Running head: DISCHARGE PLANNING

Discharge Planning Project

Burgundi Curry
University of South Florida

Running head: DISCHARGE PLANNING

Discharge Planning Project

During the clinical rotation on 05/22/2015, there was a 64 year old female who was
scheduled for a LLL lobectomy due to a suspicious nature of a lesion on 05/18. She had a chest
x-ray completed in March which showed a LLL lung nodule. The patient has a history of
hypothyroidism, fibromyalgia, osteoporosis, asthma, cholecystectomy, and laparoscopic surgery.
During the physical assessment the patient was alert and oriented to person, place, time,
and situation. Her lung sounds were clear without shortness of breath, but she had a chest tube
with water seal on her left side. There was a murmur auscultated in the tricuspid area. She had
normal active bowel sounds in all four quadrants with tympani heard during percussion. She did
not complain of any pain during palpitation, and stated she had a bowel movement and voided
that morning. Her lower extremities showed +1 pitting, and her pedal and radial pulses were 2+.
Her capillary refills were less than 3 seconds, and her skin was intact and normal color to her
ethnicity. At the time she stated she was in pain 4/10 on her left side that did not radiate, and pain
was worse during movement. She stated her pain medication with rest helped with the pain.
Discharge Diagnosis
The patient understood that she was hospitalized for LLL nodule that was discovered
during a chest x-ray and needed to have the surgery. She found out the nodule was cancer, and
needed to be educated about the pathophysiology and the effects of cancer. The biggest concept
the nurse explained was the risk factors associated with cancer. The nurse stated that each
individual acquires a number of genetic mutations over time in order to acquire cancer. Some
risk factors include obesity, radiation, alcohol, and exposed to occupational hazardous. The
patient stated she has been exposed to molds and toxins while working on a farm and as a teacher
in old buildings. She stated that she always thought cancer was related to smoking, but does not
smoke or been around second hand smoke. Now after speaking with the nurse the patient stated
she now has a better understanding of cancer. She also had concerns of different cancer

Running head: DISCHARGE PLANNING

treatments, and the nurse explained to the patient, cancer treatment is usually treated with
chemotherapy, radiotherapy, surgery, immunotherapy, or combination of these. However, she
also had concerns about depression and anxiety in regards to having cancer. The nurse placed a
consult for pastoral care, and the nurse spoke with the patient in regards to psychological stress.
The patients biggest concern was being able to cope, and hoping chemotherapy would not
change her life. She wanted to speak with more physicians about her options, and ways to deal
with cancer. The nurse explained to the patient that feeling anxious or concern about coping is
very common, and the nurse stated she will help her through this process.
Medications
The nurse reviewed the reconciled list of the patients medications, but the list wasnt
reviewed by the physician. The only medications that could be seen were the medications in the
MAR that she was currently taking. When giving the patient her medications, the dose and
indication were explained to the patient. When she was given her albuterol (Proventil) nebulizer
2.5mg that is indicated for asthma, the nurse explained to her that it may cause tachycardia,
nervousness, and to contact the provider if shortness of breath is not resolved. When taking
docusate sodium (Colace) 100mg which is a stool softener, to remember to drink plenty of water
which is about 6-8 full glasses per day, and to use other forms of bowel regulation such as
increasing bulk in her diet. There are some side effects such as mild cramping, diarrhea, and rash
when taking this medication. Lastly, the medication oxycodone-acetaminophen (Percocet) 5325mg which is indicated for pain, the nurse explained to her that some common side effects are
sedation, dizziness, constipation, physical dependence, and respiratory depression. She was also
notified to avoid alcohol and any other medications with Tylenol in it due to the fact Percocet
already has acetaminophen in the medication which is another name for Tylenol. Finally, the
patient was notified to take the medication as prescribed, and assess blood pressure, pulse and

Running head: DISCHARGE PLANNING

respirations before and periodically during administration. Patient states she does not have a
blood pressure cuff at home, and the nurse explained to her she may use CVS or Walgreens
which have blood pressure stations for free. The patient was notified this medication is known to
cause constipation, and the medication Colace should help with this issue.
The nurse explained to the patient once the list of medications is placed in the system
during discharge we can review those medications and side effects as well.
Home Assessment
The patient lives with her husband, but stated she did not think he would be able to take
care of her due to his medical issues. She stated she is considering living with her daughter, but
her daughter has a newborn and three teenagers. She does not want to be a burden, and more than
likely will live with her husband. She stated her husband, daughter, and son will be able to help
her with her medications and transportation to her follow-up appointments. The patient stated she
does not have any financial concerns because she has Blue Cross Blue shield insurance.
Follow-Up
The nurse explained to the patient that a care coordinator and home health consult
has been placed that will come to her home, and make sure she has everything she needs. The
patient states her home should not be a problem considering she does not have any stairs, and try
to keep it clutter free. The surgeon stated he wanted to see her in two weeks after discharge, but
her discharge date wasnt for sure yet due to her chest tube. The surgeon was monitoring the
input and output, and based of those values would determine when she would be discharged. She
will be following a cancer specialist to determine when she will begin chemotherapy. The
members involved in her discharge planning are the nurse, care coordinator, physician, physical
therapy, and home health.
Summary
The most important considerations to prevent readmission for this patient are making sure
her tests are completed, and addressed. Next, making sure her pain is controlled, and educated on
different ways to manage pain besides medication. Some examples with pain management are

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guided imagery, breathing exercises, and mindfulness. Also, making sure the patients concerns
about medications are addressed, and having the contact information readily available for any
concerns after leaving the hospital. Lastly, making sure everything at home is taken care of in
regards to any possible medical equipment, transportation, and home health services.

Running head: DISCHARGE PLANNING

References
Adams, M., Holland, N. & Urban, C. (2014). Pharmacology for nurses: A pathophysiology
approach (4th ed.). Boston, MA: Pearson
Huether, S.E. & McCrance, K.L. (2012). Understanding Pathophysiology (5th ed.). St. Louis,
MO: Mosby