Question

Mr. Smith, a 57-year-old patient, presents at a health fair asking questions about the age-appropriate health maintenance and promotion considerations he should be concerned about. He stated that he only goes to his physician when he is sick and the last time he saw his physician was 2 years ago when he had a sinus infection. (Learning Objectives 7 to 9) What further assessment does the nurse need to make before designing a teaching plan? What topics does the nurse need to include for Mr. Smith based on current medical recommendations? Design a teaching plan that covers the topics.

Answer 1

Assessment is the first step in patient education. Evaluate your patient’s skills and knowledge in important areas. Consider the patient’s reading level, ability to learn, ability to understand English, and resources. Use the assessment findings to develop a unique plan for the patient.

Consider the following before designing a teaching plan :

• Maintain a positive and patient attitude.
• Take a few minutes to talk and problem-solve before starting to teach.
• Identify significant cultural or social factors that may affect the teaching learning process.
• Include the patient in setting learning goals. Keep the material relevant to the learner’s needs.
• Identify and try to accommodate any disability that may affect the learning process.
• Slow the pace of instruction and gear teaching to the patient’s rate of absorption. Stop teaching if the patient appears tired or stressed.
• Break each topic into small parts. Repeat sessions when necessary. Give pertinent, positive feedback.
• Assess responses carefully to make sure the information was understood correctly. Gear the frequency and duration of your teaching to match your patient’s learning ability and need to know.

Middle-aged adults experience changes of aging to varying degrees depending upon the individual. For some individuals these changes are very stressful.

Assess to detect risk for: Skin breakdown due to dryness and decreased subcutaneous tissue, Hypertension and hyperlipidemia, Sleep apnea, Skeletal injury due to diminished bone density and osteoporosis, Assess and address nutritional needs.

Health teaching for Mr. Smith should include clarifying information about -

• He should be made aware about the need to make important lifestyle changes now, as time is of the essence before they get a chronic illness. This may include important topics such as weight loss and strategies for accomplishing weight loss goals.
• He should be made aware that as they age they become more and more vulnerable to all sorts of illnesses and injuries. This includes pneumonia, cancer and chronic endocrine diseases. Besides learning about appropriate lifestyle modification involving nutrition and exercises, also need to learn about stress management, as well as key warning signs of possible impending illnesses. For example, they may need to learn about how to spot memory problems, signs of cancer like a change in the color of a mole, or an endocrine disease, such as sudden weight gain, so that all can be caught and treated earlier.

Teaching plan includes -

• Diet

He should consume a well-balanced diet based on the food pyramid and recommended daily allowances of nutrients. Some changes in caloric intake and protein and vitamin needs appear to be desirable with aging.

• Exercise

Regular exercise should be a part of any daily plan for Mr. smith. Exercise can help keep the joints flexible, maintain muscle mass, control blood glucose levels and weight, and promote a sense of well-being. Exercise such as Walking, swimming, golfing, housekeeping, and active lawn work or gardening are all advised. To be of most benefit, exercise should consist of at least 30 minutes of continuous activity. The type, level, and amount of exercise that is most beneficial differ for each person and should be based on physician recommendations.

• Tobacco and Alcohol

It is never too late to stop smoking. Cessation may be difficult when smoking has been a long-standing habit, but various aids are now available to help smokers quit. Before using any of these aids, older adults should seek guidance from their physicians because they may need to follow some special precautions related to existing health problems.

Excessive consumption of alcoholic beverages is never recommended. Alcoholism is an all too common problem in the older adult population—both men and women—because alcohol may be used as a means of coping with depression, sleep disorders, or other problems. Occasional or moderate alcohol consumption usually is not prohibited or restricted unless some medical condition or medication precludes its use. Some physicians even recommend a glass of wine or beer as an appetite enhancer in certain situations.

• Physical Examinations and Preventive Overall Care

Mr. smith should be examined at least once a year by their physicians—more often if known health problems exist. A delay in the recognition of problems may make more difficult and more costly to treat. Physical examinations provide an opportunity for the physician to detect problems before it become more serious, to monitor and treat chronic conditions, and to prevent some health problems.

Physical examinations should include evaluations of height and weight, blood pressure, and blood cholesterol levels if this has been a concern, as well as a rectal examination. Older men need a prostate examination and blood tests to rule out prostate cancer. Persons with identified risk factors for colon cancer require occult blood screening and, possibly, a colonoscopy.

Evaluation of joints, feet, and gait should be part of the physical examination. Problems with the knees and shoulder joints can cause pain, limitation of activity, poor sleep, and decreased overall function. Some problems require surgical correction, whereas others can be treated more simply using analgesics, antiinflammatory medications, or physical therapy. Inspection of the feet often reveals problems. Neglecting the feet can lead to discomfort, restricted mobility, and a poorer quality of life.

Vision should be checked yearly to monitor for glaucoma or other eye problems. Refractive examinations can detect the need for a change in eyeglass prescription. Hearing examinations need not be done on a yearly basis unless a problem is suspected. When signs of diminished hearing are present, audiometric testing is appropriate.

Blood tests for hypothyroidism, diabetes, or cholesterol levels; electrocardiograms; and other diagnostic tests are not routinely part of the physical examination.