Assessment and Planning of Discharge Needs in Geriatrics Essay

Elderly perseverings catch unique sparkle planning charters. As such, the hospital hold up and racing shell management squad may find themselves challenged to not only identify the of necessity of individually tolerant, scarcely to in like manner address those demands when planning the long-sufferings deteriorate. In the grammatical case of Mr. Trosack, a 72-year-old widower being discharged interest a total hip replacement (THR), bursterful assessment of his category situation needs to be plumpd prior to discharge to reassure his golosh and move rec all overy once post.Healthc be IssuesAfter reappraisaling the unhurrieds chart and performing interviews with the longanimous and his family, the case film director identifies tether healthc atomic number 18 issues that need to be addressed on discharge. The persevering admits he has not seen a recompense in over 10 years prior to this hospitalization. The diligent has been diagnosed with two peeled hea lth issues hypertension and diabetes. He has been prescribed brand- sweet medications for each new diagnosis that he leave alone need to continue taking after discharge. The affected role commodenot identify pills he currently sates at home, stating simply that they atomic number 18 vitamins for energy.Importance of Healthc atomic number 18 Issues for each one of these issues needs to be addressed to ensure Mr. Trosacks galosh and continued recovery after discharge The long-suffering has not seen a doctor in over 10 years prior to this hospitalization. It is important for the case operate oner to find kayoed why the long-suffering has not seen all doctors, as it may be detrimental to his wholesome-being. For example, did he bear a bad experience with a previous supplier and refuses to go cover song? Or, has he just not felt ill? Is his reasoning efficacy still sound? Or, is on that point approximately confusion? Is he in denial or facing fear that has kept him fr om seeing mortal?If the uncomplaining role is able to relieve oneself sound decisions and simply has no concerns, he may do swell up at home. However, it may also be that he is unaw are he should be seeing a physician, as patriarchal longanimouss may not report symptoms that they con fountr part of natural aging (Besdine, 2009, para. 9). And, if he has had a bad experience in the departed with a physician, it may beget lead to a mistrust of the spotless profession. If he has been refusing to see a doctor despite some concerns over the years, it could foreshadow similar situations in the future. He may not claver when new problems or questions arise nearly is new medications.And, as attest by the cabinet of unused medications in the bathroom, he has a tale of slimy compliance, which could further impact his health. By discussing the reasons behind his lack of halt care, the case theater director give better understand the longanimouss mindset and whatever concerns he may have. If a previous providers treatment or behavior has caused a mistrust of the profession, the case passenger vehicle can recommend or introduce the diligent to new(prenominal)(a) providers, especially those that specialize in caring for geriatrics, as these providers have specialised training in caring for the ancient.If cost is a factor, the case manager can refer the patient to applicable programs such as provisions stamp programs, insurance and Medicare supplement policies, state-based programs, drug company assistance programs and more. If deportation is an issue, the case manager can refer to area agencies or ripened citizen centers to utilize low-cost or volunteer-driven run that assist in transporting seniors. The patient has been freshly diagnosed with hypertension and diabetes. New medical diagnoses can be alarming for any individual, but with elderly patients, it can often bring about a new level of uncertainty and anxiety.Like all patients, they have questions about the new diagnosis and prescribed medications. However, the elderly patients of today grew up in a time when medical problems were not openly discussed. And now, tender club often looks at senior citizens as lesser citizensa commencement for humor and pity in the media, weaker, less productive and expected to disoblige as they age (Day, 2011). Because of the way in which they were raised and the beliefs of society today, elderly patients may not feel comfortable asking questions.Knowing this, the wet-nurse allow look for additional clues from the patients interview as to how Mr. Trosack is feeling about his new diagnoses. During his interview with the case manager, the patient seems reluctant to accept his new diagnoses. Stating he doesnt need any diddly-shit medications and doesnt like being disabled, the patient also shows frustration. When a patient expresses this level of frustration and denial, there is an increased adventure for lack of compliance. The need for education is greatly increased in this elderly patient.Because he has no outward symptoms of his new diagnoses, the patient does not feel he needs the new medications. The nurse needs to help the patient understand that his medications need to be continued to help prevent future symptoms from occurring. In addition, the nurse needs to be aware of additional challenges the patient may incur. Since elderly patients have often lost several members of their family (parents, siblings, even children in some cases), they are very much aware of their sustain mortality. A new diagnosis can bring a new awareness of that mortality, sometimes leading to a first.When planning other discharge needs, the case manager needs to include these factors into her plan. Home health nurses can assist by visiting the patient at home during the week to ensure suitable medication administration as well as assessing the patient for signs of depression and worsening hypertension, diabetes or depres sion. The patient has two new medications to continue upon discharge and cannot identify pills he currently takes at home. With the patients new diagnoses, he has been prescribed new medications.He has already voiced face-off to the idea of continuing these new medications because he does not feel he needs them. Because he does not feel they are needed, he is presumable to have poor compliance in taking the medications. The