Ageing and managing health - Essay Example

? Ageing and Managing Health - Discharge Care Plan - ID Number & Total Number of Words: 2,779 Part I Discharge care plan is pertaining to the process of developing and implementing a plan for the transfer of patient from the hospital to his designated place to stay. Since discharge plan is considered as part of the admission process, the health care professionals should carefully assess and plan for the continuing care of the patient after being discharged from the hospital (DOH, 2003, p. 2). To ensure that the patient’s health condition is good at the time she is being discharged from the hospital, the student nurse should see to it that the patient’s vital signs are stable. It is equally important to know that the patient is no longer in pain at the time the patient is about to leave the hospital. To ensure that the patient is properly being taken cared of after being discharged from the hospital, the student nurse should focus on identifying continuing care that the patient will be needing to improve her overall well-being. After analyzing the case of Mrs. Jones, the following discharge care plan was created: Problem Goal Intervention Rationale Other than the history of falls, the patient is suffering from postural hopotension due to the intake of bendroflumethiazide. Postural hypotension increases the patient’s risk of accidental fall due to dizziness and inability to balance and coordinate her body movements. Other risk factors of accidental falls include: poor eye sight or impaired vision, neurological disorder, decreased lower muscle strength, brittle bones due to osteoporosis and ageing (Timby, 2009, p. 423). To reduce all factors that can increase the patient’s risks of falls. 1. Assess and teach the patient’s family members to modify the home environment of the patient by removing all things that can increase the patient’s risk of falling (Gulanick and Myers, 2011, p. 63). 2. Install railings or grab bars inside the shower room, around the bedroom, stairs, and bathroom. 3. Place a strip of light-colored adhesive tape on the edge of each stair. 4. Intruct the patient’s family members to provide the elderly patient with shoes or slippers that has non-skid soles. 5. Instruct the patient’s family members to keep all pathways in the patient’s home free from any cluster. 6. Intruct the patient’s family members to place a non-skid mat inside the patient’s shower room. 7. Encourage the patient to participate in gait training exercise programme once she has been discharge from the hospital. 1. Environmental factors such as dim light or poor lighting, unsafe stairways, irregular floor surface, and the presence of hazardous things like loose rugs, slippery or wet floors and telephone wires that scattered around the house will increase the patient’s risk of accidental falls (Timby, 2009, p. 424). 2. The installation of handrails or grab bars inside the shower room, around the bedroom, stairs, and bathroom will help reduce the patient’s risk of accidental falls (Timby, 2009, p. 424). 3. Placing a strip of light-colored adhesive tape on the edge of each stair will help increase the patient’s visibility of the stairs (Timby, 2009, p. 424). 4. Wearing non-skid soles will help reduce the risk of accidental falls (Timby, 2009, p. 424). 5. Freeing the pathways from clusters will reduce the risk wherein the patient’s Zimmer frame might accidentally touch other things causing her to loose her balance (Timby, 2009, p. 424). 6. The use of non-skid mat inside the patient’s shower room will help prevent the patient from falling (Gulanick and Myers, 2011, p. 63; Timby, 2009, p. 424). 7. Studies show that patients who are active in exercise can strengthen their muscles, improve their ability to balance and coordinate their body movements, increase their bone density which are all necessary in terms of reducing the patient’s risk for falls (Gulanick and Myers, 2011, p. 63). Problem Goal Intervention Rationale The patient prefers to microwave and eat frozen meals for lunch. To ensure that the patient is receiving proper nutrition. 1. Educate the patient and her family members about the consequences of using microwave oven in food preparation. 1. The use of microwave ovens in heating or cooking food will kill the nutrients that are present in the food (Dave, 2011). By teaching the patient and her family members about the health consequences of microwaving foods, it is possible to increase the chance wherein the patient will receive proper nutrition each day. Risk of wound infection on the patient’s shin. After 10 minutes of nurse-patient interaction, the patient is expected to learn the importance of proper nutrition and hand washing in reducing the risk of wound infection caused by prolonged wound healing. 1. Remind the patient and patient’s family members to wash hands before touching the wound. 2. Teach the patient and patient’s family members how to clean, apply and change the cover of wound with dressing. 3. Remind the patient to eat nutritious foods. 