Discharge Plan for Patient who underwent Total Hip Replacement (THR) 05/05/2012
This paper focuses on the discharge plan for patient who underwent the Total Hip Replacement (THR). The nurse, as a case manager, works with the multidisciplinary team to determine the appropriate discharge plan for the patient. The roles and responsibilities of each member are elaborated. The healthcare issues, the safety assessment are discussed. In this case study the patient lives alone during the recovery from the surgery, so the effects of social isolation and psychological factors on the recovery process are also explained.
Assessment of the Situation:
After the assessment of Mr. Trosack medical conditions, the three healthcare issues that present are identified as (1) high fall risk, (2)the insufficient family support, (3) the pain issues that are resulted from the hip fracture and the total hip replacement (THR), and (4) the impaired mobility. There are many factors that will put Mr. Trosack at risk for future falls. First, the physiological changes associated with ageing that affect mobility. These factors may include hearing loss, visual impairment, decreased muscle mass, decreased muscle strength; especially in lower extremities, as well as a decrease in endurance. These conditions make the older adults vulnerable and contributing falls. Second, some of the medications that are prescribed for Mr. Trosack such as Percocet, Glucophage, and Lopressor have adverse side effects that may increase the risk of future falls. Percocet was prescribed for his postoperative pain, Glucophage was prescribed as an anti diabetic agent, and Lopressor used to treat hypertension. Some of the side effects of Percocet associated with falls include orthostatic hypotension and sedation which can make him dizzy or drowsy. Hypoglycemia is a side effect of Glucophage and it is also risk factor for falls. Lopressor may cause fatigue, weakness, and hypotension and these symptoms could also easily increase the incidence of falls. In addition to the medications, other complications that develop after hip surgery are pain and impaired mobility which are also added risk factors of falls. Upon further assessment using the Morse fall scale it was found that Mr. Trosack scored 65. A patient who scores more than 25 is at high risk and should have fall prevention strategies in place (Mauk, 2010). Because of the several high risk fall factors that present Mr. Trosack ,it should be recommended that he not be discharged to his home where he has to mostly mange his own care and risk future injury. His family also refuses any outside nursing assistance and it will be extremely difficult for Mr. Trosack to perform the basic activities of daily living. Another healthcare issue is the insufficient family support Mr. Trosack receives. He currently lives alone in his own apartment on the second floor of a three story apartment building. He has a son, Peter who is 44 years old and married. Peter and his wife are very busy with their careers and both work about sixty hours a week. They are also trying to conceive their first child. Living this type of life and having their own family commitments will not allow them to offer much help to Mr. Trosack. It also has been shown that in the past Peter has had minimal contact with his father. The other family member that Mr. Trosack could look to is his brother, Karl. However, most of Karl’s time is occupied with working schedules at the family-owned bakery store. This limitation prevents him to assist with Mr.Trosack’s daily care. Furthermore, the results of the family interview show that the family members have inadequate knowledge about the needs of taking medications. They also do not believe that Mr. Trosack has Diabetes and assume that a modification to his diet is enough to cure the disease. Since it appears that family members...
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