Question

A nurse is reviewing the provider's prescription in the adolescent's medical chart.

History and Physical
Adolescent is sexually active with two current partners.IUD in placeReports not using condoms during sexual activity.History of type 1 diabetes mellitus
Nurses' Notes
1300:Admitted adolescent reporting ""cramping in my stomach."" Reports pain as a 4 on 0 to 10 pain scale and describes pain as constant and dull. Reports nausea and vomiting over past 24 hours.Reports painful urination and pain during sexual intercourse with minimal vaginal itching.Tenderness with palpation to lower abdomen, guarding abdomen observed. Greenish vaginal discharge observed.
Reports last menstrual period was 3 weeks ago as normal period lasted 4 days.
Vital Signs
1300:Blood pressure 118/72 mm HgHeart rate 100/minRespiratory rate 20/minTemperature 38.3° C (101° F)
Provider Prescriptions
1300:Standing prescriptions for clients who present with abdominal pain:Obtain laboratory tests:UrinalysisCervical cultureC-reactive proteinBeta hCG1400:Ceftriaxone 250 mg IM statDischarge prescriptions:Doxycycline 100 mg tab PO twice daily for 7 daysMetronidazole 500 mg PO twice daily for 14 daysOndansetron 8 mg sublingual tab every 8 hr PRN nauseaIbuprofen 400 mg tab PO every 4 to 6 hr PRN pain
Diagnostic Results
1335:Urinalysis:Appearance clear (clear)Color amber yellow (amber yellow)pH 6.5 (4.6 to 8.0)Leukocyte esterase negative (negative)WBC count 0 (0 to 4)Nitrites none (none)Cervical culture pendingC-reactive protein 12.2 mg/dL (<1.0 mg/dL)Beta hCG 3 IU/L negative (<5 IU/L)
Progress Report
​1410:16-year-old sexually active adolescent who reports having unprotected sex.Reports cramping pain in lower abdomen, tender with palpation.Reports painful urination and pain during sex.Vaginal and pelvic exams reveal greenish, thick vaginal discharge, swollen and red labia.Treat adolescent for gonorrhea and mild PID: ceftriaxone to be given in clinic.Discharge instructions and prescriptions include doxycycline, metronidazole, ondansetron, ibuprofen.Instruct to complete all medications.Refrain from sex until treatment is complete.All partners should be notified and be treated for infection.Counsel regarding condom use.Discuss complications of reinfection and when to see provider.Return to office in 1 month.
The nurse has just reviewed discharge instructions with the adolescent. Which of the following indicates whether the adolescent understands the teaching or requires further education?
For each of the statements made by the adolescent, click to specify whether the statement indicates an understanding or requires further education."

Answer 1

Determining an adolescent's understanding of discharge instructions involves assessing their ability to repeat or demonstrate what they've been taught and their adherence to the provided guidance. If misconceptions about medication or treatment are present, further education is necessary. The balance of ensuring comprehensive care and respecting patient privacy is also a critical component of healthcare provision to adolescents.

Step-by-step explanation:

To ascertain whether an adolescent understands the discharge instructions provided by a healthcare professional, the nurse should evaluate their responses to teaching. An adolescent who can accurately repeat back the instructions, demonstrate the procedures taught, or explain when and how to take their medication likely has a good understanding of the instructions. Conversely, if the adolescent expresses misconceptions such as a belief that they should seek antibiotics for all illnesses or does not follow up with the physician as advised despite ongoing symptoms, it may indicate a need for further education.

For instance, in the case of the adolescent whose provider writes a prescription for amoxicillin due to pneumonia and the patient does not recover fully, further medical assessment might be required. If the adolescent believes that an antibiotic is needed no matter what, and is willing to doctor-shop for it, this shows a misunderstanding that requires corrective teaching. Explicitly explaining the potential harms of antibiotic overuse and resistance may help in such situations.

Moreover, understanding that patient privacy is crucial, especially with minors, is part of the comprehensive understanding of healthcare. If an adolescent is apprehensive about confidentiality, it could lead to untreated conditions. Therefore, nurses and providers must navigate between ensuring adequate care while respecting an adolescent's wish for privacy under certain circumstances.