Running head: DISCHARGE PLANNING 1

Discharge Planning

Ashley Joseph

University of South Florida

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Discharge Planning

The patient is a forty-eight-year-old female who arrived to the hospital complaining of

intermittent chest pain for the past two days. Upon arrival, patient also experienced hypertension,

dyspnea, anxiety, and fatigue. Patient stated that the symptoms started after she had a

conversation on the phone with her mom, which irritated her. This incident caused her anxiety

and raised her blood pressure. She has a history of hypertension and anxiety, which causes her to

have chest pain and sometimes headaches. This patient was diagnosed with angina during this

hospital stay.

For the hospital stay, this patient was on the clinical decision unit in order to have close

monitoring of the chest pain and hypertension. Core measures were utilized for chest pain. The

patient was given aspirin for chest pain, clonidine, hydralazine and valsartan for hypertension,

lovenox for DVT prophylaxis. Due to difficulty breathing, oxygen was administered. A chest x-

ray was taken and the results indicated that there were no acute cardiopulmonary diseases

currently in this patient. Troponin levels were checked and stayed within normal limits, showing

that the patient’s chest pain was not from a myocardial infarction where there would have been

heart damage. The patient underwent a cardiac chemical stress test and tolerated it well, and the

EKG showed no abnormalities. Percocet was administered to treat the patient’s pain.

Discharge

Once the patient is stabilized, she will be discharged. Patient understands that she was

diagnosed with angina and was not suffering a heart attack; she realizes that the pain was caused

by her anxiety and hypertension. Because of this disease process, teaching will include anxiety

relieving techniques and blood pressure medication compliance. Anxiety relieving techniques
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may include listening to music, meditation, and deep breathing exercises. These can also help

decrease any pain that she may have. Patient must demonstrate these techniques before

discharge. Since this patient is overweight and consumes a poor diet, diet restrictions and the

importance of exercise must be included, since this can help relieve hypertension and chest pain.

The described diet indicated a possibility of high sugar intake, which should be modified due to

patient’s history of diabetes.

Medications

Since the patient has a history of diabetes, anxiety, chest pain, and hypertension, she

understands most of her medications as they are the same as her home medications. One

medication that was new during the hospital admission was Lovenox. This is for DVT

prophylaxis, so the patient does not need to continue this at home. Insulin Lantus is a medication

that is taken both in the hospital and at home, so the patient does not need teaching about this

medication. It is a daily medication, so she will receive it before discharge and will not need it

until the next day. The patient’s home medications for hypertension include clonidine and

valsartan, she currently has these at home so no new prescription or refill is necessary. Patient

verbalizes understanding of when to take medication and the side effects. Remind patient

importance of compliance with blood pressure medications. Hydralazine is a new prescribed

medication during the hospital stay because blood pressure was not responding well enough to

the other medications alone. Explain to patient to get up slowly when taking this medication and

include side effects in teaching: headache, nausea, tachycardia, anorexia, and dizziness.

Living Arrangements
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Living arrangements include a one-story house with patient’s children and grandchildren.

It is a safe living situation for the patient. If the patient needs assistance with transportation for

medication refills, food, and follow-up appointments, her daughter will help her. Patient has

Medicaid to help with the costs of medications and follow-up appointments.

Follow Up

Patient has no need for home health services or durable medical equipment. Patient

should have a dietary consult to discuss sugar and salt restrictions due to diabetes and

hypertension. It may also help to go over her diet to encourage healthy weight loss. It may help

to set up an appointment with a counselor to discuss patient’s anxiety and family difficulties.

Social work should be included in order to ensure patient’s insurance is processed correctly and

to be sure that the cab waiver is accepted so she can be safely transported to her home. PT may

also be included since the patient was in bed rest with many medications that can cause

dizziness, and PT can help get patient safely out of bed and ambulating again.

Important Considerations

The most important considerations to prevent readmission for this patient is to ensure

medication compliance. Medications that treat hypertension cannot be stopped abruptly because

it can cause the hypertension to become worse. Another important consideration is the patient’s

anxiety, because it is the main cause of her chest pain. If the anxiety can be treated and kept in

control, the patient will not need another hospitalization for chest pain.