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Discharge presentation for a 12-month old

Posted
kdon27 kdon27 (New) New

Hi guys,

I'm having trouble with the following discharge presentation. I'm new to nursing so I have no idea what a discharge presentation really is and what it encompasses. I've done some research in books and such even on youtube.com and found a few videos that illustrate a good presentation but all of them have involved very specific scenarios involving medications etc...

I'd appreciate any insight on what exactly I should be putting in to this scenario - I've included what me (and my group, 3 of us in total) have come up with for a 10 slide, 20 minute presentation.

Theo is an Indigenous 12-month-old toddler who usually lives at home in Fregon with his parents. Theo's dad works on a cattle station. Stella, his mother, was able to breastfeed Theo for four months until she became ill. From then on Theo was bottle fed. Last month Theo developed an upper respiratory tract infection. After four days Stella took Theo to the local health clinic because he was fussy, not drinking his bottle properly, crying more than usual, pulling at his left ear and had a temperature of 38°C. The nurse at the clinic assessed Theo and noted a red, bulging tympanic membrane with a small amount of purulent drainage from the left ear canal which was not clearing with antibiotics. At the clinic Stella came back with Theo, who had similar symptoms again but also had abdominal pain. For three days ago he has been unsettled and not wanting to lie down in his cot. He was not eating and drinking properly, and only sucked from his bottle, crying each time he did this. Theo was pyrexic and anxious. Stella looked very tired and her husband, Joe, smokes cigarettes in the house. Theo and Stella were brought down to Adelaide via the RFDS and admitted to the Women's and Children's Hospital but are getting ready to go home again.

So this is what we've got so far...

1 - Introduce the scenario, Theo's case, PMHx and current situation.

2 - Talk about Fregon and what resources are available - just a brief intro to the place.

3 to 8 - List out the issues and discuss how we can resolve them: Theo's Dad smokes & works on a farm = host of chemicals and allergens to cause respiratory infections, Mum appears unwell and tired, possibly not taking care of Theo as well as she normally could, living in Fregon means insufficient access to resources especially proper healthcare, possible lack of education with parents seeing as it is a recurrent situation, possible hostility towards modern medicine, use of traditional medicines that may harm rather than help, need for interpreter or mediator (sensitivity to cultural differences).

9 - Summarise the goals we expect to achieve

10 - References

Any help or comments are greatly appreciated :)

Thanks!

rkitty198, BSN, RN

Specializes in Med Surge, Tele, Oncology, Wound Care. Has 11 years experience.

You said mom breastfed until she became ill. Is mom still sick? Is mom healthy? Look into ways to help mom with primary care.

Dad, he smokes, and you may not get him to stop. You can always suggest he smoke outside the house- telling someone to quit smoking when they are against modern medicine may only anger him- and place blame on him for theo's health.

You stated the ear issue is not clearing with antibiotics? Well did mom have theo finish taking them? Did they even fill the script?

I would also plan in the discharge something that includes primary prevention- vitamins, flouride, vaccines. Maybe even a home health assessment.

rkitty198, BSN, RN

Specializes in Med Surge, Tele, Oncology, Wound Care. Has 11 years experience.

A discharge presentation is your assessment of the patient, risk factors and plan of care. Everything you plan to do for this family so that they don't return back to the hospital. It is your entire nursing plan of care- from start to finish. If you look at each issue with say DAR - data, action, reassess.

You said mom breastfed until she became ill. Is mom still sick? Is mom healthy? Look into ways to help mom with primary care.

Dad, he smokes, and you may not get him to stop. You can always suggest he smoke outside the house- telling someone to quit smoking when they are against modern medicine may only anger him- and place blame on him for theo's health.

You stated the ear issue is not clearing with antibiotics? Well did mom have theo finish taking them? Did they even fill the script?

I would also plan in the discharge something that includes primary prevention- vitamins, flouride, vaccines. Maybe even a home health assessment.

good ideas. "if momma ain't healthy, ain't nobody healthy!" jk. seriously, look into helping mom get healthy which in turn could help the child. maybe they need some community resources. did mom work? has she lost her job? it took four days to go to the doctor - no car, no gas? is there any abuse going on in the home? it's a practical question and one we ask in the form of, "do you feel safe where you are?" maybe it's just a geographical thing, but "not wanting to lay down in his COT" threw me a bit. do some people use the term cot instead of crib? also, you said "usually" lives at home with his parents. that just makes me think something else is going on here. the antibiotics didn't work which possibly means it wasn't due to infection, but possibly trauma? i don't know. i'm being pessimistic, maybe.

Yes, cot is the term for crib in Australia.

One thing I thought of straight away, because of the fact they live in a such a tiny isolated remote community, was to wonder about the water supply, could it be contaminated?

