Running head: TEACHING PLAN 1

Metoprolol Teaching Plan

Precious White, Susan Chon
Cedar Crest College
TEACHING PLAN 2

Medication Information/Classification/Category: Metoprolol is classified as an antihypertensive and antianginal. It is a beta

blocker that lowers both heart rate and blood pressure. It decreases the number of angina attacks and prevents myocardial infarctions.

It is in pregnancy category C.

Assessment of Learner: The patient had difficulty seeing, but he refused to bring the glasses to the hospital in fear of losing them.

Patient would need teaching on the importance of wearing his glasses to help see where he is walking and prevent falls. The patient

was also found to need teaching on how metoprolol would specifically help with his new and most recent episode of a myocardial

infarction. The patient seemed to have no idea how metoprolol would possibly affect his present medical history of conditions such as

type 2 diabetes, hypertension, and coronary artery disease. The nurse recognized that the patient was on many other medications for

his medical conditions which could indicate the importance of teaching the patient on different drug- drug interactions. Lastly, the

patient would need teaching on different ways to prevent future episodes of myocardial infarctions through activity and medication

compliance.

Assessment of Environment: The environment of his room is found to be inappropriate due to the loud sounds of the television. The

patient had a hard time hearing anything. The teaching had to be done in a quieter conference room. The patient also was feeling

uncomfortable being taught in a room with another patient in it. To provide more privacy, the nurse suggested the conference room.

The room, itself, was hot making the patient feel irritated and this decreased his concentration. The room was also darkened because

the roommate was watching television, and the patient did not want to disturb the roommate. Lastly, the patient looked unmotivated to
TEACHING PLAN 3

learn. It looked as if his admission in the hospital increased his anxiety. The nurse used therapeutic communications to ease the patient

into the teaching session to help decrease his worries.

Learning Resources

Teaching Plan

(1) Nursing Diagnosis: Risk for Falls related to orthostatic hypotension as evidenced by dizziness upon standing (Doenges
Moorhouse, & Murr, 2016).

(1) Long Term Goal: “Patient will remain free of injury” for one full year (Doenges et al., 2016, p. 302).

Short Term Goals (5) Nursing Interventions (5) Scientific Evaluations (5)
Rationales (5)

Patient will demonstrate a way Nurse will teach and Both dangling of legs and Patient demonstrated dangling of legs
to prevent orthostatic encourage patient to always slow movements help to before getting out of bed slowly.
hypotension by the end of the move slowly even when decrease orthostatic
changing position on the hypotension which further
TEACHING PLAN
teaching session.
Patient will verbalize the
importance of keeping a safe
environment by discharge date.
Patient will properly
demonstrate the use of a rolling
walker by the end of the
teaching session.
bed, and to dangle legs
before standing (Doenges et
al., 2016).
Nurse will explain: to keep
walk way free of clutter, to
maintain bright enough
lighting as well as to keep
his glasses on, and to keep
an assistive device
accessible when needing to
steady himself (Doenges et
al., 2016)
Nurse will instruct patient
to:
 First stabilize
himself by keeping
both hands on the
handles of the
walker.
 Report any
dizziness before
walking.
 Advance forward
4
reduces chances of falling
(Doenges et al., 2016).
Keeping a safe environment Patient verbalized the importance of
is important "to manage keeping a safe environment by stating
conditions that could that he will always wear his glasses
contribute to falling" due to wherever he goes and will keep
possible orthostatic walking pathways clear so that he
hypotension that metoprolol reduces chances of falling if he starts
might induce (Doenges et al., to feel dizzy.
2016, p. 304).
Assistive devices are a way Patient demonstrated use of walker
for patient to not only with steady gait and reports no
provide more stability, but dizziness while walking.
also provide a great base of
support. This support can be
beneficial for patients on
metoprolol because of the
possibility of orthostatic
hypotension causing
unexpected dizziness
(Bradley & Hernandez,
2011).
TEACHING PLAN 5

with walker.
 Step forward one
leg at a time,
making sure that
legs are aligned
with walker.
 Continue a
consistent roll
forward to provide
steadiness.
 Pace walking
according to
physical condition.

