Contemporary Nursing Issues

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GNT 1 – 724.2.4-01-07

Contemporary Nursing Issues

Mary Purvis

Healthcare Issues

In order to determine the safest and most appropriate discharge plan for this patient the case manager will work closely with the interdisciplinary team who is directly caring for the patient; together they will come up with the most effective, appropriate, and safest discharge plan. In this case study, there are several important healthcare issues the case manager needs to address with the team prior to Mr. Trosack’s discharge from the hospital. The first issue that needs to be addressed is the issue of the patient’s safety. There are many concerns regarding Mr. Trosack’s living environment. The case manager would want to inform the team, that the patient lives alone in a two-story apartment, and the only access to the apartment is up two flights of stairs. It should be discussed that it would be unsafe to send him back home under these conditions, and take the risk that he might fall down again, especially now that his functional ability is compromised. Secondly, there is the issue of the family, and their inability and lack of understanding to adequately care for the patient at this time. The team would discuss the concerns regarding the patient’s family support, and their understanding of what Mr. Trosack’s discharge needs would be. As the patient and his son have been distant and unable to really unite, a social worker referral may be needed to help bring the family together. And the third issue the team needs to discuss is whether the patient has the ability to manage and care himself. The patient has just had a major surgery on his hip one month ago, and has just been newly diagnosed with diabetes and high blood pressure. This raises the concern that the patient may not have the physical or cognitive ability at this time to care for his newly diagnosed illnesses when he gets home. Sending Mr. Trosack home may cause a major decline in his health and healing process. This may result in frailty, which could lead the patient to go down hill rapidly. Finally, the case manager would discuss the patient’s new loss of independence. The case manager will share her findings from the patients interview with the team regarding the patient’s prior level of functioning. Up until this injury and hospitalization the patient was very independent, active, healthy, and a productive member of society. He was working everyday, still managing a bakery with his brother and making major life decisions. He was in control of his life, and now he has very little control of his life. This is a big change in the patient’s usual lifestyle. He is going through a role change and new life transition. Importance of Issues

When planning a patient’s discharge it is important to identify and address any safety concerns there might be. In learning the patient would need to return to his second level apartment alone, would then alert the team that this patient is at high risk for a fall if he returns to his current residence. Falls are a serious health risk as the result of a fall can lead to injury, loss of independence, reduced quality of life, and death (Mauk, 2009). If Mr. Trosack falls again, it could cause his health to decline rapidly and he may never recover. Mr. Trosack will require more help in order to complete the healing progress and stay well when he returns home. It is important to make sure the patient has adequate support and help in place prior to sending the patient home. The lack of family support and understanding of the care the patient will need regarding the patient’s disease management and his physical ability to care for himself, when he returns home, is worrisome. Mr. Trosack would be left alone most of the time, as the son and his wife are at work and are not available to physically be with him, and take care of him. It will be important for the case manager to facilitate communication with the patient...
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