Health Education Plan: Teaching the Patient with Hepatitic C For years, nursing was a task-oriented career. A nurse’s primary responsibility was to provide for the physical needs of patients experiencing illness. Nursing has evolved into a profession, which holistically treats and educates patients in a variety of health situations including acute illness, chronic disease, and preventative care. The competent practice of patient education has become a critical element in nursing.
This paper will show the process of formulating a detailed patient specific teaching plan for a patient newly diagnosed with Hepatitis C. Hepatitis means liver inflammation and refers to a group of viral infections, most commonly Hepatitis A, Hepatitis B, and Hepatitis C. The Center for Disease Control and Prevention (2009, ¶1) states, “Hepatitis C virus (HCV) is the most common chronic bloodborne infection in the United States; approximately 3. 2 million persons are chronically infected. ” Neighbors and Tannehill-Jones (2006, p. 10) reports, “Over 12,000 individuals die each year from hepatitis C. ” HCV is transmitted by exposure to infected blood; either by blood transfusions of unscreened blood or injecting drugs, although, other less common exposures to blood may result in HCV. “The majority of infected persons might not be aware of their infection because they are not clinically ill. However, infected persons serve as a source of transmission to others and are at risk for chronic liver disease or other HCV-related chronic diseases decades after infection” (CDCP, 2009, ¶2).
Early symptoms of HCV are usually mild but may include fever, fatigue, dark urine, clay-colored stool, abdominal pain, jaundice, loss of appetite, nausea, vomiting, and joint pain (CDCP, 2009). Many times HCV infection is not detected until a physician orders routine liver enzyme tests or when a patient donates blood and the screen reveals HCV-positive result. Treatment for HCV depends on the stage. Antiviral drugs are being used with some success. Alcohol is prohibited. Proper nutrition and rest are necessary. Vitamins, minerals and diet supplements may be should be considered to prevent malnutrition.
Diuretics may be needed if ascites occur. Herbal medicines such as milk thistle, licorice, have been used in India for thousands of years in liver disease treatment and prevention though they do come with risks and should be used with caution. H. B. Trant is an active 83-year-old Caucasian male, with an extensive history of Coronary Artery Disease. He underwent Coronary Artery Bypass surgery, in the early 1980s and has received routine medical care after that for hypertension, squamous cell carcinoma skin lesions, and minor illnesses. He recently visited his physician with complaint of unplanned weight loss and fatigue.
The physical assessment revealed unplanned 15-pound weight loss and enlarged spleen. In addition to comprehensive blood panel, his physician ordered anti-HCVtest, which had a positive result. Subsequently an RIBA, a supplemental anti-HCV test indicated a positive result. His ALT test was within normal limits. The patient has no history of illicit drug use or any other questionable activities. He stopped smoking shortly after his heart surgery and has not used alcohol since he was 20-years-old. The physician determined that the most likely cause of exposure was a blood transfusion he received during his heart surgery, in the early 1980s.
At that time, there was inadequate screening of donated blood. The patient was diagnosed with Chronic Hepatitis C and scheduled to undergo liver biopsy to assess potential liver damage. The patient is an active rancher in a small rural community, where he has lived his whole life. He graduated from high school and served in the United States Army. He is a long-time deacon of the Baptist church and teaches Sunday school class each week. His wife of 62 years is suffering from Alzheimer’s disease and remains at home. He has three adult children who live nearby and are available for assistance and support.
Patient education about health is a pertinent part of the nursing practice. The nurse must assess each patient on and individual basis by performing a learning needs assessment and determining preferred learning methods. In this patient’s case, the nurse performs a learning needs assessment, which includes general screening questions to determine what knowledge the patient has regarding his disease process, how he perceives his present condition, and the patient’s preferred learning methods. Knowing the preferred learning method, specific to the patient, will determine what teaching methods should be used.
