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TEACHING CARE PLAN
Nursing 102
Teaching Care Plan
Medical Surgical Rotation
Caitlin Baeder

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Abstract
This paper illustrates an interaction and teaching between the student nurse and client which
takes place at Saint Mary’s Medical Center. Using a functional health pattern assessment, the
nursing process, physical assessment, and interview, a plan of care has been established and used
to relate to the material learned during this rotation.
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Teaching Care Plan
The student nurse met her patient CA on April 10th
, 2015 in Saint Mary’s Medical Center
(SMMC). CA is a married 37 year old female diagnosed with Thyroid Cancer and had a
thyroidectomy performed during her stay at the hospital. CA’s allergies included latex and
shellfish. The patient stated her medical history was sparse. She had mild asthma when she was a
child that flares up in the spring and she was diagnosed with endometriosis when she was in her
twenties. The patient was awake, alert, and oriented and appeared calm, well-kempt, and clean;
however she seemed distressed due to her pain level. By 1000, she had brushed her hair and
teeth, washed her face, and put on makeup once her pain subsided.
While performing a head-to-toe assessment of CA, the student nurse found the patient’s
incision site from the thyroidectomy. The incision was an inch in length and sutured with Steri-
strips. There was no drainage, edema, or inflammation present, however there was redness
present and created a border that measured to be an inch in width. The incision wasn’t warm on
palpation, her WBC was within the normal range, and the patient didn’t report an itching
sensation on the surgical site; however she stated she was in severe pain (reported 9 or 10 on the
pain scale). The finding was ruled out as a possible reaction to the steri-strips.
The patient had a decreased appetite due to the surgery being performed on her throat,
causing her pain. Because the pain was so great, CA spoke in a whispered or low voice to
prevent having increased pain sensations. She ordered vanilla pudding, apple sauce, and hot tea
from the cafeteria, but only finished 50% of her meal. She drank about 12 ounces of water during
the nursing student’s shift, but stated that she was in pain while doing so. CA had Potassium
Chloride (KCl) IV solution running at 84 milliliters per hour.
Assessment data is included in the Functional Health Pattern (FHP) (Appendix A).

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Nursing Diagnosis
Acute Pain related to recent surgical procedure as evidenced by the patient reporting
consistent pain that worsens when she swallows.
Knowledge Deficit related to nonpharmacological methods of pain relief as evidenced by
patient stating “I don’t know how I’m going to deal with this pain when I go home.”
Priority
It’s important to teach the patient how to relive the pain as it has been noted to have a
potentially harmful effect on a person’s well-being and it has already began to show in the
patient. Pain could interfere with sleep (CA stated she has been sleeping for less than 8 hours),
and affects appetite (CA has been eating less than 50% of her meals and has stated her appetite
has decreased). A natural response to pain is to stop activity, tense muscles, and withdraw from
the pain-provoking activities. In this case, CA is limiting her use of the muscles in her neck and
reduced the activities requiring her to swallow, decreasing her intake of oral fluids. Uncontrolled
pain impairs immune function, which slows healing and increases susceptibility to infections and
dermal ulcers. The short, shallow breathing that accompanies pain produces atelectasis, lowers
circulating oxygen levels, and increases cardiac workload. The physical stress and emotional
distress of severe or prolonged pain can contribute to the development of a wide variety of
physical and emotional disorders. Persistent, severe pain changes the nervous system in a way
that intensifies, spreads, and prolongs the pain, risking the development of incurable chronic pain
syndromes. Unrelieved pain changes the structure and function of the nervous system within 24
hours by prolonging and intensifying the pain experience. It is a result of repeated stress on
afferent nerves, creating a greatly enhanced response and activity level in the CNS. This also
allows normal tissue surrounding the affected area to become extremely sensitive to pressure in

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areas that were previously not identified as painful. To prevent the development of persistent
pain and promote overall health and well-being, the student nurse must act to promote optimal
and effective pain control.
Planning
1. Short term goal: By 1400 today, the patient will successfully demonstrate three
nonpharmcological methods of pain relief.
Rationale: to assist in comfort-function goals and allow the patient to play a role in pain
control; nonpharmcological methods also allow the patient to have more control over her
pain and be able to manage pain without the use of medications if she wants to avoid the
side effects (confusion, weakness, sedation, respiratory distress, ect)
2. Long term goal: By discharge, the patient will state less than 2 on the pain scale at all
times.
Rationale: if pain is not treated, it can decrease the patient’s appetite and make it difficult
for the patient to establish normal sleep patterns. This can cause a lack in energy or
ability to perform ADLs, facilitating delayed healing and causing more medical issues.
Implementation
Intervention 1: The student nurse assessed CA’s ability and readiness to learn and assessed
the patient’s presence of pain. When using the 0-10 numerical pain rating scale to get a valid and
reliable self-report, CA stated her pain level was present and reached a “9 or 10.”
Rationale 1: Learning readiness changes over time based on situational, physical,
and emotional changes. Teaching goals cannot be properly met if the patient’s pain is still

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present and severe because the patient will be focusing only on the pain and not on what is being
taught, decreasing the patient’s retention. By using single-dimension pain ratings, the student
nurse was able to use valid and reliable resources to measure pain intensity level and to
determine if the patient can provide a self-report.
Intervention 2: The student nurse assessed the patient’s pain presence routinely; for
example, when obtaining vital signs, and during activity and rest. CA stated the presence of pain
was at its highest when she would need to swallow.
Rationale 2: Pain assessment is as important as physiological vital signs. Pain
should be reliably assessed both at rest (important for comfort) and during movement (important
for function and decreased patient risk of cardiopulmonary and thromboembolic events). By
investigating when the pain was present, the student nurse can now create an environment that
prevents the pain to be at its highest and can teach the patient how to avoid it.
Intervention 3: The student nurse taught CA the use of physical nonpharmacologic
techniques such as ice or heat application, cutaneous stimulation, massage, heat and cold
application, acupressure, contralateral simulation, and immobilization or bracing to help with
pain management. Teaching took place before pain occurred or increased and was in
combination with other pain relief measures.
Rationale 3: Physical interventions like cutaneous stimulation can provide
effective temporary pain relief by distracting the patient and focusing attention on other stimuli,
away from painful sensations, reducing pain perception as a result. Physical interventions also
interfere with the transmission and perception of pain by stimulating sensory nerve fibers that
activate the endorphin system of pain control and diminishing conscious awareness of pain.

