Running head: DISCHARGE PLANNING 1

Discharge Planning

Michael Sandin

University of South Florida

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Discharge Planning

The patient, RH, is a 56-year-old female with a history of hypertension, peripheral

vascular disease, hyperlipidemia and ischemic cardiomyopathy. In on July tent, RH received a

heart transplant. The indication of this transplant seemed to be the extensive medical history

related to the cardiovascular system. She had three occurrences of a myocardial infarction in

2006, 2008, 2011 and had prior stent placement related to each of these incidents. The patient

was admitted into the hospital through the emergency department on the tenth of October. She

presented with dyspnea, edema and pain. Current assessment findings show only trace amounts

of edema (1+) in all extremities, 0/10 pain, and clear lung sounds with no shortness of breath.

The patient was alert and oriented to person, place, time and situation. RH was ready to learn

about her medications and discharge instructions.

The patient presented as fully aware to person, place, time and situation. She was in no

pain and ready to learn. The patient fully understood the reasoning for why she was hospitalized,

stating that she “couldn’t breathe” and was “swelling up.” While she didn’t understand the

complications resulting in these symptoms, she did have the general idea of how her medications

and how they worked in relieving those symptoms.

The patient has a good understanding of the medications crucial to her treatment. The

plan for organization in regards to when to take each medication was to plan out the medications

using a pill organizer, separating the medications into times of day by checking boxes for ease of

reading. Instructions were given by the nurse on which medications to take at what time, and

these medications were highlighted for ease of reading. While going through the list of

medications, the side effects and purpose of the medications were covered. Medications that she

was currently receiving at the hospital, but were not continued as a prescription for when she got
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home, were not included in the discharge planning. This included medications like heparin,

Senokt-S, and Bactroban. One such medication was Furosemide (Lasix). Some of the clinical

side effects of this medication includes nausea, excessive urination, vomiting, diarrhea,

constipation and other side effects (Vallerand, Sanoski & Deglin, 2015). She understood how the

medication made her urinate more frequently and helped remove the fluids from her body. The

patient was educated on how the medication could cause orthostatic hypotension and result in

dizziness (Vallerand, Sanoski & Deglin, 2015). I provided education that she should be careful

when standing up or changing positions slowly after taking the medication as it can help

minimize orthostatic hypotension (Vallerand, Sanoski & Deglin, 2015). There is also a risk of

electrolyte imbalance from excessive excretion, especially for her potassium level (Vallerand,

Sanoski & Deglin, 2015). I also helped lead a review of her anti-rejection medications, and the

importance of taking them to prevent complications with her heart transplant. The patient fully

understood the need to take Cellcept, Deltasone, Prograf, Bactrim DS, Septra DS and Valcyte.

The patient had taken prior classes with pharmacy after her transplant, and had a good

understanding of what to do regarding the drug regimen. The review of these medications

focused on the risk for infection. Celcept, for example, is a drug used to prevent rejection by

suppressing T- and B- lymphocyte growth (Vallerand, Sanoski & Deglin, 2015). She was told to

monitor for signs of infection like increased temperature, or cold- and flu-like symptoms, and

that she should contact her provider (Vallerand, Sanoski & Deglin, 2015). Other medications

were also covered in regards to when to take the medications and what they were for. The patient

did not present with any further questions about their effects or any reactions that could result

from taking the medications.

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The patient was being discharge to her home where she lives with her husband. Her

husband will also be providing transportation from the hospital, and would be able to assist her

to getting to follow-up appointments if needed. The patient ambulates on her own and does not

require any special equipment like a walker. She reported the ability to walk around to most

spots in her house without any symptoms of dyspnea, and should have no issues getting around

her house relating to this system. The patient reported that there were only two steps to get into

the house, and that she would have no issues navigating these steps. She stated that her husband

has a steady job and they have insurance, so there should be no issues paying or medications or

getting to follow-up appointments

There were several follow-up appointments scheduled. The main one was with her

cardiologist, which was scheduled for the following week on the eighteenth. The patient reported

no known issues on her ability to attend this appointment and had plans to schedule the

appointments with her other doctors. One of the main discharge teaching points stressed was

managing the symptoms of fluid volume overload. The nurse and I educated the patient on

having a balanced intake and output and was educated on the symptoms of fluid volume

overload. This intervention is important because having both fluid and sodium restrictions can

help manage excessive fluid volume (Ackley & Ladwig, 2014). This included the prior education

on taking the prescribed diuretics, and knowing the signs and symptoms, the need to sleep with

two pillows and when to call her doctor. Essentially, we covered the need to consistently take her

diuretic medication, monitoring her signs of fluid volume overload, and the importance of

maintaining a consistent intake of fluids. The patient verbalized understanding of her treatment

regimen and presented with no further questions before discharge.

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References

Ackley, B. J., & Ladwig, G. B. (2014). Nursing Diagnosis Handbook: An Evidence-Based Guide

to Planning Care (10th ed.). Maryland Heights, MO: Mosby-Elsevier.

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2015). Davis's Drug Guide for Nurses (14th

ed.). Philadelphia, PA: Davis Company.