The learning needs assessment performed by the RN indicates that the patient is lacking sufficient understanding related to his disease. The patient completed a copy of the VARK questionnaire. The information obtained from this assessment indicated the patient’s primary preferred learning style was visual with kinesthetic secondary. The nurse and the patient together discuss the issues and agree that the patient needs additional information and teaching in specific areas and set the learning objectives noted in the Teaching Plan (see Table I. . Redman (2007) states the following: Educational objectives are based on assessment of a patient’s readiness and need to learn; they are the framework for the instructional plan. Instructional forms and teaching materials are identified or constructed to provide the learning conditions necessary for meeting the objectives. Teaching plans put these elements together and guide implementation ( p. 52 ) Table I Teaching Plan for H. B. Trant – Hepatitis C Patient learning objective Content Education Mode* Modifications/Comments Objectives met Date/Initial) Patient will define the disease process of Hepatitis C and the effects on the body. Anatomy and Physiology as it related to the liver and Hepatitis C. Modes of transmission and ways to prevent accidentally exposing others. Signs and symptoms of liver damage and liver failure. V, P, DSon and daughter with patient to view video and participate in discussion. Pamphlets also given to family members. 11/18/09 DC Patient will demonstrate ability to make healthy food choices. All alcoholic beverages are strictly forbidden.
Multivitamins to supplement dietary intake. Consult with dietician to evaluate diet and make recommendation. V, D, RDPatient scheduled to meet with dietician on 11/20/09 Continue dietary information at 11/25/2009 follow-up appt. Patient will relate the importance of follow-up care to monitor for liver damage. Follow-through with liver biopsy. Physician visit every three months for lab work. Visit physician if change in condition occurs. V, P, DScheduled for liver biopsy on 11/23/2009 Will discuss additional follow-up after liver biopsy results.
Patient will specify actions to help reduce fatigue related to decreased metabolic energy secondary to liver dysfunction. Small frequent meals Avoid activity immediately after meals Keep frequently used objects within easy reach Decrease environmental stimuli. Participate in activities that promote relaxation: massage, relaxation tapes, yoga. D, PProvided local resources for massage therapy and yoga classes and individual instruction. 11/18/09 DC Patient will specify need and steps involved in liver biopsy to decrease procedure related anxiety.
Out-patient procedure. Local anesthesia. V, DPatient and family members viewed liver biopsy video and participated in discussion. Scheduled for liver biopsy on 11/23/2009 11/18/09 DC *Education Mode Key: V-Video, P-Pamphlet, D-Discussion, R-Reciprocal Demonstration (Redman, 2007), (Swearingen, 2008), (National Digestive Disease Clearinghouse, 2009) The teaching plan is a fluid learning tool that can be changed and adjusted as the patient progresses through the disease process.
Objectives should also be re-addressed at times during the learning process. Neither the nurse nor patient should have expectations that all learning objectives will be completed at once. Education is an on-going process. In conclusion, the patient portrayed in this paper received appropriate holistic assessment and intervention relating to his education needs. In particular, the patient’s emotional needs were addressed. The nurse and patient determined by that he has a strong support system with his children, friends, and church family.
He was not interested in participating in group therapy, though he is aware of the group option and local resources available. This is not always the case, creating an individualized patient teaching plan requires time. The nurse must perform not only a physical assessment but also a learning assessment, develop patient specific goals, research information, and provide resources to the patient. With the current staffing shortages in the nursing profession, nurses in the acute setting find it difficult to create teaching plans, due to lack of time and resources.
Hospitals have developed generic teaching pathways, which do assist in the process, but do not account for individual specific needs. Patient education is a critical element in health care. Hospitals and nursing staff must work together to provide education resulting in informed patients. Informed patients are much more likely to make positive decisions affecting their health and reducing health care costs. References Centers for Disease Control and Prevention . (2009). Hepatitis C Information for Health Professionals. Retrieved November 18, 2009, from http://www. dc. gov/hepatitis/HCV/index. htm National Digestive Disease Clearinghouse. (2009). What I need to know about Hepatitis C. Retrieved November 18, 2009, from http://digestive. niddk. nih. gov/ddiseases/pubs/hepc_ez/index. htm Neighbors, M. , & Tannehill-Jones, R. (2006). Human Diseases (2nd ed. ). Clifton Park, NY: Thomson Delmar Learning. Redman, B. (2007). The Practice of Patient Education: A Case Study Approach (10th ed. ). St. Louis, MO: Mosby Elsevier. Swearingen, P. (2008). All-in-One Care Planning Resource (2nd ed. ). St. Louis, MO: Mosby Elsevier.