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Intervention 4: The student nurse taught CA the use of cognitive-behavioral
nonpharmacologic techniques such as relaxation, guided imagery, music therapy, and distraction
to help with pain management. The teaching took place before the pain occurred or increased and
was in combination with other pain relief measures.
Rationale 4: Cognitive-behavioral interventions like distraction draws the
person’s attention away from the pain and lessens the perception of pain. It makes the person
unaware of the pain only for the amount of time and to the extent that the intervention holds his
or her “undivided” attention. The cognitive-behavioral interventions also facilitate relaxation,
decreasing muscle tension, activating the sympathetic nervous system, and putting the patient at
lower risk for stress-related types of pain.
Intervention 5: The student nurse checked the medical order for any drug prescribed along
with its dose, and frequency along with determining analgesic selection based on type and
severity of the patient’s pain. CA was prescribed morphine, the dose being 4 mg every 3 to 4
hours via IV push and scheduled to be administered before meals.
Rationale 5: By performing a drug check, this ensures that the nurse has the right
drug, right route, right dosage, right patient, and right frequency. This also helps the nurse when
determining a plan of action when the patient reports severe pain.
Evaluation
Outcomes were fully met. CA was able to verbalize pain and discomfort, stating willingness to
try relaxation techniques. CA attempted to do so and stated that ice and heat application and
distractions (such as watching a movie or her favorite TV show) were the most effective. By
discharge, the patient stated “the pain is a 2” on a scale of 0-10 about 30 minutes after IV

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administration of morphine. CA was also able to swallow soft food like apple sauce and drink
water without reporting severe pain.
Self Evaluation
I think I did pretty well when it came to following the caring concepts. I was aware of my
patient’s need for care, individualizing it to her needs and providing any assistance required.
Every action I performed had the intention to do something for or with my patient to assist and
promote positive change through the nursing process. By judging the positive changes, I was
able to determine the basis of what is good for the patient, therefore allowing the care provided
to reflect the patient’s welfare and human dignity when she was in a vulnerable state. However, I
know that certain things could have been done differently to improve the situation. I only noted
three medications she was prescribed when she had more in the MAR. By not knowing what the
other medications were, I didn’t keep a full awareness of my patient’s health and how they could
have affected her healing process. I could have also provided my patient with more learning
resources so she felt more prepared when she was discharged that day.
I encountered a couple of barriers during the teaching process that were resolved prior
and during teaching. The patient was in a great amount of pain during her stay at the hospital so I
had to conduct a pain assessment and manage the pain before teaching could begin. The patient
was also a bit preoccupied with her illness and unable to concentrate on new information. After
the doctor was able to explain her prognosis, she was able to relax and teaching was successful.

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References
Ackley, B. J., & Ladwig, G. B. (2013). Nursing Diagnosis Handbook (10th ed.). Maryland
Heights: Elsevier.
Berman, A., & Snyder, S. (2009). Chapter 46: Pain Management. In Kozier and Erb's
Fundamentals of Nursing (9th ed.). Upper Saddle River, New Jersey: Pearson.
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2011). Chapter 50: Endocrine
Problems. In Medical Surgical Nursing: Assessment and Management of Clinical Problems
(8th ed.). St. Louis, Missouri: Elsevier.
Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2013). Davis's Drug Guide for Nurses (13th
ed.). Philadelphia, PA: F.A. Davis Company.

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Appendix A
FHP

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Appendix B
Medications received by the client during this hospitalizations are listed below (authors, year):
ceFAZolin (Kefzol): Anti-infective used as treatment of infections caused by susceptible
organisms such as (and not limited to) skin infections, pneumonia, and septicemia.
Dose range: IV in adults for perioperative prophylaxis: 1 g given 30-60 minutes prior to
incision; 500 mg to 1 g given for all surgeries q 6-8 hr for 24 hr postoperatively.
Side effects: colitis, diarrhea, nausea, pain/phlebitis at IV site, pruritus, superinfection
Labs: may cause an increase serum AST, ALT, alkaline phosphatase, bilirubin, LDH,
BUN, and creatinine
Dexamethasone (Decadron): Corticosteroid used to suppress inflammation and modification of
the normal immune response
Dose range: PO, IM, IV in adults to treat anti-inflammatory symptoms: 0.75-9 mg daily
in divided doses q 6-12 hr.
Side effects: hypertension, nausea, vomiting, thromboembolism, fluid retention
Labs: may decrease WBC, serum potassium, and calcium, but may increase serum
sodium concentrations
Morphine (AVINza): Opioid analgesic used to manage moderate to severe pain.
Dose range: IV in adults greater than or equal to 50 kg: 4-10 mg q 3-4 hrs
Side effects: respiratory depression, hypotension, bradycardia, confusion, sedation
Labs: May increase plasma amylase and lipase levels

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