How to do a better teaching plan for pulmonary edema patient?

[evelyna52]

Hello there! I am a nursing student who is currently studying my first year of Diploma in Nursing.

I am doing a case study which includes teaching plan. I had finished a draft of the teaching plan, however the lecturer commented that I might not on a right track.

Here is the case scenario:

"a 78 years old male who is admitted to A&E complaining of difficulty in breathing while lying flat for one day. He complains of swelling of both feet for the past one week.

Medical history: Type II Diabetes, Hypertension and Smoker Vital Sign on arrival: BP 90/60mmhg, HR 120bpm, RR 28bpm.

Physical assessment findings: Upon auscultation crackles were heard over the base of lungs. No chest tenderness.

Diagnosis: pulmonary edema."

My topic for the teaching plan is "How to manage pulmonary edema by monitoring hypertension". Since pulmonary edema is a chronic disease which is difficult to cure, so I think maybe we can manage it by monitoring patient's chronic condition, which are hypertension and diabetes. And my whole teaching plan is about the nursing management for hypertension, such as lifestyle modification, take antihypertensive medication as prescribed regularly etc.

Then, my lecturer said my teaching plan might not possible that monitoring hypertension will not help much on pulmonary edema.

Now, I am very confused about what I should teach to the patient. I would like to ask for idea for the teaching plan. Your reply will be greatly appreciated. Thank you!

[la_chica_suerte85, BSN, RN]

You might need to study more on the pathophysiology of pulmonary edema because managing hypertension (also, did the pt present with hypertension???) will not be a direct way of preventing pulmonary edema. You have to look at how and why fluid backs up into the lungs, what the danger signs are before it actually gets this bad, the medications that are used for this and so on and so forth. It might make better sense to you how to do a teaching on pulmonary edema (especially in the context of why the pt was lying flat for one whole day).

[evelyna52]

Thank you so much for your reply.

I reviewed on the case scenario. The patient only has a history of hypertension. I think of 3 topics for the teaching plan.

1. "How to manage onset pulmonary edema by restricting fluid intake " Maybe I can teach the patient to prevent pulmonary edema from getting more serious.

2. "How to manage pulmonary edema by taking medication as prescribed"

Maybe I can just teach the patient about the side effects and the indication of the drugs that help him to get better from the disease?

I really don't have much idea. Please kindly guide me.

[HouTx, BSN, MSN, EdD]

Our pt teaching plans are problem-centered because that makes them more meaningful to the patient (what's in it for me). By structuring it in this way, we lessen the "eyes-glazing-over-with-too-much-high-level-information" effect.

First, we help patients get a better understanding of why they're having shortness of breath.. using diagrams and such so show how fluid collects in the lungs. We help them figure out how to utilize positioning to 'move' edema away from their lungs and improve airway function (HOB up, sitting upright with arms resting on overchair/bed support, etc. We teach them how to monitor their own fluid build-up - daily weights, dependent edema, etc. We stress safety - especially if they have hx of dizziness, using oxygen, etc. THEN we go into the "preventative" therapies... helping them to understand the role of each medication. If they really understand all the prior information, this part is easier, and they are much more compliant with meds.

It is critically important to chunk the information into smaller bits. And use 'teach back' methodology after each chunk to make sure that they really understand the concepts. We also try to stay reality-based, by incorporating knowledge of their post-discharge situation. Where will they be living? Who is their caregiver? Does their arthritis prevent them from being able to effectively manipulate their nebulizer connections?

Does that help?