Would you send them home?
Patient is newly prescribed Furosemide (Lasix). After your teaching, the patient states "I'll take it at bedtime, so I don't forget." Ready or not?
Not.
The patient should be instructed to take it early in the day as it should cause frequent urination.
Common side effect: Frequent urination, low potassium, dehydration
Patient teaching:Take in morning (not bedtime unless insomnia is a goal), eat potassium-rich foods if allowed, monitor for dizziness/cramps.
Commonly given for CHF and fluid retention.
Furosemide/Lasix
Teach a new diabetic how to use their glucometer and what the numbers mean.
Clean hands, proper strip use, correct technique
When to check (fasting, before meals, etc.)
Basic understanding of low vs high readings
What to do if low (<70 symptoms + treatment)
Logging results
This should always be included when teaching medications to ensure safe at-home use.
What are side effects, purpose, dose, and timing?
Patient seen in primary care clinic, or discharged from inpatient, is newly diagnosed with hypertension and prescribed Lisinopril. The patient states that they'll take the medication "when my blood pressure feels high". Ready or not?
Not.
Why? What should they be able to tell you about their new diagnosis and medication?
A patient newly diagnosed with Congestive Heart Failure (CHF) states that they will notify their provider "if I gain like 10 pounds" Ready or not?
Not.
The patient should notify their provider if they have a weight gain of 2-3lbs in a day or 5lbs in week.
Common side effect: Increased appetite, mood changes, elevated blood sugar
Patient teaching: Take in the morning with food, don’t stop abruptly, monitor blood sugar if diabetic
Commonly prescribed for asthma exacerbations, COPD exacerbations, inflammatory conditions
Prednisone/corticosteroids
Teach a patient with a new splint and ibuprofen prescription how to care for both.
Keep splint dry and intact
Do not insert objects inside splint
Check circulation (color, warmth, sensation, movement)
NSAID use with food
Report increasing pain, swelling, numbness
This is the gold standard approach that combines explanation, demonstration, and confirmation.
What is the teach-back method with return demonstration?
Patient seen in pulmonology clinic for new diagnosis of asthma. They were prescribed: Albuterol inhaler (rescue inhaler), Fluticasone/salmeterol inhaler (maintenance/controller)Prior to discharge, the patient:
Correctly explains difference between inhalers without prompting
Demonstrates proper inhaler + spacer technique independently
States they will use controller inhaler daily “even if I feel fine”
Correctly identifies when to use rescue inhaler
States, “If I’m using my rescue inhaler more than usual, I should call the clinic”
Ready or not?
Ready!
Patient was prescribed antibiotic to take once discharged from the hospital. The patient states, "I should take all of the pills in the bottle as directed by the instructions on the bottle, even if I start to feel better." Ready or not?
Ready!
Common side effect: Dry, persistent cough, dizziness
Patient teaching: Rise slowly from sitting/lying, report swelling of face/lips, don’t use salt substitutes with potassium.
Commonly prescribed for: hypertension
Lisinopril/ACE Inhibitor
Teach a patient how to care for a surgical wound and safely use a walker at home.
Clean/dry dressing changes as ordered
Hand hygiene before/after care
Walker placement (move walker → step → step)
Fall prevention (clear pathways, slow movements)
Report infection or wound changes
This step ensures patients actively demonstrate skills like medication administration or device use.
What is return demonstration?
Patient seen in endocrinology clinic for the first time after being diagnosed with Type 2 diabetes last week.
They were prescribed metformin and basal insulin (glargine) by their PCP prior to this visit. During your assessment, the patient says they "think" Metformin is for their "sugar", reports NOT starting insulin because they "didn't want to mess it up" and says, "I'll probably just cut out sweets and see how it goes." Are they ready or not to return home? If not, what's missing?
Not.
They don't have a clear understanding of their medication purpose, dosing, etc. They don't understand that diet alone will not fix their condition.
Patient was made aware by the virtual nurse who was reviewing their discharge instructions that they have an upcoming appointment with Dr. Lipprandt, but they do not know why they have the appointment or when the appointment is. Ready or not?
Not.
What are the next steps prior to discharging this patient?
Common Side Effects: Drowsiness/sedation, dizziness, dry mouth, fatigue, blurred vision (less common)
Patient Teaching: Do not drive or operate machinery until you know how it affects you, avoid alcohol and other sedating meds, take exactly as prescribed, change positions slowly to prevent dizziness/falls, may cause significant drowsiness.
Commonly prescribed for muscle spasms and strains
Zanaflex, Flexeril, Robaxin/muscle relaxants
You have 10 seconds to teach a patient starting home oxygen therapy and safety precautions.
No smoking/open flames near oxygen
Keep tank upright and secured
Avoid oil-based products (flammable risk)
Check tubing safety (tripping hazard)
When to call provider (worsening SOB despite oxygen)
The patient was discharged but later returned because instructions were unclear or incomplete.
What is preventable readmission?
Patient returns to clinic 5 days post-op with a JP drain in place. They report emptying it, "when it looks full" about once a day. Output has decreased but they haven't been measuring it. They are able to demonstrate how to open and empty the drain, but they do NOT know how to properly compress it to maintain suction. They aren't keeping a log of output and admit to showering normally and letting water run over the site. Is this patient good to return home without any further instruction? Ready or not?
Not.
What should you do next?
Patient seen in outpatient wound care is told to return in 48 hours for wound check. Patient states, "If it looks okay, I probably won't come back." Ready or not?
Not.
What is your next step?
Common Side Effects: Generally well tolerated, mild hypotension (especially with rapid infusion), Rare: liver enzyme elevation with repeated/high dosing
Common uses: pain and fever control in hospital settings
Given IV when oral route isn’t possible (NPO, post-op, nausea/vomiting)
Not stronger than oral—just faster and more controlled delivery
Nurses monitor liver function if used repeatedly or long-term
Ofirmev/Acetaminophen (IV)
Teach a patient how to use an insulin pen and dispose of needles safely.
Correct injection technique and site rotation
Dose verification before injection
Never reuse needles
Dispose in sharps container (not trash)
Recognize and treat hypoglycemia
This is the most common cause of discharge misunderstandings that leads to readmission.
What is assumption of understanding without verification?
Patient is being discharged after a left below-knee amputation due to uncontrolled diabetes and peripheral vascular disease. They are medically stable but require extensive home management. At discharge, the patient is prescribed:Oral antibiotics for 10 days (infection prevention/treatment) and has a Home health referral + outpatient wound care clinic follow-up 2x/week. Home medical equipment includes wheelchair, transfer board, and commode. Patient is also instructed to do daily wound dressing changes at home until seen by wound care. Prior to discharge, after discharge instructions and education has been reviewed, what should the patient be able to teach/repeat back that would make them READY to go?
Correct antibiotic adherence (finish full course, no early stopping)
Hands-on wound dressing return demonstration
Clear distinction between normal healing vs signs of infection
Safe use of mobility equipment + transfer training
Importance of maintaining scheduled wound care visits