4. Instruct the patient and the patient’s family members to report signs of foul smell or unusual discharge at the wound site. 1. Washing hands before touching the wound will help reduce the risk of infecting the wound. 2. Applying dressing on wound can help reduce the risk of infecting the wound (Hess, 2005, p. 150). 3. Eating nutritious foods such as diet with high in vitamin C and protein will help in the process of wound healing (Broyles, Reiss and Evans, 2013, p. 293). 4. To enable the medical care team to immediately respond to risk of wound infection. Problem Goal Intervention Rationale The patient has a history of urinary incontinence. To ensure that the patient will be able to have undisturb sleep at night. 1. Instruct the patient to limit or avoid the intake of caffeine and citrus fruit juices once she is discharged from the hospital. 2. Instruct the patient to limit the intake of fluid after dinner time 3. Remind the patient and the patient’s family members that the patient is running out of pads. 4. Teach the patient to continue buttock exercises and perineal exercises in order to decrease the incidence of urinary incontinence. 1. Since caffeine is diuretic, the intake of too much caffeine and citrus fruit juices can increase the patient’s urge to urinate (Ries et al., 2009, p. 166). 2. This intervention will help decrease the patient’s urge to urinate at night. 3. Wearing absorbent pads will prevent the patient from undergoing an embarrasing moment (Holloway, 2004, p. 836). Therefore, remining the patient and patient’s family members to buy enough supply of pads will make the patient feel more relax since the patient will not have to worry about running out of pads to use. 4. Performing buttock and perineal exercises regularly will help the patient able to regain her control on urinary incontinence. Thus, allowing the patient to continuously socialize with other people around her (Holloway, 2004, p. 836). Problem Goal Intervention Rationale The patient was diagnosed with osteoarthritis on her hips. To ensure that the patient is able to fully understand and effectively manage osteoarthritis once she returns home. To ensure that the patient is free from pain and discomfort caused by osteoporosis on her hips prior to hospital discharge. 1. Educate the patient and her family members with regards to the importance of continuous mobility as a form of excerise. 2. Instruct the patient to maintain her proper body weight at all times. 3. Remind the patient to take enough rest periods throughout the day. 4. Encourage the patient to make it a habit to observe the proper body mechanics. 1. The patient should show stable vital signs. 2. Instruct the patient to perform isometric exercises and active or passive ROM exercises. 1. Daily excerises like performing range of motion or isometric exercises will help decrease the pain caused by osteoarthritis and improve the patient’s joints mobility (McCann, Moreau, and Robinson et al., 2003, p. 191). 2. Aside from promoting joint flexibility, maintaining the proper body weight will help reduce the patient’s joint stress and pain (McCann, Moreau, and Robinson et al., 2003, p. 191). 3. Observing periods of rest will help reduce the patient’s joint stress and pain (McCann, Moreau, and Robinson et al., 2003, p. 191). 4. Observing proper body mechanics will help reduce the patient’s joint stress and pain (McCann, Moreau, and Robinson et al., 2003, p. 191). 1. A stable vital signs mean that the patient is not experiencing any pain caused by osteoarthritis on the hips (McCann, Moreau, and Robinson et al., 2003, p. 191). 2. To ensure that the patient’s pain caused by osteoarthritis is properly managed prior to hospital discharge (Gulanick and Myers, 2011, p. 666). Problem Goal Intervention Rationale The patient is required to take multiple medications including 5 mg of bendrofluumethiazide (bendrofuzide) every morning, 10 mg of alendronate at least 30 minutes before breakfast, and 2 tablets of co-codamol 8/500 every 6 hours. To enable the patient receive the maximum benefit from the prescribed medications and to reduce risk of further health complications. 1. Order medication from the Pharmacy prior to discharge. 2. Ensure correct medication is dispensed. 3. Explain the importance of (1) right drug; (2) right dose; (3) right route (i.e. intravenous, intradermal, subcutaneous, oral, etc.); (4) right time; and (5) right patient. 4. Remind and instruct the patient and the patient’s family members that the patient should stop taking paracetamol to minimize the pain caused by osteoarthritis. 5. Instruct the patient to immediately discard open medications or those with unreadable label or expiration date. 1. Securing medications from the pharmacy prior to discharge will increase the chances wherein the patient will get hold of the right kind of medications before she reaches her home. 2. The intake of wrong medication can only cause the patient to suffer from further health complications. Therefore, it is necessary on the part of the nurses to ensure that the right medication was given to the patient. 