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Running head: DISCHARGE PLANNING

Discharge Planning Project


Vivarian Moulton, RN student
University of South Florida

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Discharge Planning Project

The patient is a 81 year old Hispanic female who came to the emergency room on February 14 th
with three to seven days of progressive shortness of breath that was unrelieved by her Chronic
Obstructive Pulmonary Disease (COPD) treatment at home. She also experienced coughing with
minimum sputum, a cold, fever, and lower extremity edema. A chest x ray revealed new pulmonary
edema, cardiomegaly, and right lower lobe infiltration. A respiratory viral panel and urinalysis were
ordered and came back negative. The patient was placed on telemetry monitoring, given supplemental
oxygen via nasal cannula, and respiratory therapy, IV steroids, IV antibiotics, and diuretics were started.
The patient will not be discharged today as she is still receiving IV steroids.
Discharge Diagnosis
The patient understands that she was admitted for a COPD exacerbation. The patient
demonstrated an understanding in the disease processes for COPD, CHF, and pneumonia and their ability
to exacerbate each other. Through teach back, the patient exhibited an understanding of risk factors to
help decrease these exacerbations and better manage her health.
Core Measures
According to Donna Kinones (2015), pneumonia (PN) core measures include ensuring blood
cultures are drawn for those in the emergency department prior to antibiotics are administered, blood
cultures for those transferred to ICU, and that appropriate antibiotics are given within 24 hours of arrival.
This core measure was met as blood cultures were drawn prior to antibiotic treatment being started.
According to the Joint Commission (2015), COPD core measures include staff and patient
education, use of the incentive spirometry, smoking cessation, risk factor reduction, and coordination of
care. All of the core measures were met for the patients COPD exacerbation according to the care plans
and assessments documented in the Electronic Medical Record (EMR).

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Medications

The patients reconciliation list includes the next expected dose and the EMR shows the last dose
given but there are no new at home medications. The patient understands her medications and the need to
take as prescribed in addition to their possible side effects.
Albuterol (ProAir)
According to Vallerand, A., Sanoski, C., & Deglin, J., (2014) the patient needs immediately report
wheezing or the completion of one canister in less than two weeks she needs to notify her health care
provider (HCP). She should also demonstrate proper administration technique.
Azithromycin
It is important, according to Vallerand et al., (2014), for the patient to take all of this antibiotic
and to report chest pain, jaundice, fever, bloody diarrhea, and changes in vaginal discharge, to her HCP.
Digoxin
While in the hospital, the patient needs to demonstrate how to take her pulse because, according to
Vallerand et al., (2014) she needs to report pulses less than 60 and greater than 100, and changes in heart
rate to her HCP. She should also notify HCP of any over the counter medications, vitamins, and herbals.
Diltiazem
According to Vallerand et al., (2014) the patient should report dizziness, swelling of extremities,
dyspnea or persistent headaches to her HCP. She should also avoid large amounts of grapefruit juice.
Furosemide
According to Vallerand et al., (2014) the patient should immediately contact her HCP with any rash,
muscle cramps or weakness, tingling of her extremities, and weight gain over three pounds in one day.

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Home Assessment

The patient currently lives with her granddaughter, her four great grandchildren, and her older
brother. This is a safe living environment as there are no stairs within the home, no throw rugs or clutter
within the patients home. The patient did not express any concern regarding her medications as they are
filled by her neighbor and the cost is covered by her insurance. Her granddaughter does the grocery
shopping for the entire house. The patient goes to her appointments by booking a limited amount of
scheduled rides through her insurance program. The patient did express financial concerns over the loss of
her food stamps.
Follow up
The patient does have a need for home health services because pneumonia is high risk for
readmission. The patient only durable equipment the patient has is an oxygen concentration tank. The
patient will need to follow up with her primary care doctor, and cardiologist but those appointments have
not been scheduled yet. A dietician, physical and respiratory therapists, and a social worker should also be
involved in the discharge planning.
Summary
The patient was treated for COPD, CHF and pneumonia. Her readmissions should be decreased
because the patient demonstrated an understanding of avoiding secondhand smoke, remaining up to date
on vaccinations, and frequent hand washing. The patient needs to maintain her follow up appointments
with her pulmonologist, cardiologists and primary care doctor to help manage her conditions and
symptoms efficiently. Not keeping her appointments will only increase her risk of readmissions.

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References

Kinones, D. (2015). Evidenced based core measures and You. [Presentation]. Retrieved 01/27/2015 from
St. Josephs Evidence based coordinator
The Joint Commission (2015). Advanced certification in Chronic Obstructive Pulmonary
Disease. [Website] The Joint Commissions Management of the Patient with Chronic Obstructive
Pulmonary Disease. Retrieved from
http://www.jointcommission.org/certification/chronic_obstructive_pulmonary_disease.aspx
Vallerand, A., Sanoski, C., & Deglin, J. (2014). Daviss Drug Guide. [Azithromycin, Albuterol (ProAir),
Digoxin, Diltiazem, Heparin, Insulin ASPART, Furosemide, Potassium chloride, Rocephin,
Levothyroxine, Methylprednisolone] Unbound Medicine, Inc. [Software]. Available from
http://www.unboundmedicine.com/products/nursing_central.