If Theo and his mother are getting ready to be discharged, you'd have to assume that Theo is now well enough (or almost) to go home so think about the problems the family face because of where they live, and if there is anything you can do to help address those.

I don't see any evidence of trauma here, I think 'usually lives at home' is written that way because the child is currently a long way from home in a major capital city hospital. Ear infections are unfortunately common in indigenous children in Australia, particularly those in remote areas, and generally more severe with significant risk of hearing loss. OP, I think it would be important to address this somehow in your discharge planning.

Yes, cot is the term for crib in Australia.

One thing I thought of straight away, because of the fact they live in a such a tiny isolated remote community, was to wonder about the water supply, could it be contaminated?

If Theo and his mother are getting ready to be discharged, you'd have to assume that Theo is now well enough (or almost) to go home so think about the problems the family face because of where they live, and if there is anything you can do to help address those.

I don't see any evidence of trauma here, I think 'usually lives at home' is written that way because the child is currently a long way from home in a major capital city hospital. Ear infections are unfortunately common in indigenous children in Australia, particularly those in remote areas, and generally more severe with significant risk of hearing loss. OP, I think it would be important to address this somehow in your discharge planning.

oh, okay. i figured the "cot" reference might be a geographical thing, but the "usually lives at home" i wasn't sure about. i tend to look too deeply into things - especially if i know it's an assignment bc they try their best to tease your brain. even if a patient was staying in the hospital, i wouldn't expect it to say "usually" lives at home. :lol2:

pfongk

Specializes in Aged care, disability, community. Has 20ish years experience.

Another one you might want to include is, "Is Theo's mother cleaning the bottles and making the formula up correctly?" She may not be due to being on tank water and wanting to save water. If that is the case, has she weaned him to a cup as opposed to a bottle as they're easier to keep clean. She may also be able to re-lactate and can get into contact with the ABA about this. Do they have a phone connected or just a radio? if they have the phone connected, are they aware of 13health? This may help with Theo's health as opposed to waiting for clinic to turn up (making assumptions here as to the clinic being within driving distance every month or so).

GHGoonette, BSN, RN

Specializes in PACU, OR.

What about referral to an ear, nose & throat specialist? The symptoms described indicate possible grommet insertion to relieve the middle ear pressure and prevent damage to the ossicles. Pain in the ear and/or throat will make baby reluctant to suck.

Double-Helix, BSN, RN

Specializes in PICU, Sedation/Radiology, PACU. Has 9 years experience.

This is a fictional situation, I hope? Because if it's not, all the information you gave out is a serious violation of patient confidentiality and HIPAA...

Sparrowhawk

Specializes in LTC.

This is a fictional situation, I hope? Because if it's not, all the information you gave out is a serious violation of patient confidentiality and HIPAA...

Pretty sure, reading contextually that it is. *wink*

K+MgSO4, BSN

Specializes in Surgical, quality,management. Has 12 years experience.

In Australia no HIPPA.

How about a referal to the Indigenous health worker at Adelaide Hospital who may be able to put mum in contact with some supports that they may not have. Rural & remote nursing service, review for mum while they are at the hospital if she hasn't already had one. Has the tank water quality gotten worse lately? talk about boiling water before using it.

good luck.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 40 years experience.

This is a fictional situation, I hope? Because if it's not, all the information you gave out is a serious violation of patient confidentiality and HIPAA...

I hate to be a smart alec but......HIPAA.......is a US Government passed law.......

This is a fictional situation, I hope? Because if it's not, all the information you gave out is a serious violation of patient confidentiality and HIPAA...

I'm pretty sure they don't have HIPAA in Australia.

pfongk

Specializes in Aged care, disability, community. Has 20ish years experience.

Nope, no HIPAA here but it would be covered under the privacy act of 1987.

Thanks so much for the wonderful replies everybody!! :)

You said mom breastfed until she became ill. Is mom still sick? Is mom healthy? Look into ways to help mom with primary care.

Dad, he smokes, and you may not get him to stop. You can always suggest he smoke outside the house- telling someone to quit smoking when they are against modern medicine may only anger him- and place blame on him for theo's health.

You stated the ear issue is not clearing with antibiotics? Well did mom have theo finish taking them? Did they even fill the script?

I would also plan in the discharge something that includes primary prevention- vitamins, flouride, vaccines. Maybe even a home health assessment.

Unfortunately it doesn't say. Just says at the start she became sick. But we are working under the impression that she may have difficulties taking care of the baby at home - we are still researching the situation of Aborigines in Fregon..

This is a fictional situation, I hope? Because if it's not, all the information you gave out is a serious violation of patient confidentiality and HIPAA...

Absolutely. We have same reverence for patient confidentiality as the US does.