Help needed for in care planning,discharge planning assessment

[MissDilini]

Hi i am a div2 nursing student. 3 months in.

How would a div2 nurse Go about a discharge planning assessment for a homeless patient.

For example service referrals, ADLS assistance,accomodation needs, service referrals.

Do talk to someone in a more superior position and if so, who usually?

In a plan of care would i write what i observe and what information is given on the patients observation charts, blood/urine test results and then what should be done?

For example:

Further testing to investigate abnormal findings.

Increase fluids as patient intake is inadequate? Pain relief for his pain( he has undergone surgery for a compound fracture of the left tibia) has chronic bronchitits and significant chest pain. Suspected liver problems on my behalf related to signs and symptoms displayed in patient(enlarged liver,jaundice,alcohol abuse)

Any help is greatly appreciated!

Thankyou!

[DolceVita, ADN, BSN, RN]

Speak to your clinical instructor first and get guidance. Are you in clinicals right now? If so, your clinical site will have a process ( and probably forms) you should follow.

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I would go right back to the nursing process:

Assessment Diagnosis Planning Interventions Evaluation

Assess the patient fully first. You will need to ask them directly who can assist them with activities etc. You can only make referrals if you know the patient's limits and needs. Can they afford their discharge medications? How are they going to get their discharge medications if they are immobile? Do they understand their diagnosis and its implications (do you understand it)? For what signs and symptoms should they seek additional care (what are the potential complications of his condition)? Is there internal or external fixation (think infection possibilities)?

If there are more tests to be done we schedule them for the patient before discharge.

You can't really just say "increase fluids" you must give a specific daily amount (you may wish to specify which type of fluids too i.e. not beer). Also, why does he need to increase fluids? For how long?

Will he be discharged with narcotics? If he is a drinker that can be a bit dodgy.

I don't know what all this "on my behalf" suspecting "liver problems" is exactly. If you palpate the liver and it is enlarged, plus the pt is jaundiced then it needs reported prior to discharge and LFTs run.

You get the idea? Google discharge planning and you will find a lot of information on what to consider. I would go to your instructor first to make sure you aren't doing more than you need to at your level. We did not do discharge planning early on.

I am just spit-balling here. Now must go get more coffee!

[MissDilini]

haha coffee:)

No we have not really gone into this much at all, and we are not in our clinicals.

I am just 3 months into my course so this is all new to me. I have spent so much time on this and it is due in 4 days:(

We have just been asked for assessment and nursing interventions on pt(communication,breathing and circulation,medications,wounds,elimination,spiritual and cultural lifestyle).

It is also asking for ducumentation that is likely to be used in during the patients stay in the acute care hospital and a statemnt as to why. Fluid balance chart to monitor his fluid intake?

It is a health task for analyse health information and is worth 100% of the subject mark:s i have completed most of it but i am unsure about thse parts and what is expected of me.

The patient needs anti hypertensive medication but he will not be able to afford them as he is homeless, he will not take them either, he needed assistance mobilising, eating and drinking, grooming.As a nursing student in a hospital who would i speak to about these issues?

It is out of my scope of practice. To whose attention should i bring these issues to?

It also asks for the significance of his blood test results(Levels of haemoglobin,serum billirubin and thrombocyte count(80*10^9/l) how do i work this out?

Thankyou for your help!:) it means alot.

[RNTutor, BSN, RN]

Is this a case study on paper, or an actual pt that you are working with? If it is just a case study, don't stress out too much! All that knowledge you need in order to do teaching with pts will come with time and studying. Like the blood test results. You can refer to a Med-surg book, or a Manual of Diagnostic and Laboratory Tests (I use from from Mosby's) in order to learn what the lab results are for yourself. As a nurse, you're not the one that is supposed to present the lab results and interpretation to the patient initially, that is the MD's job (i.e. you can't tell the pt that based on his lab results he has cancer, for example, even if he does). But you can always answer general questions. For example, "what is the haemoglobin test for? It measures the number of RBCs, and if it were high it would mean you have too many, and if it were low it would mean you don't have enough."

Hope this helps, but it really sounds like you need to get some clarification from the instructor, or even a classmate, just so you can be reassured that you're on the right track.