3. The potency and effectiveness of the medication is highly dependent on the 5 rights known as the (1) right drug; (2) right dose; (3) right route (i.e. intravenous, intradermal, subcutaneous, oral, etc.); (4) right time; and (5) right patient (Benjamin, 2003). Therefore, the nurse should see to it that the patient and the patient’s family members are clear about when and how to take each drug. 4. Paracetamol and co-codamol are both analgesic. To control the patient’s pain, the patient’s doctor has already prescribed a new analgesic drug called the co-codamol. Therefore, continuing the intake of paracetamol may only cause adverse effects on the part of the patient. 5. Open medications and medications with unreadable label on brand name or expiration date are considered unsafe drugs (Rosdahl and Kowalski, 2008, pp. 837 - 839). Part II To educate the nurses with regards to discharge policy and other accepted practices, the Department of Health published a publication entitled “Discharge from Hospital: Pathway, Process, and Practice” (Counsel and Care, 2010, p. 11). Under this publication, it was noted that nurses should follow the hospital’s single assessment process (SAP) when preparing the patient for discharge. Basically, SAP is “a standardized assessment process and care management system for older people” (DOH, 2003, p. 10). When preparing the patients’ discharge care plan, nurses should consider legislations like the Community Care (Delayed Discharges, etc.) Act of 2003. Not applicable to mentally-ill patients, the Community Care (Delayed Discharges, etc.) Act of 2003 aims to reduce the number of delays when discharging the patients from the hospital (Counsel and Care, 2010, p. 12). Implemented back in 2004, the Act empowers the NHS hospital trusts to have the legal right to charge the Social Service Department (SSD) for causing delay in the process of discharging the patients from the hospital (Godden, McCCoy and Pollock, 2009). By charging SSD ?100 per day (?120 in the South East), there is a higher chance wherein the patients’ discharge procedure can be hastened without too much delay from the SSD’s failure to deliver post-discharge arrangements on time (Counsel and Care, 2010, p. 14; Godden, McCCoy and Pollock, 2009; DOH, 2003b). As part of section 47 of the NHS and Community Care Act of 1990, the discharge process requires the NHS bodies should notify SSD of patients who will be discharge from the hospital (Disability Alliance, n.d.). By notifying SSD ahead of time, the personnel of SSD can immediately process the payment on behalf of the patient. Section 2(1)(b) of Community Care (Delayed Discharges etc.) Act 2003 mentioned that it is not safe for the patient to be discharge from the hospital not unless he or she has at least one or more community care services assigned to promote his or her ability to recover from his or her illnesses (legislation.gov.uk, 2003). Therefore, when developing a discharge plan for the patient, the nurses should be given at least 2 days to assess the patient and seek consultation from the NHS bodies with regards to other community care services that the patient will need after being discharged from the hospital (Disability Alliance, n.d.). Under the Community Care (Delayed Discharges, etc.) Act of 2003, the local authorities can offer free community care services like “intermediate care” and “community equipment service” to the elderly patients who has been discharged from the hospital (National Archives, 2009; Disability Alliance, n.d.). In general, intermediate care is all about extending a short-term care programme to each of the elderly patient. The main purpose of intermediate care is to allow the elderly patients regain their independence by staying and living comfortably within their own home (Counsel and Care, 2010, p. 17). To assist the elderly patients with their needs after being discharge from the hospital, the community equipment service entitles each of the elderly patients a small amount of financial aid equivalent to less than ?1,000 (Counsel and Care, 2010, p. 17; Disability Alliance, n.d.). The nurses or carers play a significant role in assessing and developing discharge care plan for the patients (DOH, 2003, p. 8). Aside from talking to the patient in advance about their expected date of discharge, preparing enough supply of medicine for the patient, and arranging transportation for the patient by coordinating with the patient’s family members (Counsel and Care, 2010, p. 11), nurses should keep in mind that they need to oblige with the NMC code of conduct to help them avoid coming up with a prejudiced treatment and care decisions on behalf of the patients. In other words, the NMC code of conduct will serve as a guide on how the nursing students should design a discharge care plan for the patient. The NMC code of conduct explained that autonomy reminds each of the nursing students that the patient has the right to make their own decision with regards to their preferred care and treatment whereas informed consent strongly suggests that the nursing students should