NURSING DX

BEHAVIORAL OBJ.
Knowledge Deficit: Cogitive: Client will
r/t wound care
state 3 parts of
sound care by D/C
with 100% accuracy

ADN/TRANSITION
Sample Teaching Plan
CONTENT
METHODS
I. Wound care
1.one on one
A. Importance
discussion
1. Ability to heal
2.pamphlets on incision
2. Prevention of infect
care
B. Components
3.video on incisional
1. Removal of old drsg. care
2. Inspection of wound 4.Written instructions
3. Cleansing of wound
4. Wound drsg.
C. wound care
1. Wash hands with
soap & water x 3 mins
2. Apply clean gloves
3. Remove drgs by touch
outside only - closing
dirty section inwards.

4.Discard in plastic bag

5.Chg. Gloves
6.cleanse with 1/2 str.
h2o2 & h2o. Allow to
air dry

7.Open sterile gauze

package using sterile
tech. Do not touch
inside of drsg.
8.Tear 2 strios of tape
about 6"long.
9.Apply sterile drsg over
incision without touching
incision with hands.

10.Apply tape to top

and bottom of drsg.
11.Discard used equip.
12.wash hands.

IMPLEMENTATION
1.Nurse will assess
client's readiness to
learn, prior to initial
teach. Session
2.Nurse will establish
trusting relationship with
client on day one of
hosp.
3.Nurse will review
concepts of wound care
while performing drsg.
chg for client each hosp
day.
4.Nurse will teach client
concepts for 10mins. 2
x per shift until
discharge.
5.Nurse will allow q&a
session at each teach
session until d/c
6.Nurse will validate
clients knowledge for
correctness at each 10
min teaching session 2
x per shift until
discharge.

EVALUATION
client able to state 3
parts of wound care with
75% accuracy 2 times
per shift by day 3 of
hosp. Teaching
interventions remain
ongoing.

NURSING DX
BEHAVIORAL OBJ.
Knowledge Deficit: Affective: Client will
r/t wound care
discuss feelings re:
wound care by D/C

CONTENT
I. Feelings re wounds
A.fear re:Ability to heal
B.queasiness regard
necessity to touch area
C.possible repulsivness
by Self & S/O
D.Worry about infection
II. Validity of feelings
A. Normality of
B.initial feelings
C.Ability to cope after
exposure

METHODS
1.one on one
discussion
2. Group process
3. Journal keeping
4. Role playing

IMPLEMENTATION

EVALUATION
client able to discuss
client's readiness to
feelings one on one
learn, prior to initial
during each drsg
teach. Session
change 2x per shift by
2.Nurse will establish
2nd hosp day
trusting relationship with client unable to discuss
client on day one of hosp feelings in group
3.Nurse will discuss
process. Continue one
possible feelings client on one disc. Utilize
may have regarding
journal keeping instead
wound care at each
of group process for
drsg. chg
remainder of hosp. Stay.
4.Nurse will encourage S/O willing to participate
client to verbalize
in one on one disc. By
feelings regarding
2nd hops day. Teaching
wound care throughout interventions remain
dressing changes - 2x
ongoing.
per shift until discharge.
5.Nurse will allow q&a
session at each teach
session until d/c
6.Nurse will validate
clients feelings regarding
wound care at each
teaching session 2x
/shift until discharge.
7.Nurse will encourage
s/o participation in
discussion of feelings
regarding wound care 2x
per shift at drsg chg
throughout hospl
8.Nurse will contact
support group for post
hosp. Care to cont.
interventions.
1.Nurse will assess

NURSING DX
BEHAVIORAL OBJ.
knowledge Deficit: psychomotor: client will
r/t wound care
demonstrate wound
care by D/C
with 100% accuracy

CONTENT
METHODS
I.Wound care
1. Demonstrate with
A.Wound care
return demonstration
1.wash hands with soap
& water x3 mins.
2.apply clean gloves
3.remove drgs by touch
outside only -closing
dirty section inward.
examine drsg. For
drainage - color amt,
smell, consistency
4.discard in plastic bag
5.remove. Gloves
6.rewash hands
7.Apply sterile gloves
according to sterile
glove technique
8.cleanse with 1/2 str.
h2o2 & h2o. Using
sterile cotton tip
applicators clean in one
direction only allow to
air dry
9.Open sterile gauze
package using sterile
tech. Do not touch
inside of drsg.
10.Tear 2 strips of tape
about 6"long.
11.Apply sterile drsg
over incision without

EVALUATION
client able to demo
wound care with 50%
accuracy by 1st drsg chg
on 3rd hosp.- teaching
interventions remain
ongoing.
client on day one of hosp Or: client able to
3.Nurse will demonstrate demonstrate wound
wound care 2x per shift care with 100%
on 1st day of hosp.
accuracy by d/c
4.Nurse will allow q&a
session at each teach
session until d/c
5.Nurse will encourage
client to participate in
wound care by holding
equip.and applying tape
at each dress. Chg.2x

touching incision with hand

x per shift until dischg

12.Appply tape to top

and bottom of drsg.
13.Discard used equip.
14. wash hands

IMPLEMENTATION
1.Nurse will assess
clients readiness to
learn, prior to initial
teach session
2.Nurse will establish
trusting relationship with

per shift on 2nd hosp day

6.Nurse will assist

client with performing
own wound care 1x on
3rd hosp day.
7.Clent will preform
entire wound care
procedure by 2nd drsg
chg on 3rd hosp day
8.Nurse will validate
clients knowledge for
correctness at each 10
min teaching session 2
8.Nurse will provide
positive reinforcement for

efforts of client at each

drsg chg.2xper shift

Implimentation con't
9.Nurse will provide
client & S/O with written
instructions at d/c