Patient will be able to
participate in physical therapy
three times a week until
discharge date.
Nurse will refer to physical
therapy and explain to
patient how it will better
the central nervous system
side effects of the
metoprolol.
Treatment will "improve Patient completed three, thirty-minute
patient’s balance, strength, or physical therapy sessions, every week
mobility" (Doenges, et al., and displayed improved balance by
2016, p. 304) which all help discharge. Patient also stated he would
to effectively ambulate. The continue to do some minimal exercises
overall treatment will aid in outside of the hospital.
decreasing chances of falls
from dizziness and fatigue
that metoprolol can cause
(Vallerand, Snanoski, &
Deglin, 2015).

Patient will state significance
of making sure to notify any
changes in addition of new
medications even if they are
herbs or over the counter
Nurse will explain that use
of metoprolol with other
antihypertensives can
actually further increase
bradycardia and orthostatic
Metoprolol has many drug-
drug interactions. When the
patient is on so many drugs,
it is important to give any
updates on newer drugs
Patient stated understanding of the
risks of polypharmacy by teaching
back the idea that Metoprolol's
therapeutic effects can be increase with
use of other medications that are
TEACHING PLAN 6

medications being taken out of
the hospital.
hypotension. The nurse will taken because polypharmacy antihypertensives and increase
also explain that there are can affect the patient's health orthostatic hypotension. Patient stated
other drug- drug by causing unwanted that he would update the hospital at all
interactions with reactions (Doenges, et al., times to make sure that he never puts
metoprolol such as: 2016). As metoprolol does himself for a risk for fall when in the
lower the heart rate and home alone.
 Drugs like digoxin blood pressure, further use of
and verapamil can
other antihypertensives can
lower heart rates to cause unwanted orthostatic
unexpected levels. hypotension which increases
 Concurrent use with the chances that the patient
alcohol and nitrates will fall (Vallerand et al.,
can cause a risk for 2015).
acute indigestion.
 Use with MAO
inhibitors can
increase chances of
hypertension.
(Vallerand et al., 2015)

(2) Nursing Diagnosis: Decreased cardiac output related to altered heart rate as evidenced by low heart rates at 50bpm and edema of
the lower extremities (Doenges et al., 2016).

