Patient Teaching
Earlier in this chapter, under Patient Education,
the goals and principles of patient teaching were
addressed. When taken in the context of the medical
patient, there are some general areas of patient
teaching needs that must be considered, particularly as
the patient approaches discharge from an inpatient
status. Those areas include the following:
Follow-up appointments
Modification in daily living activities and habits
Modification in diet, including fluid intake
Medications and treatment to be continued after
discharge
Measures to be taken to promote health and
prevent illness
Rest
The primary reason for prescribing rest as a
therapeutic measure for the medical patient is to
prevent further damage to the body or a part of the body
when the normal demand of use exceeds the ability to
respond. However, prolonged or indiscriminate use of
restparticularly bed restis potentially hazardous.
Some of the common complications occurring as a
result of prolonged bed rest are
circulatory problems (such as development of
thrombi and emboli) and subsequent skin
problems (such as decubiti);
respiratory problems (such as atelectasis and
pneumonia);
gastrointestinal problems (such as anorexia,
constipation, and fecal impactions);
urinary tract problems (such as retention,
infection, or the formation of calculi);
musculoskeletal problems (such as weakness,
atrophy, and the development of contractures);
and
psychological problems (such as apathy,
depression, and temporary personality changes).
The prevention of complications is the key concept
in therapeutic management for the patient on
prolonged bed rest. Awareness of the potential hazards
is the first step in prevention. Alert observations are
essential: Skin condition, respirations, food and fluid
intake, urinary and bowel habits, evidence of
discomfort, range of motion, and mood are all critical
elements that provide indications of impending
problems. When this data is properly reported, the
healthcare team has time to employ measures that will
arrest the development of preventable complications.
THE SURGICAL PATIENT
LEARNING OBJECTIVE: Evaluate the
needs of a surgical patient during the
preoperative, operative, recovery, and
postoperative phases of his treatment.
Surgical procedures are classified into two major
categories: emergency and elective.
Emergency
surgery is that required immediately to save a life or
maintain a necessary function. Elective surgery is that
which, in most cases, needs to be done but can be
scheduled at a time beneficial to both the patient and
the provider. Regardless of the type of surgery, every
surgical patient requires specialized care at each of
four phases.
These phases are classified as
p re o p e r a t i v e ,
o p e r a t i v e ,
re c o v e r y ,
a n d
postoperative. The following discussion will address
the basic concepts of care in each phase.
Preoperative Phase
Before undergoing a surgical procedure, the
patient must be in the best possible psychological,
spiritual, and physical condition. Psychological
preparation begins the moment the patient learns of the
necessity of the operation.
The physician is
responsible for explaining the surgical procedure to the
patient, including the events that can be expected after
the procedure. Since other staff personnel reinforce
the physicians explanation, all members of the team
must know what the physician has told the patient. In
this manner, they are better able to answer the patients
questions. All patients approaching surgery are fearful
and anxious. The staff can assist in reducing this fear
by instilling confidence in the patient regarding the
competence of those providing care. The patient
should be given the opportunity and freedom to
express any feelings or fears concerning the proposed
procedure. Even in an emergency, it is possible to give
a patient and the family psychological support. Often
this is accomplished simply by the confident and
skillful manner in which the administrative and
physical preoperative preparation is performed.
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