patient would utility greatly from education about why the medications have been prescribed and thatwith remove compliancehe provide be more likely to appease free of symptoms. The patient being ineffectual to state which pills he does take on a daily basis is cause for concern. Without the name of the pills, there is no way to verify its overall safety.Furthermore, the nurse and case manager cannot be sure there are no contraindications to taking the newly prescribed medications with the pre-admission supplements. The patients inability to recall the name of the pills also reiterates the concerns above regarding the new medications he has been prescribed. The case manager needs to work with the patients nurse to ensure the patient understands the immensity of maintaining a current medication list, including over-the-counter vitamins for energy, to avoid future problems when being seen for other medical concerns. The Interdisciplinary TeamFor the patients discharge to be a success, the case manager needs to incorporate appropriate members of the healthcare police squad to make a discharge plan. In the case of Mr. Trosack, this interdisciplinary team needs to include the patients nurse, material and occupational therapy mental faculty, a dietician, a pharmacist, and staff from the local home health internal representation or public health govern. Each member of the team leave bring to the discharge plan a unique vision for the patients recovery. The nurse is familiar with the patients medical history, as well as his feelings reg arding his new diagnoses and medications.S/He has learned how outdo to communicate with the patient and worked to educate the patient on his new health problems and medications. In creating a discharge plan, the nurse go away share this learning with the home health nurse, include the medication and treatment regimens that are to be continued, and identify goals for the patient related to each. The natural therapist give get word the team on the patients abilities and limitations in relation to the patients ambulation and transfers. He may visit the patients home to complete an evaluation of additional needs.And, he ordain create an arrange regimen for the patient to continue once home and make recommendations for assistive devices that the patient may be able to use. The occupational therapist forget also identify assistive devices and continued therapy needs, however, these recommendations will be in relation to the patients activities of daily living (ADLs) rather than a mbulation. She will watch the patient get completely dressed to identify any special needs and assess risk (can the patient tie his seat or will the laces be a fall hazard? ).She will assess the patients ability to shower or bathe, flavour for shortcomings or safety concerns. She may also visit the home to complete a home safety evaluation, watch the patient has he carries out his ADLs, and make recommendations for ways to alter his methods to ensure safety. The dietician will make nutritional recommendations based on the patients needs for equal to(predicate) healing. In doing so, she will take into consideration his abilities and limitations identified by the physical and occupational therapists. The dietician may suggest menus for the patient to follow.And, her knowledge of nutrition will allow for suggestions on easy-to-carry foods, snacks or supplements that require no refrigeration and can be stored outdoor(a) the kitchen, devising it easier for the patient to obtain. The pharmacist will provide the other members of the team with information related to his medication regimen. He will alert the other team members to possible side effects, unseemly reactions and interactions that may occur. This information will be helpful to the other members of the team as they make their own recommendations for needs after discharge.The dietician will nclude foods that have less chance of interacting with medications and the therapy staff will be alerted to side effects that may impact the patients safety. Because the patient will be homebound, he will likely be referred to home health. The staff from the home health agency or public health district will take the information from all of the team members in making their own plans for assignment and recommendations after discharge. They will perform safety evaluations of their own to identify risks for patient and staff alike. They will assign staff to the patient based on the recommendations from the nurse and thera pists.They may sign the patient up for meals-on-wheels, or a similar program, based on the recommendations of the dietician and assessments of the patients ability to cook and clean up as needed. They will reiterate the teaching provided by the nurse and therapists piece visiting the patient and look for side effects or adverse reactions while workings with the patient. In short, they will develop a complete plan of care to incorporate all of the feedback from the interdisciplinary team. Safety Assessment There are several areas of concern in regards to safety at the patients residence.First, the patient requires a walker and lives on the second floor in a building with no elevator. This presents a safety issue, as well as a potential psycho kind problem. Not only will the patient be unable to safely enter his flatbed without assistance but, he will also not be able to safely leave. The patient, should he reach his flat tire after discharge, would be isolated from friends and f amily and completely homebound. He would not be able to assist in the bakery primed(p) downstairs instead, becoming dependant on his brother to maintain the business.Additionally, the family members interviewed by the case manager share concerns about the patients safety once inside his apartment, due to the small and cluttered surround. They worry that the apartment is too cluttered with memorabilia from World War II for him to safely walk with a walker. Per the safety assessment, there are also several rugs passim the space. Each rug represents a trip hazard and should be removed(p) from the environment prior to the patients discharge home. Additionally, there are no safety devices in the bathroom. While these devices can be installed, the patient is at risk until the installation is complete.And, until the devices are installed, the patient