inform the patients about the purpose and rationale behind each of the intervention stated in the discharge plan (Nursing & Midwifery Council, 2012, p. 2). The nursing student should also be able to provide the patient with a clear instruction on how the patient can follow whatever intervention(s) is written on the patients’ discharge care plan. It means that regardless of whether or not the patient will accept or refuse to accept something in the discharge care plan is all up to the patient provided that the nursing student has performed his/her duty to inform, instruct, and remind the patient on what to do after the patient has been discharged from the hospital. Johnson (1994) identified the five senses of nursing as nurse’s ability to: (1) grasp meaning in patient encounters; (2) establish strong connection with the patient; (3) skillfully perform nursing activities; (4) rationally determine an appropriate course of nursing action; and (5) morally conduct nursing practice [cited in Kim, 2010, p. 212]. With this in mind, the student nurses should provide holistic care by feeling and understanding the needs of the patients. On the other hand, one of the concepts of Roper-Logan-Tierney model is to promote the patient’s activities of daily living by making the patient’s home environment a safe place to live (Holland et al., 2008, p. 2). Therefore, to protect the elderly patient from the risk of fall, the nurse should carefully assess her home environment before sending her home (Counsel and Care, 2010, p. 12). Up to the present time, there are on-going controversies suggesting that the use of microwave ovens in heating or cooking food will actually kill the nutrients that are present in the food (Dave, 2011). To promote healthy eating and ensure that the patient is getting the right nutrition, the patient’s discharge plan should include arranging extra social services that will be in-charge of delivering healthy foods to the patient. References Benjamin, D. (2003). Reducing medication errors and increasing patient safety: case studies in clinical pharmacology. Journal of clinical Pharmacology, 43(7), pp. 768-783. Broyles, B., Reiss, B. and Evans, M. (2013). Pharmacological Aspects of Nursing Care. 8th Edition. NY: Cengage Learning. Counsel and Care. (2010, November 1). Hospital discharge. [Online] Available at: http://www.firststopcareadvice.org.uk/downloads/resources/1532.pdf [Accessed 4 September 2012]. Dave, A. (2011, April 26). Do Microwave Ovens Destroy Nutrients? [Online] Available at: http://www.livestrong.com/article/378757-do-microwave-ovens-destroy-nutrients/ [Accessed 4 September 2012]. Disability Alliance. (n.d.). Delayed discharge from hospital. [Online] Available at: http://www.disabilityalliance.org/ben10.htm [Accessed 4 September 2012]. DOH. (2003a, January 28). Discharge from hospital: pathway, process and practice. [Online] Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4116525.pdf [Accessed 4 September 2012]. DOH. (2003b). The Community Care (Delayed Discharges, etc.) Act 2003: Guidance for Implementation. London: Department of Health. Godden, S., McCCoy, D. and Pollock, A. (2009). Policy on the rebound: trends and causes of delayed discharges in the NHS. Journal of the Royal Society of Medicine, 102(1), pp. 22-28. Gulanick, M. and Myers, J. (2011). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. 7th Edition. MI: Elsevier Mosby. Hess, C. (2005). Clinical Guide: Wound Care. 5th Edition . Ambler: Lippincott William & Wilkins. Holland, K., Jenkins, J., Solomon, J. and Whittam, S. (2008). Applying the Roper-Logan-Tierney Model in Practice. 2nd Edition. London: Churchill Livingstone. Holloway, N. (2004). Medical-Surgical Care Planning. 4th Edition. Ambler: Lippincott Williams & Wilkins. Kim, H. (2010). The Nature of Theoretical Thinking in Nursing. Third Edition. NY: Springer Publishing Company. legislation.gov.uk. (2003). Community Care (Delayed Discharges etc.) Act 2003. [Online] Available at: http://www.legislation.gov.uk/ukpga/2003/5/part/1 [Accessed 4 September 2012]. McCann, J., Moreau, D., Robinson, J., et al. (2003). ElderCare Strategies: Expert Care Plans for Older Adults. PA: Lippincott Williams & Wilkins. National Archives. (2009, May 11). The Community Care (Delayed Discharges) Act 2003. [Online] Available at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/IntegratedCare/Delayeddischarges/DH_4000508 [Accessed 4 September 2012]. Nursing & Midwifery Council. (2012). The Code of Conduct. Professional standards for nurses and midwives. [Online] Available at: http://www.nmc-uk.org/Documents/Consultations/NMC%20Consultation%20-%20code%20of%20conduct%20-%20%20Phase%202%20draft%20code.pdf [Accessed 9 September 2012]. Ries, R., Fielin, D., Miller, S. and Saitz, R. (2009). Principles of Addiction Medicine. 4th Edition. PA: Lippincott Williams & Wilkins. Rosdahl, C. and Kowalski, M. (2008). Textbook of Basic Nursing. 9th Edition. PA: Lippincott Williams & Wilkins. Timby, B. (2009). Fundamental Nursing Skills and Concepts. 9th Edition. WY: Lippincott Williams & Wilkins. Read More