Lefort Colpocleisis Teaching Plan

Teaching Plan for the Patient with LeFort Colpocleisis
Addressing the learning needs of patients is a major responsibility for nurses. Through teaching plans, nurses can help patients and their families have a safe experience and prevent possible complications. Each patient needs an individualized and comprehensive teaching plan. Nurses must anticipate goals and barriers, identify the subjects they will teach, the methods they will use to teach, and assess their readiness to learn. In addition, nurses should reflect on the effectiveness of their teaching plan to determine if the desired goal was met. Educating clients can improve their quality of life. According to Berman, Synder, and Frandsen (2016), “the goal is to assist the client to achieve the most optimal health status possible” (p.865).
The teaching plan will be focused around a 78-year-old female with complete uterine prolapse and urinary incontinence was admitted to the hospital. Her husband helps with clean intermittent catheterization. She was presented to the hospital on 2/28/17 preoperative for LeFort Colpocleisis (LFC). Aside from health issues, she suffers from atrophic vaginitis, asthma with COPD, and osteoarthritis. LeFort
Colpocleisis (LFC) is an operation, which treats the symptoms of prolapse by sewing the front and back walls of the vagina together (Elkattah et al., 2014, p. 1). According to Abassy and Kenton (2012), LFC is associated with success rates of greater than 90%, both anatomically and reports of patient satisfaction (p. 3). Patients are no longer able to have sexual intercourse following this procedure. A few of the most important postoperative nursing diagnoses that apply to this patient are risk for infection, risk for impaired skin integrity, and sexual dysfunction. It is imperative to include the patient’s husband in the teaching plan because she is dependent on him.
Teaching plan objectives can be created in order to help the patient reach a healthy recovery. Since most patients will go home the day after LFC, discharge teaching is very important. The patient has several learning needs. The patient’s learning needs that are essential to focus on are preventing blood clots, enhance lung expansion, reduce risk for infection at the wound site, and sexual dysfunction. Assessment data that might affect the teaching plan for the patient is that she is a native speaking Spanish elderly patient. The plan is to include her husband in the teaching process, who is a fluent English speaker and is willing to help translate. Additionally, the nurse should arrange an interpreter for further clarification. The nurse will begin by teaching about the importance of preventing blood clots by demonstrating the use of compression socks and leg exercises postoperatively. These interventions will help promote venous return. The first leg exercise will be to alternate dorsiflexion and plantar flexion of the feet, the second will be to flex and extend the knees, and last to raise and lower the legs alternating from the surface of the bed (Kozier, 2016, p. 886). Emphasize the importance of early ambulation after surgery and promote walking as tolerated to keep the blood flowing and prevent clots. The patient should be informed to avoid lifting any objects more than 10 lbs. for at least 4-6 weeks after surgery (Greenleaf, 2012, p.1).
Another important learning need for this patient is to enhance lung expansion especially due to her history of asthma with COPD. After surgery, the nurse should monitor vital signs and assess lung sounds. The nurse will counsel the patient that pneumonia can occur from not expanding their lungs frequently. As a result, the nurse will demonstrate deep-breathing exercises to enhance lung expansion. This will be achieved by asking the patient to sit up tall, place the palms of her hands on her ribcage and ask to inhale slowly and evenly through nose as they feel their chest expand then exhale slowly through their mouth. The nurse will encourage the patient to do these exercises every 2 hours (Lemone et al., 2015, p. 873).
While in the hospital, the nurse will assess the surgical site for any signs of infection.
In order to reduce the risk of infection at the wound site, the nurse will teach the patient signs and symptoms of infection. The nurse should enforce that once the patient is discharged from the hospital, it is essential to contact their physician if they experience a fever greater than 100.4 F, increasing or severe pain, vaginal bleeding greater than 1 pad an hour, redness, swelling or any leakage from the incision as this can indicate an infection (Greenleaf, 2012, p.8). According to Greenleaf (2012), There is nothing the patient needs to put on their incision, but it is important to keep the site clean and dry (p.4). To clean the site, she may be instructed to use mild soap and
water.
On a psychosocial level, the patient may experience anxiety or feelings of depression about the effects of surgery, which is a common barrier to behavioral change. A contributing factor may be the patients’ sexual dysfunction due to the surgery. It is important to address this topic with both the patient and include her husband as well. The nurse will provide opportunities for the client and her spouse to talk about concerns of sexual functioning, listening to the concerns of the patient, and encourage them to share their concerns with their partner (Lemone et al., 2015, p. 1320) It is the nurse’s goal to encourage the patient to express feelings that may signal negative self-concept as well as to discuss basic anatomy and be honest in answers to the client’s questions.
To assess if the patients learning needs were met the nurse evaluated the expected outcomes. Having the patient verbalize and demonstrate teachings will indicate successful teaching. Asking questions is another method used to evaluate if there are areas of teaching that need further reinforcement. In order to help build motivation and patient’s willingness to learn, involve them by setting goals together about their care. Offer precise and positive reinforcement for even small achievements. The presence of the patient’s husband will provide strong emotional support. The written and verbal information provided by the nurse will be at patient’s/families level of understanding. The nurse will emphasize the follow up postoperative appointment scheduled after 2 weeks and ensure the patient has a safe ride home.