(2) Long Term Goal: Patient will maintain an increased cardiac output for the next one year.
TEACHING PLAN
Short Term Goals (5)
Patient will demonstrate how
to properly take his own pulse
by the end of the teaching
session.
7
Nursing Interventions (5) Scientific Evaluations (5)
Rationales (5)
Nurse will instruct patient Metoprolol blocks beta1 Patient demonstrated proper technique of
to: receptors which work to taking a pulse and obtained the same
lower the heart rate, and in number as the nurse. Patient properly
 Use the inside of
return increases occurrences showed usage of two fingers to take the
their wrist. pulse over the radial artery.
of bradycardia (Kee, Hayes,
 Place index and & McCuistion, 2015).
middle finger just
below the thumb
 Apply gentle
pressure until pulse
is felt
 Once a regular
rhythm is felt, start
to count the number
of beats within 30
seconds, using a
clock or a watch
(with a second
hand)
 Multiply the
number obtained by
2
 Record findings
TEACHING PLAN
Patient will state the
importance of elevating legs
by the end of the teaching
session.
Patient will increase activity
levels using small steps at a
time by discharge date.
Patient will state the
importance of "home
monitoring of weight, pulse
and blood pressure" (Doenges
et al., 2016, p. 130) by the
discharge date.
Nurse will teach patient to
elevate peripheral
extremities with edema
during resting times to
promote venous return
(Doenges et al., 2016).
Nurse will instruct patient
to slowly increase the
amount and types of
exercises that the patient
likes to do such as walking
or simply bathing himself.
Nurse will explain to:
 Monitor weight
daily, at the same
time in similar
clothing, using a
scale
 Monitor pulse daily
by placing two
fingers below the
thumb and feeling
for a regular
rhythmic pulse.
8
Promoting venous return Patient stated the importance of elevating
through elevation of the legs legs and stated that he was aware that
decreases edema, an adverse edema was a side effect of metoprolol.
side effect of Metoprolol
(Vallerand et al., 2015).
Metoprolol decreases heart Patient showed great improvement in the
rate which can cause ability to independently do more
problems with breathing activities through increasing activities
such as dyspnea. Gradual daily, in small increments. Patient was
increase in activity avoids able to walk multiple laps around the
working the heart too much unit and bath himself by the discharge
and lowers the amount of date.
oxygen needed for the heart
to effectively work
(Doenges et al., 2016).
Monitoring allows physician Patient stated that he will monitor for
and nurse “to detect change any significant changes in weight, pulse,
and allow for timely and blood pressure to know when to
intervention” (Doenges et obtain immediate assistance from
al., 2016, p. 130). physician.
Metoprolol can cause edema
yielding weight gain from
fluid retention. Assessing
blood pressure and pulses
can be used to identify the
need for a different dosage
and to prevent adverse side
TEACHING PLAN
Count for 30
seconds and
multiply by 2.
Record findings
 Monitor blood
pressure daily
Patient will state at least three Nurse will teach the patient
signs of decreased cardiac important symptoms to
function by the end of the report that may signify
teaching session. cardiac problems.
 Chest pain
 Shortness of breath
 Hypotension
 Lightheadedness
(Doenges et al., 2016)
(3) Nursing Diagnosis: Deficient Knowledge related to new condition as evidenced by patient stating, “Why am I taking this
medication?” (Doenges et al., 2016).
(3) Long Term Goal: “Patient will identify resources that can be used for more information after discharge” (Ladwig et al., 2014, p.
493).
9
effects; like bradycardia and
possible heart failure
(Vallerand et al., 2015).
Metoprolol does have many Patient stated that he learned that he
side effects related to the should always report when he feels
cardiovascular system such difficulty in breathing, dizziness from
as bradycardia and edema, hypotension, and any chest pain that
but heart failure is also an could possibly signify heart failure.
adverse effect of the
medication (Vallerand et al.
2015). Metoprolol is
therefore contraindicated in
those with low heart rates
and heart block (Kee et al.,
2015).
TEACHING PLAN
Short Term Goals (5)
Patient will state the
therapeutic effects of the
medication by the end of the
teaching session.
Patient will understand the
effects of metoprolol on his
blood glucose levels by the end
of the teaching season.
Patient will state the
understanding of medication
compliance by the end of the
teaching plan.
Nursing Interventions (5)
Nurse will teach the patient
that metoprolol is beta
blocker used to lower
overall blood pressure and
heart rate, as well as
decrease the chances of
heart failure (Vallerand et
al., 2016).
Nurse will teach the patient
“to monitor blood glucose”,
daily. Nurse will also teach
the patient to watch for
weakness and any
irritability that may be
related to hypoglycemia
(Vallerand et al. 2015).
Nurse will teach the
"patient to take medication
as directed, at the same
time each day, even if
feeling well; do not skip or
double up on missed doses.
Take missed doses as soon
as possible up to eight
hours before next dose"
Scientific
Rationales (5)
It creates an understanding
of why metoprolol is used
for treatment and increases
motivation to adhere to drug
regimen (Doenges et al.,
2016).
Metoprolol can block signs
of hypoglycemia such as an
increase in heart rate because
of it's affect of lowering
heart rate (Kee et al. 2015).
Patients should always
comply to drug regimen
because stopping the
medication suddenly can
cause exacerbated side
effects of metoprolol such as
hypertension and
arrhythmias (Doenges et al.,
10
Evaluations (5)
Patient stated he understood the effects
of metoprolol in heart rate and his high
blood pressure related to his
hypertension. Patient also states he
now knows how metoprolol is used in
prevention of future Myocardial
infarctions.
Patient taught back the importance of
monitoring the effects of metoprolol on
his blood glucose levels and how
hypoglycemia could be masked.
Patient stated that he would take the
drug regularly without doubling doses
if he skipped a dose. Patient also stated
he knows that rebound hypertension
and arrhythmias could be a great risk if
he just stopped.
TEACHING PLAN
Patient will state adverse signs
and symptoms of medication
that indicates the need for
Physician’s intervention by the
end of the teaching session.
Patient will state the most
important drug-drug
interactions with metoprolol by
the end of the teaching session.
11
(Doenges, et al., p. 841). 2016).
Nurse will teach patient to Adverse signs and symptoms Patient stated that he will report: slow
notify physician of: are important to know and pulse, difficulty breathing, wheezing,
report due to most of the cold hands and feet, dizziness and
 “Slow pulse”
adverse reactions of confusion to get immediate help.
 “Difficulty metoprolol being life-
breathing” threatening. Notifying the
 “Wheezing” physician can allow for
 “Cold hands and timely evaluation/
feet” intervention by healthcare
 “Dizziness” provider” (Doenges et al.,
 “Confusion” 2016, p. 566).
(Vallerand et al., 2015, p.
841)
Nurse will teach drug- drug It is important to note that Patient stated that he understood that
interactions that may be metoprolol can interact with metoprolol can dangerously interact
related to the patient’s other drugs and increase with any of the current medications
current health history. unwanted side effects such that he is taking and, he should be
as hypotension and aware that he should notify of any new
 Digoxin has the medications or supplements.
hypoglycemia (Vallerand et
possibility of
al., 2015).
increasing
bradycardia.
 Other
antihypertensives
that the patient may
TEACHING PLAN 12

be on for his
hypertension could
further increase
chances of
hypotension.
 Insulin that the
patient could use for
his type 2 diabetes
may be less
effective.
(Vallerand et al., 2015)

