HEALTH TEACHING WORKSHEET NUR 120 Genesee Community College Nursing Program Patients diagnosis ___Right Knee Arthroplasty____

In relation to the patients diagnosis, what are you teaching and why is this health teaching necessary? 75 year old patient (HB) was admitted to the inpatient unit on 4/18/11, who underwent L Total Knee Arthroplasty. There were no complications postop. At 0830 on 4/19, HBs VS were as follows; temperature 37.2 C, BP 100/56, pulse 84, respirations 16. HB is calm, cooperative, oriented x3, and pain was noted at 4 at the incision site, on a scale of 1-10. HB will be starting Coumadin therapy on 4/19, and will continue taking it for 5 weeks following discharge from the hospital. It is important that HB understands why she will be on Coumadin and why it is so important to follow her doctors orders to prevent bleeding complications post-operatively. The patient will be instructed in the correct usage of the anti-coagulant before leaving the hospital. Identify one (1) expected outcome for this teaching learning session. (You must use a behaviorally stated outcome from one of the three learning domains identified in your class notes). HB will verbalize after our discussion the importance of following the Coumadin therapy regimen prescribed by her doctor in the coming weeks after discharge. (Cognitive)

Date ___4/25/11___________ Student _______Karolyn Shea________

List two (2) teaching learning principles that you plan to incorporate into your teaching plan and explain how you will use them. (These are identified in your class notes and text). 1. Learning is more effective when it is in response to a felt need of the learner or is meaningful to the learner. HB has undergone L Total Knee Arthroplasty as a measure to alleviate the pain associated with arthritis in her knees. HB is likely to follow the teaching plan and the MD orders following discharge. HB verbalized that she was happy to have her knee surgery done, since the pain she experienced limited her ADLs at home. She had R Knee Arthroplasty surgery in 2009. 2. Learning is made easier when the learner is aware of his/her progress. HB verbalized that when she had her R Knee Arthroplasty surgery in 2009, she was on Coumadin Therapy for several weeks, and complied with the MD orders. HB stated that there were no bleeding complications following her surgery in 2009.

How long do you estimate that your health teaching session will last? 10-15 minutes Identify two (2) teaching methods that you plan to use and explain how you will use them in your teaching session. 1. Discussion with the patient, HB, how Coumadin works by reducing the livers ability to use Vitamin K. Vitamin K plays a role as the bodys natural blood clotting process. I will discuss with HB the

List three (3) professional resources that you used to develop your teaching plan. They must be within five years and they must be cited using APA format. One of these resources must be from a professional journal (online or print). Attach a copy of any internet resources.

1.

Walker, M.B., & Bussey, H.I. (2008, January). Vitamin k and warfarin: what you should know. Retrieved from http://www.clotcare.com/clotcare/vitaminkandwarfarin.aspx

HEALTH TEACH WORKSHEET

Page 1

importance in following the guidelines her surgeon has outlined for her to reduce the risk of forming a blood clot after discharge from the hospital. (Discussion) 2. Printed materials will be provided for HB to reinforce our discussion on Coumadin Therapy. Included will be information for her diet, since large amounts of Vitamin K can alter the results that monitor her blood clotting factors, PT and INR. (Printed Materials)

2. S h e a , J . M . , & V e n k a t e s h , D . ( 2 0 0 9 ) . T h i n g s y o u s h o u l d k n o w
about taking coumadin. Retrieved from http://www.pcca.net/CoumadinTherapy.html

3. W o f f a r d , J . L . , W e l l s , M . D . , & S i n g h , S . ( 2 0 0 8 ) . B e s t
strategies for patient education about anti coagulation with warfarin: a systematic review. BioMed Central Health Services Research, 8(40), 1472-1483.

Outline the exact content you plan to present to the patient in an organized, logical manner. (Use outline format) I. Discuss Coumadin therapy as a post-op DVT prophylaxis A. Liver uses vitamin K to make blood clotting proteins which plays a role in your body's natural clotting process. B. Coumadin reduces your risk of forming a blood clot,

Evaluate the patients/familys response to the teaching. Identify whether or not you met your expected outcome. I feel I would have met my expected outcome with the Pt verbalizing that she understands the importance of following her MDs orders on the regimen of taking Coumadin. The Pt is aware of the process of Coumadin therapy, since she experienced taking it for several weeks following her R knee arthroplasty surgery in 2009, without complications. The Pt would most likely ask what kinds of foods are high/low in Vitamin K. I would then give her the list of foods that I printed for her on Foods in the diet that are have high, moderate, and low amounts of Vitamin K.

especially DVTs that can occur following surgery from blood stasis in the legs due to reduced mobility. C. Best defense against DVT is to stay well hydrated, get up and walk according to your doctors orders
II. Discuss blood tests, PT and INR A. Weekly blood draws will be taken from HB to monitor clotting times B. Dosage adjustments will be made to keep blood clotting times in the therapeutic range, per MD Discuss diet in relationship with taking Coumadin A. Maintain a consistent dietary intake of vitamin K by

III.

eating the same types of food normally eaten B. Explain the vitamin K content of the foods by giving HB a list of high and low vitamin K content foods
IV. Allow HB to ask any questions she may have to clarify anything weve discussed
HEALTH TEACH WORKSHEET Page 2

HB Coumadin Discharge Orders: Goal Range- 1.5-2.5 x Indication- Post-op DVT prophylaxis Anticipated Duration- 5 weeks Managed By- Rashid, MD (surgeon) PT / INR blood draw day after transfer, then every M, W, F for 2 weeks. Then every duration time on Coumadin PT / INR draws on M and Thursday.

KG/s08; RH/s10(\GUYETT\HEALTH TEACH WORKSHEET)

HEALTH TEACH WORKSHEET

Page 3