Running head: DISCHARGE PLANNING 1

Discharge Planning Project

Madzid Coric

University of South Florida College of Nursing

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Introduction

Patient PL is a 44-year-old male who presented to the emergency department with

abdominal pain and nausea on September 19, 2017. PL was recently discharged on August 29

after a laparoscopic appendectomy was performed. PL was scheduled to remove stitching one

week after the procedure was performed, but never came to the appointment. He presented with

the stitching still in place and reports erythema at incision site with traces of abdominal swelling.

He was diagnosed with cellulitis at the site, and has been prescribed clindamycin to treat the

infection. The patient also states he has not eaten anything since hospitalization, due to

intractable nausea and vomiting. Since hospitalization, PL has also reported a new onset of chest

pain at rest. He has a history of hypertension, uncontrolled diabetes mellitus (weight 288

pounds), depression, hyperlipidemia, and has tested positive for MRSA (nares).

Discharge Diagnosis

After about 30 minutes of speaking to the patient, it can be concluded that he does

understand the reason for his hospitalization. He states that his depression has been at an all-time

high, and is the cause for not returning to remove his stitching. He expressed that had he knew

hed have all these problems he would have just forced himself go to the hospital to take the

stitchings out. It was discussed with the patient the importance of following physician orders

and that the path to getting better starts with full compliance. Teaching was also given on the

disease process, as the patient did not understand why he has continued to feel nauseous after

being in the hospital. Multiple core measures for a patient presenting with abdominal pain and

nausea were met: discharged on an analgesic, compliance education, discharged on

antithrombotic therapy, and assessed for appropriate discharge.

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Medications

PLs reconciled medication list includes: Coreg, Cymbalta, Clindamycin, Gabapentin,

Heparin, Lisinopril, Oxycodone, Miralax, Novolog 25u, and Plavix. It was questioned to the

nurse why the patient was prescribed Plavix by the emergency department physician, as the

patient has no history of heart problems or stroke. The attending physician was phoned, and a

note was made on the patients chart regarding this medication. The most pertinent medication

prescribed is Clindamycin (Cleocin), which is used for treating bacterial infections (Vallerand,

Sanoski, & Deglin, 2015). PL will be taking a 300mg capsule, orally, twice a day for 2 weeks

after discharge. The importance of medication compliance for this medication was discussed

with the patient in order to ensure a prompt recovery from the cellulitis. Side effects include

heartburn, nausea, joint pain, and vomiting (Vallerand, Sanoski, & Deglin, 2015). Discharge

paperwork included each medications dose, time of day to take, and for how long to continue

taking. Meds-to-beds delivered all medications to the patients bedside, and during discharge

each medication bottle was gone over with the patient to ensure proper knowledge of each drug.

The patient was also given additional teaching on glycemic control using Novolog. According to

the Davis Drug Guide (2015), common side effects of Novolog include anxiety, irritability,

mood changes, dizziness, sweating, confusion, and headache. Tips on sensing a low blood

glucose level were also given to the patient, such as noticing clammy skin with sweating. The

patient was also able to teach-back the information provided to him, and understood that he will

be taking his insulin 3 times a day with meals for proper glycemic control.

Home Assessment

PL lives alone in an apartment in Tampa, and expressed safe and comfortable living

conditions. He claims his self-care efficacy has always been high, but has had family crises lately
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that have put him into a severe depressive state, which has continued to put his health and

wellbeing at risk. The patient states he has a friend who has been trying to keep him accountable

with his medications and doctor visits, but he lives in Virginia and is not able to see the patient

physically. Suggestions for journaling, setting phone alerts and reminders, creating goals, and

taking walks to improve his weight loss were given to the patient to help with accountability and

compliance. The Anxiety and Depression Association of America were also cited as a resource

for finding group sessions with other individuals battling depression.

Keeping a close eye on his incision site was also stressed to the patient. Paying close

attention to any unusual drainage, pain, or swelling. Financially, the Patient is on Medicaid and

is currently retired, and does not state any issues with his medical financing.

Follow Up

PLs first follow up appointment is scheduled in two weeks on October 9 to see his

primary-care physician. It was discussed with the patient that it would be best to schedule the

appointment in the morning, so as to not allow the day to get away from me. Social work was

consulted to ensure patient had proper documents sent over to his primary-care physician for his

current visit. The patient was also instructed that if he had any questions or concerns after being

discharged to call his primary-care physician or TGH.

Summary

Unfortunately, this patient had undergone a domino-effect of health issues. Often in

healthcare, if you do not treat the underlying causes, the risk for getting sicker only increases. In

this case, the patients outlook and cooperation during the time spent caring for and discharging

him, appears he is willing and motivated to take better care of himself. As nurses, being the

advocate and motivator for patients can sometimes be the vital component of seeing a patient
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better themselves. With proper preparation and the tools given, PL will hopefully recovery

quickly from his infection, and continue to work on his diabetes and weight loss.
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References

Vallerand, A., Sanoski, C., & Deglin, J. (2015). Davis's Drug Guide for Nurses (15th ed.).

Philadelphia, PA: F.A. Davis Company.