(4) Nursing Diagnosis: Activity intolerance related to side effects of medication as evidence by patient looking fatigued after a short
walk around the unit (Doenges et al., 2016).

(1) Long Term Goal: Patient will have an increase in tolerance for activities continuously for remaining years.

Short Term Goals (5) Nursing Interventions (5) Scientific Evaluations (5)
Rationales (5)

Patient will show gradual Nurse will give multiple Metoprolol has side effects Patient showed gradual increase in the
increase in tolerance every day ideas for patients to such as dizziness, fatigue, past week by using tips given such as
until discharge. gradually be able to tolerate and weakness and using these demonstrating brushing of teeth while
activities that patient would techniques help with sitting down and taking time with
TEACHING PLAN 13

like. "conversing energy" for the walking using the walker. Patient
patient to increase activity reported decreased side effects of
 Teaching to take
tolerance (Doenges et al., medication such as fatigue and
breaks in between 2016, p. 34) dizziness.
walks. For every 5
minute walk, the
patient could take a
1 or 2 minute break
depending on
condition.
 Teaching to do
certain care
activities such as
brushing teeth or
combing hair by
sitting down to help
prevent exhaustion.
(Doenges et al., 2016)

Patient will verbalize
understanding of how proper
nutrition aids in activity
tolerance by the end of the
teaching session.
Nurse will explain the
importance of eating meals
with balanced nutrition by
including vegetables,
protein, carbohydrates, and
a variety of foods.
Eating meals with balanced
nutrition to provide enough
energy for activities
throughout the day. The
energy can prevent the
central nervous system side
effects of fatigue and
weakness from Metoprolol
when performing activities
(Doenges et al., 2016, p. 35).
Patient verbalized that he would begin
to balance his meals by eating a variety
of foods to make sure that he has
enough energy to walk and do
activities that require any physical
energy.
TEACHING PLAN
Patient will demonstrate
proper monitoring of how
activities affect his condition
everyday.
Patient will state the
importance of compliance in
planning activities together
with the nurse.
Patient will demonstrate
competency in self-care
activities by discharge.
Nurse will teach patient that
patient could keep a journal
at the bed side to record any
difficulties to report to the
nurse or physician when
doing activities that require
energy.
Nurse will teach patient that
compliance in planning
activities will enhance the
patient's will to participate
and increase activity
intolerance.
Nurse will explain to
patient that medication side
effects could make certain
self- care activities more
difficult. Nurse will also
explain that by having the
patient monitor their own
responses to activity, they
can make adjustments
Metoprolol side effects do
cause cardiac problems such
as low heart rates that could
affect activity (Doenges et
al., 2016). The medication
could also cause drowsiness
which might get in the way
of activities when they
require more energy
(Vallarand et al., 2015).
Metoprolol can cause side
affect of fatigue, but
depression as well. Having
the patient comply can help
to make more individualized
planning of activities, but
also plan for activities when
the patient is motivated and
has the energy for them
(Doenges et al., 2016).
Allowing for patients to
make adjustments prevents
them from using too much
energy when they are
fatigued (Doenges et al.
2016). This could make it
harder for the patient breath
possible causing
bronchospasms from side
14
Patient demonstrated proper
monitoring by writing the time of the
activity, the kind of activity done, and
the body responses such as shortness of
breath and fatigue which could be
increased with Metoprolol.
Patient stated that certain side of
effects of metoprolol can increase
chances of having a lower ability to
tolerate activities from weak feelings,
and he might lose motivation if he is
depressed.
On the day of discharge, patient
demonstrated ambulation with
assistance of the walker only and
showed no signs of breathing problems
or fatigue. Patient was seen making
adjustments by slowing down when he
was starting to feel tried and increasing
pace when feeling more energetic.
TEACHING PLAN 15

themselves. effects of Metoprolol (Kee et

al., 2015).

