Discharge Planning Paper

Running head: DISCHARGE PLANNING 1
Discharge Planning Project
Taylor Brashears
University of South Florida

DISCHARGE PLANNING 2
Patient Hospitalization
On October 26, 2017, E.D., a 72 year old male, was admitted to Lakeland Regional
Health due to complaints of worsening abdominal pain from his ventral hernia. E.D. has history
of incarcerated hernias, systolic congestive heart failure, coronary artery disease, hypertension,
hyperlipidemia, diabetes mellitus II, chronic obstructive pulmonary disease, chronic kidney
disease, obstructive sleep apnea, and atrial fibrillation. Upon examination, it was determine E.D.
would need a ventral hernia repair, but would need to wait until October 29 due to the Xarelto he
was taking for his atrial fibrillation. On October 29, a successful ventral hernia repair was
performed and E.D. tolerated it well. On October 30 and October 31, the E.D. was monitored for
postoperative complications.
Discharge Diagnosis
The patients admission was due to his ventral hernia impending incarceration. The
patient verbalized he understands why he was hospitalized by stating he, needed to get a hernia
repair because my bowels were getting pushed up and causing problems. Although this
simplified explanation is correct, it is important to explain to the patient that the hernia is a bulge
through an opening in the muscles of the abdomen due to weak abdominal muscles, or a hole in
the abdominal muscles. It is also important to teach him postoperative care for the repaired
hernia. First, that it is normal to have pain during the following days and that over the counter
medication will typically help. Second, that he will need to avoid lifting any objects over fifteen
pounds for the first two weeks following surgery. Third, he should increase his fluids and dietary
fiber to decrease strain during a bowel movement. Finally, that there is a possibility of infection
due to incision on this abdomen, and that he should be watching for signs and symptoms
including increased pain, swelling, redness, warmth, or fever. If any of these symptoms occur, he
should call his provider right away. There are not any associated core measures.
Medications
Since the patient has not yet been discharged, a reconciled medication list has not been
provided, although the only new medications Percocet and Tylenol for pain. If he were being
discharged a reconciled medication list would be provided, with information such as the last dose
and the next expected dose. Patient teaching would also be provided since the patient verbalized
he did not understand the side effects of the drugs. For Percocet, patient teaching would include
that is a combination of oxycodone and acetaminophen and is used for treating moderate pain.
The common side effects of it include headache, dizziness, constipation, and drowsiness. If
dizziness occurs, moving and changing positions slowly will help. If constipation occurs, a stool
softener or increased fluids and fiber may help. The adverse effects that may occur and need to
be reported to a provider would include a decrease in respiratory rate, slow, shallow breathing, or
lightheadedness. For Tylenol, patient teaching would include that it is used for treating minimal
pain. Common side effects for Tylenol are nausea, stomach pain, and loss of appetite. It is
extremely important to teach that acetaminophen, which is an active drug in both Percocet and
Tylenol can cause liver failure. The maximum amount of acetaminophen a patient can take a day
is 4 grams and he should not exceed this amount. Also for both drugs, it is important to not drink
any alcohol while using them. After explaining all of this to him, it would be necessary to ask
him questions about the information he was told to ensure understanding.
Home Assessment
The patient lives with his wife and stated that he feels safe in his living situation. The
patient has handrails on both sides of the steps leading up to his one-story house, keeps the floor
free of clutter, and uses a chair in the shower. The patient relies on himself for self-care and
drives himself to wherever his needs are. He stated that if he is not able to, his wife attends to his
needs. The patient does not have any financial concerns confirmed by his statement that his wife
has insurance and they have Medicare.
Follow Up
The patient is not in any need of home health services and does not need any durable
medical equipment at home. The patient currently has one follow up appointment scheduled with
his primary care provider on November 2, 2017 and will also need a follow up appointment with
his surgeon in two weeks on November 13, 2017, although it has not yet been scheduled.
Physical therapy should be included in discharge planning to teach the patient on how to
strengthen the abdominal muscles to prevent another hernia in the future.
Summary
There are multiple considerations to prevent this patient from readmission. The most
important is to keep the surgical site from infection. This includes keeping the site clean,
performing wound care, and immediately reporting any signs and symptoms of infection. Other
considerations are to avoid lifting heavy objects for the next two weeks, increase fluids and fiber,
and perform physical exercise as the therapist instructs.

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Running head: DISCHARGE PLANNING 1

Discharge Planning Project

University of South Florida

him questions about the information he was told to ensure understanding.

has insurance and they have Medicare.

strengthen the abdominal muscles to prevent another hernia in the future.

and perform physical exercise as the therapist instructs.

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