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M E T H O D TEACHING PLAN Student: _Cassie Williams___

Client’s Initials: A. A. Date: _March 28, 2009__


Diagnosis: __Peripheral Vascular Disease_______
Teaching Techniques: Give explanations, One-on-One discussions, Demonstrations, and
information pamphlets.

M (Medications):
Lovenox (enoxaparin sodium). This medication is an anti-coagulant. It
helps to prevent DVT’s, and pulmonary embolisms. DVT’s are blood clots in
the peripheral veins (usually the legs) that can travel to your lungs and
cause a pulmonary embolism. This drug is very important because with
peripheral vascular disease your peripheral venous system is not getting
efficient circulation, and Lovenox will help stop the clotting process. This
drug is given as an injection usually around left and right abdomen walls
where there is fatty tissue. Be sure and rotate your injection sites. You will be
taking 40 mg SubQ once daily. You will need to avoid OTC drugs that contain
aspirin or other salicylates. Also watch for signs of bleeding if noted notify
you MD at once. Some other adverse reactions to look for are edema,
peripheral edema, nausea and confusion. If you experience any of these
reactions notify your MD.
Aldactone (spironolactone). This medication is a potassium-sparing
diuretic. It promotes water and sodium excretion and hinders potassium
excretion, it also helps to lower your BP. This medicine will help control any
edema in your lower extremities because your Lovenox can cause peripheral
edema. This will also help to maintain a stable BP. You will be taking 50 mg
P.O. daily. Take this drug with meals to enhance absorption, and stay away
from foods that are high in potassium because this medication is a
potassium sparing diuretic and you could be at risk for hyperkalemia. Also
try and take this medicine early in the day to prevent loss of sleep due to
nocturia.
Diflucan (fluconazole). This medication is an anti-fungal. Since you
have a wound on your foot it is going to hinder fungal growth. This
medication will help with the healing process and help clean your blood of
fungal growth. You will be taking 200 mg P.O. daily. Some adverse reactions
to watch out for are nausea, anaphylaxis, headache and abdominal pain. If
any of these occur notify your MD. Also while taking this medication be sure
and stay properly hydrated.
Zosyn (piperacillin sodium and tazobactam sodium). This medication
is an antibiotic. It kills susceptible bacteria from infections. You will be
receiving 3.375 g Zosyn q6h as a 30 minute I.V. infusion. While taking this
drug you will need to watch your salt intake because pipercillin contains 1.98
mEq of sodium per gram. Also watch out for adverse reactions such as
headache, insomnia, constipation, diarrhea, and nausea. We will need to
monitor you PT/INR also because taking this drug with anticoagulants tends
to increase the risk of bleeding complications.

E (Environment):
(I am going to assess the patient for social support to help her ambulate
because she has a large wound on her left foot at the amputation site.) Since
you are having difficulties getting around due to your infected foot keep in
mind that when you get home you will need to make sure there is no debris
on the floor to aid you in falling. If there are throw rugs make sure they are
picked up so that your walker does not get tangled when ambulating. Also if
there are any family pets make sure they are not circling around your feet or
in the general area when you are ambulating. You want your major traffic
areas to be clean and easy to get around in. If there are any coffee tables
with sharp edges make sure and move them if possible so that you don’t
have a chance of bumping your leg and breaking the skin. When you are at
home sitting in a chair elevate your feet or the foot of the bed 6 to 8 inches.
This will help arterial blood supply to the extremities. You have been
ambulating without assistance just remember, when you go home to make
sure you don’t overdo yourself. Try and utilize having your daughter there to
help you.

T (Treatments):
While in the hospital you are having hyperbaric oxygen therapy (HBO). HBO
is a treatment that uses pressurized oxygen to aid in healing wounds. While
you are in therapy you will be placed in a chamber that circulates 100%
pressurized oxygen. (Patient received a copy of the info. pamphlet.) Your
treatments will typically last 90 to 120 minutes. The chamber is clear so you
can watch tv or take a nap it you like. There will be a nurse and doctor with
you to monitor your status. There are limited side effects and they are listed
in the information pamphlet I gave you. If you have any questions at all feel
free to ask. While in the hospital you will be receiving wound care but when
you go home you will need to be able to properly do this yourself if needed
when the home health nurse is not there. ( I instructed the patient on how to
use proper aseptic technique when performing wound care and she
demonstrated that she was able to do it without any complications.) The
home health nursing you will have coming to assist you can also show your
daughter how to assist you or herself in proper wound care. Try and keep
your feet well taken care of because you have PVD, and diabetes you sores
with heal at a slower rate and you have poor circulation. Your tissues don’t
get proper tissue perfusion so your wounds will take a lot longer to heal. So
the best thing to do is to prevent any possible wounds and keep your feet
clean and well taken care of.
H (Health Knowledge of Disease): Since you have diabetes,
hypertension, and septicemia, it is very important that you understand what
peripheral vascular disease is and how it affects you. Peripheral vascular
disease is an abnormal condition that affects the blood vessels in the legs
and arms. As you already have stated you know that having diabetes slows
down the healing process and lowers your immunity. Well having PVD along
with diabetes really puts you at risk for wounds because you aren’t getting
sufficient blood perfusion to your legs and feet. As a diabetic foot care is
extremely important and has to constantly be kept up with to prevent
breakdown. If you aren’t getting sufficient blood to your peripheral
extremities then keeping up with your foot care is going to be a struggle as
you can see with your wound and amputation. Also having PVD puts you at
risk for DVT’s and pulmonary embolisms. So it’s very important that you
keep on your medication regimen and eat a balanced diet and exercise.
Upon discharge if you see that your condition is worsening contact your MD
asap to schedule an appointment.

O (Out/In patient Referrals):


There is a consult for the dietitian to assist with the explanation of your diet
and to help include daughter in meal planning at home. You have a consult
for a home health nurse so she will be following up with you. Make sure that
you quickly address any appointments you need to make after discharge.
And finally, follow up with your primary care physician.

D (Diet):
You are on a 1800 calorie ADA diet, no added sugar, no concentrated sugar.
Also you need to be aware of foods that are high in sodium, and potassium
so there are no adverse reactions with your medications. (I gave a sample
menu to the patient.)

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