Question

The client is a 72 year old gentleman who lives with his wife and is a part-time crossing guard at the local elementary school. He is in relatively good health. His only complaint is osteoarthritis in his hands and knees for which he takes NSAIDs prn. He fell walking up the stairs to his bedroom at home. He presented to the ER with a fracture of the right hip and underwent on open reduction and internal fixation repair (ORIF). He has been discharged from the PACU and is now on the orthopedic surgery floor to recover from surgery prior to discharge to a rehab facility. Currently, his vital signs are stable, his dressing is dry and intact, his pain is controlled well with the prescribed narcotic analgesics, and he is continent of bowel and bladder. He is alert but confused and disoriented to place and time. His wife states that he never had this problem before surgery.

After 4 days in the hospital, the client is ready for discharge to the skilled nursing facility for rehabilitation. His incision is healing well; it still has staples and a dry dressing. His pain is controlled with oral narcotics. He has recovered from the surgery without complications. The only change from the previous assessment is his mental status. He is now oriented but has a short term memory deficit.

After 3 weeks of rehab for gait training using a walker, the client is ready for discharge home with his wife. He is gaining strength and uses the walker well although the arthritis in his hands makes his grip weak. He is to have PT at home for a few more weeks. His incision is completely healed. He takes NSAIDs for pain. He continues to have a short term memory deficit. His wife is happy to see him come home; she has been lonely at home with only their dog for company. She is also nervous about caring for him by herself. Their son lives over an hour away and is busy with his own job and family. 1. List at least three assessments that are needed prior to discharge. 2. List at least three areas for the nurse to give education or assistance to the wife specific to her situation to prepare her home for her husband’s discharge and to prepare her for her role as a caregiver. 3. Compose an SBAR report to the nurse who will be the client’s case manager at the home health agency.

Answer 1

Answer 1) :

patient discharge : it is the point at which patient leave the hospital with proper planning ,many patients can leave the hospital earlier and recover comfortably at home .all members of health care team are responsible for helping with discharge planning process.

- patient leaves the hospital either return to home or is transferred to another facility such as rehabilitation or nursing home.

it involves medical instruction that the patient will need to fully recover.

teach the patient for better understanding of their condition and to improve their health status .

in above question ,assessment prior to dischage ,have some components those are

• Assess for the original reason for admission to hospital .
• assess for any complications present in patient prior to discharge.
• assess ,is the patient is able to ambulate safely and climb stairs if necessory.
• assess for medication profile be reviwed by the physician or not .
• check for any consultations are missed prior to discharge .
• assess for any dietician recommendations before discharge.
• assess for the family support available at home or not .
• assess for any referrals are needed for the patient .
• Assess for the bill clearance .
• assess for patient general condition wheather patient is oriented ,or fit for discharge or not.
• assess for any care giver present at home or not.

2) answer :

• Nurse should educate patient wife about his condition clearly ,( Should give information about his health status ,here patient is disoriented and he has some short term memory loss ).
• Nurse should educate the patient about ,whta type of home environment needed for client ( here patient is having problem with the knees ,and his walking ability may altered or weakened ,so advice the wife to provide wheal chair as needed ,and adviced to dont wet the floor ,there may be chance to slip .
• adviced to keep the patient things are all available to him .
• make all the facilities( bathroom ,kitchen,bedroom ) near and it must be in ground floor it self ,so patient can have the facilities near to him .
• dont make to climb the upstairs ,there may be chance to fall .
• adviced to keep the floor dry to prevent the falls .
• Educate the wife about the paient need in self care activities , and adviced to make the patient happy .
• adviced to understand the patient with his short term memory .
• educate about care of the surgical wound even it is healed .
• adviced to make the patient stay with all the family members for emotional attachment.

3) answer : SBAR i. A acronym for situation.

,background,assessment,recommendations,it is a technique that can be used to facilitate prompt and appropriate communication between the physician or nurse to the patient .

Compose a SBAR report to nurse :

ptient name :

age :

ip no :

diagnosis :

date of surgical intervention :

surgery notes :

dischage notes :

present health condition:

what is the present need for hospital care :