, damaged, or breaks, skin or nails on the toes/fingers below the cast become discolored, such as blue or gray.

Cast care II

SN educated patient/caregiver that if itching occurs under the case to refrain from placing any objects under the cast to scratch. Items like; pencils, pen, chop sticks or wire hangers can cause damage to the skin scratching it and causing infections.

Cast care III

SN instructed patient/caregiver about cast care: keep the cast clean and avoid getting dirt or sand inside the cast. Do not apply powder or lotion on or near the cast. Cover the cast when eating, do not place anything inside the cast, even for itchy areas. Sticking items inside the cast can injure the skin and lead to infection. Using a hair dryer on the cool setting may help soothe itching, do not pull the padding out from inside your cast.

Cast care IV

SN instructed patient/caregiver that keeping your regular cast dry is very important! There are no devices that are 100% effective in keeping any cast dry. Sponge baths are the safest way to keep the cast dry. If you have to take a bath or shower, please follow these instructions: place a towel or washcloth around the upper portion of the cast. Cover the entire cast with 2 plastic bags (use two in case one has a leak, secure the bag at the top with tape or a rubber band, if the cast gets moist, dry the top or bottom of the cast using a blow dryer. Use only the cool or low setting, if the cast is soaked all the way through, it needs to be changed (call doctor office).

Cast care V

INCIDENT

After a Fall

SN instructed patient/caregiver that after a fall he/she should call for help. If no one responds and he or she does not feel injured, it is advisable to crawl to the nearest chair or strong piece of furniture to try to get up and continue to call for help.

Prevent fall I

SN instructed patient/caregiver on measures to prevent falls at home: Keep a cordless phone and a flashlight with new batteries by the bed. Walk on the grass when the sidewalks are wet or slippery. Clean any spilled or splashed grease on the kitchen floor immediately to prevent accidents. Remove small area rugs and place non-slip treads on bare wood floors, steps and at the top and bottom of the stairs to prevent falls. Keep appliances cords out of areas where you walk. Patient and/or caregiver instructed to install grab bars in the bathtub. Place a rubber mat or adhesive texture strips on the bottom of the bathtub and/or shower to prevent falls. Patient/ caregiver instructed not to pile up items on the floor, stairway or pathways between rooms. Instructed about the importance to use an assistive device all the time, while walking and transfer, to prevent falls and possible fractures.

Prevent fall II

SN instructed patient/caregiver to make sure lighting is adequate and to wipe up spills immediately to prevent falls.

Hallways clear

SN educated patient/caregiver on importance of keeping hallways clear: free of boxes, clutter, disburse or loose rugs; these pose a great risk for falls and potential injuries.

Report fall

SN instructed patient/caregiver to contact SN/Agency to report any fall with or without minor injury and to call 911 for fall resulting in serious injury or a fall causing severe pain or immobility.

OTHERS

When to call 911

SN instructed Pt and CG if patient develop symptoms requiring emergency assistance such as: difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face call 911.

Seizure

SN instructed patient/caregiver what should be done in the event of seizure. Place a pillow or something soft under her head to protect it. Remove and hard objects or furniture that may get in the way and cause injury. Turn her on her side to help avoid aspiration of secretions into the lungs. Never place anything in her mouth or try to restrain her in any way. Notify physician (MD) of any seizure activity as well as duration of the seizure. When the seizure has subsided, she may feel disoriented or tired so it’s okay to allow her to rest and sleep. Patient and caregiver verbalized understanding of all teaching.

Hurricane Preparedness

SN instructed patient/caregiver about Hurricane Preparedness. Due to the time of year being Hurricane season, SN educated Pt/ CG on this agencies hurricane preparedness including this agencies policies and procedures. SN discussed how to maintain safety in the event of a severe storm. Provided patient with a list of essentials…adequate supply of medications, food, water, first aid, batteries and pet supplies. Helped patient to locate the closest shelter and provided emergency phone numbers. SN further instructed Pt/CG to look into the hurricane preparedness policies and procedures for this ALF as well as, in the case of extreme emergencies, this ALF’s transfer/relocation protocols.

Overexertion

SN educated patient/caregiver that overexertion must be avoided; patient should stop any activity that produces increased difficulty breathing, palpitations, sweating, dizziness or lightheadedness and that if these symptoms occur Pt should contact SN or MD.

Pernicious anemia

SN educated Pt/CG that Vitamin B12 is given to treat pernicious anemia, which is a condition that causes the body not to produce red blood cells. Symptoms include diarrhea or constipation, fatigue, lack of energy, or lightheadedness when standing up or with exertion, loss of appetite, pale skin, problems concentrating, shortness of breath, mostly during exercise. If not treated pernicious anemia can lead to irreversible nerve damage in spinal cord.

Osteomyelitis

The patient and caregiver were instructed in osteomyelitis in the necessity of wound care using aseptic method for dressing changes. The patient was advised to care of a casted extremity. The patient was reviewed to care for external fixator device. The patient was recommended how to use and care for the Hickman catheter for home antibiotic therapy. The patient was encouraged in the importance of immobilizing the affected part to reduction the spread of infected material.

Chemotherapy

SN instructed patient and caregiver that after the chemotherapy patient call the doctor if have any of these symptoms: Signs of infection, such as fever, chills, or sweats; Diarrhea that does not go away or is bloody; Severe nausea and vomiting; Inability to eat or drink; Extreme weakness; Redness, swelling, or drainage from any place where you have an IV line inserted; A new skin rash or blisters; Jaundice (your skin or the white part of your eyes looks yellow); Pain in your abdomen; A very bad headache or one that does not go away; A cough that is getting worse; Trouble breathing when you are at rest or when you are doing simple tasks; Burning when you urinate.

Fluid Retention

SN instructed patient/caregiver on fluid retention. Fluid retention leaks into body tissues from the blood. The lymphatic system is a network of tubes throughout the body that drains this fluid from tissues and empties it back into the bloodstream.