cannot be assessed by the occupational therapist to ensure safe use. With the safety issues present in his current apartment, it is unlik ely the patient will continue to improve in this environment. Not only is he at a high risk for fall and injury in this apartment, but his mobility will also be greatly limited by the crowded environment, reducing his physical activity. such(prenominal) limitation would reduce the patients physical improvement, which is vital in recovery from a total hip replacement. Discharge Planning call for Per the family interview, there is a lack of support available to the patient.For any patient to recovery successfully after discharge from the inpatient setting, they must have adequate support from friends and family. Elderly patients are especially reliant on adequate support, as they are more likely to experience a functional decline from baseline in the two weeks following a hospital discharge (Naylor et al. , 1994). Mr. Trosack has a brother and a married old son. Mr. Trosack co-owns the bakery with his brother, who is now running the bakery on his own. His son is middling estranged due to a difference in religious beliefs, has a young family of his own, and works nearly 60 hours a week, as does his wife. no(prenominal) of the people closest to Mr. Trosack can make him a priority in their lives. During the family interview, the case manager learns that they were planning on taking turns assisting the patient in his home. However, their busy lifestyles leave little time for that and they do not indirect request to bring in outside assistance. Further, the family does not seem to understand the importance of regular medication administration in addition to denying the two new medical conditions exist since the patient has shown no outward symptoms of being sick.Their upshot to cleaning up the apartment is throwing away some of the patients most treasured items. Rather than asking for suggestions in making the apartment safer, the family would prefer to have Mr. Trosack dispose of his memorabilia from World War II. This, combined with the social closing off bro ught on by being homebound and unable to come in in his long-time business, would worsen his chances of developing depression. Should the patient develop depression, his recovery would be further impacted by lack of compliance with medications (Carney, Freedland, Eisen, Rich, & Jaffe, 1995).Further, depression can lead to elderly patients becoming confused or forgetful, eating less, poor hygiene, and becoming further isolated from friends and family (A. D. A. M. Medical Encyclopedia, n. d. ), all of which would further retard a complete recovery. Social Isolation & Psychological Factors With the patients physical limitations, if he were to discharge to his apartment, he would be isolated from the outside world. Because he still relies on a walker, he would be unable to climb or descend the stairs and unable to participate in his own bakery business.He would also rely on visitors for his groceries, nut removal as well as any social interaction. scorn the fact that family members are physically close to his apartment, the relationships are strained and their schedules do not allow for him to become a priority in their lives. When patients are socially isolated, they tend to do poorly. Not only do socially isolated people tend to become anxious and depressed, but they are also more likely to develop high blood pressure. Additionally, isolation has been significantly correlated both with an extended wound-healing time (Cacioppo & Hawkley, 2003).Despite the length of time the patient has been in the hospital setting, he is still regain and his body is still healing. The patient needs to be in an environment that promotes healing. Furthermore, isolation has also been shown to cause impaired vision and hearing, which could increase the likeliness of fall and injury in the patients cluttered apartment (Frintner, 2008) In addition to the health-related dangers of social isolation, there are emotional reactions to isolation that one should consider when planning Mr.Trosacks discharge. Isolation and loneliness not only affect the bodys immune and cardiovascular systems, but it can also lead to sleep disturbances and depression (Marano, 2003). Depression makes social interactions difficult and sometimes even stressful, causing the depressed person to adjourn from family and friends even more. And, with the patient being unable to fulfill his duties at his family-owned business, the likelihood of developing depression increases, due to a reduced sense of utilization (Smith, Robinson, & Segal, 2011).The patients risk for isolation upon discharge home indicates that the patient may do better in another setting. Recommendation Upon review of Mr. Trosacks chart, interviews with the patient and family and the safety assessment performed, it is the recommendation of this writer that the patient not be discharged home. This recommendation would be different if the patient lived on a first-floor apartment or had access to an elevator. However, given the safety and isolation issues present in his home, the patient would be better served in an assisted living facility.Because the patient does not need skilled nurse care, and can perform his most of his ADLs, the patient does not require nursing home placement. An assisted living facility would allow the patient to have some independence in regards to his individual space and performing his ADLs while ensuring the patient a safe environment. An assisted living facility allows for supervise of the patient overall wellness and general health and can ordain medication administration and observe compliance (Maryland State Bar Association, 1998).The services provided by the assisted living facility would help to ensure that the patient stays safe by keeping a watchful center on the patientroutine safety checks are performed and fall risks are identified and corrected as needed. The facility can also monitor his overall health through the routine safety checks as well as monitor his medication compliance, ensuring the patient takes his medications as scheduled. Furthermore, several facilities crack social activities, which would increase the patients likelihood of continued physical activity and reduce the risk of depression and decline after discharge.