(5) Nursing Diagnosis: Ineffective peripheral tissue perfusion related to decrease in blood circulation as evidence by past medical
conditions and sedentary lifestyle (Doenges et al., 2016).

(5) Long Term Goal: Patient will “demonstrate adequate tissue perfusion as evidence by palpable peripheral pulses, warm and dry
skin and absence of respiratory distress” (Ladwig et al., 2014, p. 736) until the next hospital check up.

Short Term Goals (5) Nursing Interventions (5) Scientific Evaluations (5)
Rationales (5)

Patient will be able to
properly check for capillary
refill by the end of the
teaching session.
Nurse will instruct patient
on how to check their
capillary refill by pressing
on the fingernail until it
turns white; noting that
color return is less than two
seconds.
“A slow capillary refill may Patient properly checked capillary refill
indicate poor perfusion” of finger, noting that color change was
which may be a result of immediate upon release of pressure.
bradycardia, an adverse side
effect of metoprolol.
(“Symptomatic
Bradycardia”, 2014, para.
8).
TEACHING PLAN
Patient will identify at least
three exercises that will
promote blood circulation by
the end of the teaching
session.
Patient will identify at least
three techniques of keeping
his salt intake down.
Nurse will teach the patient
various ways of promoting
blood flow.
 Walking (as tolerated)
 Wearing compression
stockings
 Staying hydrated-
drinking water
 Basic exercises (as
tolerated): point toe, toe
point flex
 Balanced nutrition and
diet
Nurse will teach the patient
various ways of reducing
salt in the diet.
 Use fresh rather than
packaged meat
 Use fresh
fruits/vegetables as
16
“Exercise prevents venous Patient identified walking, staying
stasis and further circulatory hydrated and doing basic exercises as
compromise.” Wearing the three ways of promoting blood
compression stockings circulation; that he will continue to do
after discharge.
reduces edema. Sufficient
fluid intake as well as a
balanced, nutritional diet
maximizes “cardiac output
needed for tissue perfusion.”
All necessary to increase
blood flow to be able to
decrease the occurrences of
orthostatic hypotension; a
major side effect of
metoprolol.
(Wayne, 2016, “Venous
Insufficiency”, para. 6).
(Wayne, 2016, “Rationales”,
para 2).
A high sodium diet creates Patient stated he will buy fresh meat
water retention which in and fruit as well as begin to read the
return elevates the blood food labels to decrease his sodium
pressure thus creating more intake.
of a strain on the heart;
working against the intended
therapeutic effects of
TEACHING PLAN 17

opposed to canned metoprolol.

 Become more aware of
food labels
 Use other herbs for
seasoning

Patient will verbalize
knowledge of smoking
cessation related to his health.
Nurse will explain and teach
to the patient how unhealthy
smoking can be in general
but in combination with his
hypertension, diabetes
mellitus, asthma, coronary
artery disease and recent
diagnosis of Myocardial
infarction.
Tobacco increases heart rate
and blood pressure, working
against the intended effects
of metoprolol; which in this
case is to help prevent future
Myocardial Infarctions.
Patient stated how smoking could’ve
contributed to his current health
problems, and how he will quit to
benefit his health in the future.

Patient will verbalize the
understanding of changes
positions often.
Nurse will teach patient to
change positions such as
elevating of legs, sitting,
and standing for shorter
periods of time (Doenges et
al., 2016).
Metoprolol's effect of Patient stated that he learned that
lowering blood pressure and Metoprolol could affect circulation in
heart rate can cause his body. Therefore, he would have to
problems in decreased make sure he did not stay in the same
circulation and further cause position for too long.
edema. Changing positions
often helps to prevent the
edema and any decrease in
circulation (Doenges et al.,
2016).
TEACHING PLAN 18

References

Bradley, S. M., & Hernandez, C. R. (2011). Geriatric assistive devices. Retrieved from http://www.aafp.org/afp/2011/0815/p405.html

Doenges, M. E., Moorhouse M. F., & Murr, A. C. (2016). Nursing diagnosis manual: Planning, individualizing, and documenting

client care. Philadelphia, PA: F.A Davis Company.

Kee, J. L., Hayes, E. R., & McCuistion, L. E. (2015). Pharmacology: A patient- centered nursing process approach (8th ed.). St.

Louis, MO: Saunders.

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2015). Davis’s drug guide for nurses (15th ed.). Philadelphia, PA: F.A Davis

Company.