Running Head: DISCHARGE PLANNING 1

Discharge Planning Project

Morgan Butts

University of South Florida

9/28/17
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Discharge Planning Project

For consideration of discharge, AF is a 70 year old male who presented to the ED from a

skilled nursing facility (SNF) for exacerbated cellulitis and elevated temperature of 101.2. The

patient presented with a decreased mental status due to respiratory distress. After receiving

ceftriaxone (Rocephin) 1 g IV for the infection, the patients fever reduced and is now at 98.0.

Patient has a history of schizophrenia, CVA with expressive dysphasia, seizures, HTN, PVD,

DM2, MRSA, and has a right BKA. Patient will be discharged to Bristol SNF when bariatric bed

is available. No core measures were included with this patient care.

Discharge Diagnosis

Due to the expressive dysphagia and schizophrenia, the patient had a difficult time

understanding and expressing what his discharge plan included. He was unable to answer most

question clearly and effectively. For instance, when asked if he understood why he was

hospitalized, the patient responded, because I had my foot cut off, referring to his right below-

the-knee amputation which was performed in 2016. He expresses pain in his left arm but is

unsure what it is causing the pain. This patient needs education on his diagnosis of cellulitis,

what caused his exacerbations, and what treatment he received throughout his course of stay.

Teaching the patient to control his diabetes and hypertension, to alert his nurses at the facility of

swelling and irritation of his arm, and providing information about the importance of his

antibiotics is crucial for his healing now and upon discharge.

Medications

As for his medications, the patient will return to his SNF with five new medications, all

of which he will be receiving education for. These include apixaban (Eliquis) 5 mg oral tabs

taken DIB for his PVD with side effects of bleeding, headaches, and dizziness; oxycodone
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hydrochloride/acetaminophen (Percocet) 5/325 mg tabs for pain with side effects of dizziness,

drowsiness, nausea, and vomiting; ciprofloxacin hydrocloride (Cipro) 500 mg tabs for the

infection with side effects of diarrhea and dizziness; diltiazem hydrochloride (Cardizem) tabs for

his HTN with side effects of dizziness, nausea and fatigue; and doxycycline hyclate

(Vibramycin) 100 mg tabs for the infection with side effects of nausea and possible

superinfection. After asking the patient if he understands all his medications, the patient replied,

No. No one told me about them before. Even after clarification, the patient still stated that he is

unsure and to ask the social worker. This indicates a further need to collaborate with the patients

facility on maintaining a steady approach to keeping the patient informed on his medications and

the rationale for each, especially with the addition of five new medications.

Home Assessment

Though the patient was not being discharged to home, his understanding of his living

situation was not expressed clearly. In response to questions like, who do you live with, and

do you have roommates, the patient replied, all I got is social security. However, the patient

has a clear understanding about the management of his care, transportation, and medication. In

regards to transport to follow up appoints, I just ask someone to take me to go places if I cant

do it myself, he states. The patient followed up by commenting, the nurse social worker will

get my medications. This remains true for financial concerns. The patient is aware that if he

needs food or any form of care, he can simply ask the socialist who he believes will pay for it.

Otherwise, I ask my younger brother for money, he adds, though his brother lives in

Wisconsin. Though the patient may have difficulty expressing his thoughts, he seems to be

understanding where he is being discharged to and how he will be taken care of while there.
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Follow Up

Upon discharge, the patient has two follow up appointments requested with specialists.

These specialists include a cardiologist and a pulmonary specialist both one week from

discharge. Because these appointments have not been scheduled, the social worker at the SNF

will need to be informed of the request and will need to call on behalf of the patient. The patient

has no knowledge or understanding of any follow up appointments and became paranoid when

asked if he had any by stating, you are trying to trick me because you already know the

answer. It is important that though the social worker will be coordinating the appointment and

the transportation, the patient should be made aware of these appointments as well. In addition to

these specialists and the social worker, the psychiatrist, neurologist, PT, and OT should be

consulted and included in the patients long term plan of care.

Summary

Because he is returning to the same SNF, there is a continuity of care upon discharge.

This is optimal for the patient, for it will decrease anxiety and paranoia associated with his

schizophrenia. As for his cellulitis, the patient should be continually educated on his condition,

how to prevent exacerbations, what symptoms to report to his nurse, and what medications he is

taking for it. This will help decrease the probability of hospital readmission. As a whole,

consistent physical and mental assessment, patient communication, and collaboration with the

entire care team will be most beneficial for this patient and his ongoing conditions.