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Running head: DISCHARGE PLANNING PROJECT

Discharge Planning Project


Matthew Studstrup
University of South Florida

DISCHARGE PLANNING PROJECT

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Patient Summary

This Patient is a 69 year old male, who was admitted on 1/7/15 for elective surgery. He
has a history of lung cancer, for which he received chemotherapy. On 1/8/15, he had a left
thoracotomy for pneumonectomy. The surgeon extracted the left lung and 10 lymph nodes (9
negative, 1 positive). On 1/16/15, this patient had a FL modified barium swallow. The results
concluded that the oral and pharyngeal phases of swallowing were normal, and no regurgitation
or aspiration was present. His diet was then advanced. This patient also received daily chest Xrays. These were monitoring to make sure the mediport was stable in the SVC, the right lung was
clear, heart size was unchanged, and stable changes in the left pneumonectomy. The patients
lung sounds were clear in all the lobes of the right lung, and no sounds were auscultated on the
left. The patient had two incisions, one on his left upper back, and the other on his left flank. On
1/23/15, the patient stated, My breathing is easier. Before the surgery I was out of breath just
walking around, but now Im fine. On 1/23/15, the patients White Blood Cell count rose from
11 to 16. The providers wanted to watch this value, and depending on how it appeared the next
day, the patient would be discharged. Patient also has a history of A. flutter, Diabetes Mellitus
type 2, COPD, prostate cancer.
Discharge Diagnosis
The patient understands he was admitted to the hospital for an elective surgery
(thoracotomy for pneumonectomy) to remove lung cancer. The surgeon removed 10 lymph
nodes, and pathology stated nine were negative and 1 was positive. He was told the surgery was
successful and his lung cancer was removed.

DISCHARGE PLANNING PROJECT

Patient teaching for this patient is vast. The first lesson is smoking cessation, which he
successfully quit last year, but he needs to continue not smoking, as well as staying away from
second hand smoke. Another teaching is about exercise. He needs to be on an exercise regimen,
taking breaks when he is short of breath. PT will also help with strength building exercises. He
should also continue to use his incentive spirometer to prevent pneumonia or atelectasis. He
needs to know how to care for his incision sites, and when to go to the doctor (any signs of
infection).
The Joint Commission States that the core measures for a post- operative patient include:
prophylactic antibiotic within 1 hour prior to the first incision, prophylactic antibiotics
discontinued 24 hour post-op, temperature and glucose management, GI prophylaxis, DVT
prophylaxis (2015).
Medications
The patient is not receiving any new medications. The patient takes albuterol as a long
term inhaler to manage his COPD. He is taking Cardezem, and amiodarone to stabalize his heart
rate and rhythm. He is also taking Novolog to manage his Diabetes. The patient stated he
understood the medication, any potential side effects, and when he should call the doctor or go to
the emergency department. The Davis drug guide described what the patient should watch for
with his medication list. With Albuterol, the two most important teachings include: advising
patients to use albuterol first if using other inhalation medications and allowing 5 min to elapse
before administering other inhalant medications. Advise the patient to rinse mouth with water
after each inhalation dose to minimize dry mouth and clean the mouthpiece with water at least
once a week. With amiodarone, avoid grapefruit juice, photosensitivity reactions may occur so be
advised to wear sunblock and protective clothing, and patient should be educated on taking their

DISCHARGE PLANNING PROJECT

pulse and blood pressure. Lastly, emphasize the importance of follow-up exams, including chest
x-ray. and pulmonary function tests every 36 months and ophthalmic exams after 6 months of
therapy, and then annually. With Novolog, theres a lot of patient education. The patient must
rotate injection sites and know the signs of hypoglycemia. Its also good to know Onset:15 min,
Peak: 1-2hr, and Duration: 3-4hr. Hypoglycemia is most likely to occur at the peak, and one must
take the insulin 15-30 before eating depending on the onset. Lastly, with Cardizem, the patient
must take the medication at the same time every day, avoid large amounts of grapefruit juice,
change positions slowly to avoid orthostatic hypotension, and wear protective sunscreen (2014).
Home Assessment
The patient lives with his wife in a single family home. He ambulates with a walker. The
home will need to be assessed for throw rugs, stairs, and wide enough halls and spaces to get the
walker through. His wife is very much involved with his care. She takes care of picking up the
prescriptions and helping him to get around. She will drive him to the follow-up appointments,
and help him with ADLs. The patient wasnt asked about financial concerns, but he is retired,
and his has Medicare insurance, with no supplemental plan.
Follow Up
This patient doesnt need a home health care nurse, but may need to have the home
inspected for obstructions to his walker, such as throw rugs, stairs, and furniture, as well as
assessment for shower or shower chair in order for the patient to bathe. Follow up appointments
will be needed for post-op assessment with the surgeon, as well as the pulmonologist to make
sure he continues to be cancer free. They hadnt been scheduled yet because the patient was still
waiting on the WBC analysis to be considered for discharge. Social work will need to be

DISCHARGE PLANNING PROJECT

included in order to do the home inspection and order the necessary equipment, like a shower
chair. Even though the patient ambulates well, PT would be ordered to do strength building
exercises.
Summary
The most important consideration for this patient to prevent readmission is infection
control. The patient must understand the proper care for his incision sites as well as know when
to call the doctor. He and his wife must be educated on the signs of infection, such as being
warm, swollen, red, or having purulent drainage. Another important teaching for this patient is
follow up appointments. He will need to have them once a year to maintain his cancer free state,
as well as to monitor for potential metastasis.

References

DISCHARGE PLANNING PROJECT


(2014) Daviss Laboratory and Diagnostic Tests (Complete Blood Count; Potassium, Blood).
Nursing Central.
(2015) Surgical Care Improvement Project Core Measure Set. The Joint Commission. Retrieved
March 21, 2015.

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