Discharge Planning - Schistosomiasis Infection Patient

Running head: DISCHARGE PLANNING
DISCHARGE PLANNING
Name of the Student
Name of the university
Author’s note

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Introduction
The case study surrounds a patient who was admitted with a Schistosomiasis infection
was further diagnosed with HIV. HIV is a viral diseases that makes a patient
immunocompromised, and makes a patient susceptible to any kind of infection. This paper will
provide a comprehensive discharge planning of Dillon Hunt along with the probable care
packages required. This paper has also provided rationale for the reason why communication is
important in discharge planning . Furthermore, a discharge planning has been included with the
report.
Package of care utilized for Dillon
The case study reveals that Dillon has been diagnosed with schistosomiasis that is caused
by the reaction of the body towards worms eggs. Generally infections with all the major
schistosoma species has been found to be treated with Praziquantel. However, it has been clearly
mentioned in the case study that Dillon was allergic to Praziquantel, hence his treatment has been
incomplete and had to leave with lymphadenopathy. However, there are few alternatives
praziquantel. There are antimonial compounds and metrifonate that were used previously but are
not used due to their excessive toxicity (Chai 2013). Oxamniquine is the alternative drug that can
be provided to Dillon. In case there are no such alternatives left to treat the patient (Patel et al.
2017). Drug desensitization can be carried out that involved the desensitization process where
the immune system of the patient is altered in response to the drug treatment. Premedications that
can be given to the patient before the desensitization involves administration of the
antihistamines and steroids and the H2-receptor antagonists and leukotriene receptor antagonists.

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As per the case study, the patient had been suffering from HIV infection. The package of
care for HIV involves HIV testing and counselling including the provider initiated testing and
counselling and testing of the other partners and the family members. Cotrimoxazole prophylaxis
can be initiated. Secondly, it is necessary to initiate a tuberculosis screening for Dillon, as HIV
infection patients are highly susceptible to Tuberculosis infections (WHO, 2019). If he was
screened positive then further diagnostic treatment should be commenced. This should be
followed along with the anti-retroviral therapy. Penfold et al. (2014) on the other hand have
referred to seven basic care packages like cotrimoxazole prophylaxis, insecticide-treated bed
nets, HIV voluntary counselling, multivitamins and ionized preventive therapy and condoms.
After the ART therapy has been initiated it is necessary to keep a monitoring of the CD4 count.
Viral load is linked with the loss of the CD4 cells (WHO, 2019). It is recommended to initiate
the ART at a CD 4 count of about 350/mm3. It is also necessary to check whether the patient has
HIV drug resistance. In case, the monotherapy fails, a combination of the drug treatments can be
initiated - highly active antiretroviral therapy (HAART). It is also called combination
antiretroviral therapy (cART).
It is necessary that Dillon should be monitored for his adherence to the ART and needs to
be measured at the time of each clinical visits. The physicians should always be prompted by the
viral load. Dillon and his family should be provided with both emotional and the support for
practical living. Both the patient and the family should fit the entire drug regimen to a daily
routine and should be educated that non-adherence might lead to resistance.
However, the package of care for Dillon should include a nutritional assessment and
planning, maintenance of hydration and shin integrity, good skin turgor and adequate urinary

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output. Dillon can be referred with community resource, who a provide assistance in individual
need.
Definition of discharge planning? Is the discharge for this scenario simple or complex?
What factors need to be considered when planning discharge and what MDT professionals
would be involved?
Discharge planning can be referred to as an interdisciplinary approach for the continuity
of care and process which includes detection, assessment, goal setting, planning, implementation,
coordination and evaluation (Gonçalves‐Bradley et al. 2014). An effective discharge planning
supports the continuity of care and is considered to be a critical link between the treatments that
has been received in hospital by the patient and the care obtained in the post discharge period
(Shepperd et al. 2013).
The care plan for Dillon is complex since he suffers from multiple complications, both
form an HIV infection and Schizostomiasis and needs multiple things to be considered. An
effective discharge planning for Dillon would consists of the following activities and procedures
along the care pathway. On admission, it is necessary to prepare a detailed and accurate record of
the patient. Review an assessment information and the date of the estimated discharge with
reference to the standard care pathway and the complexity of the circumstances needs to be
considered. The multidisciplinary tram needs to be informed about the estimated date of the
discharge and the review assessment criteria. Referrals can be made to the community referral
services and social care agencies for the patients requiring rehabilitation or financial assistance.
The care package needs to be finalized including the order of the take home medicines (Waring

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et al. 2016). On the day of discharge, all the documentation shall be completed, the discharge
letter needs to be issued by the general practitioners and conformation is given for the final
discharge (Waring et al. 2016). The follow up planning would involve the provision of the
prescriptions for antiretroviral therapy and a follow up appointment with a family physician of
HIV specialist within 7 days after the discharge (Antoniou et al. 2019).
The discharge planning would include education about adherence to the medications and
importance of immediate reporting in case of any side effects (Hunter and Birmingham 2013).
The patient should be education to practice safe sex. Dillon should be carefully asked not to
share same needles or not donate blood, semen or any other organs. Dillon should refrain himself
from getting tattoos. The doctors should inform Dillon about the maintenance of general
cleanliness to prevent other infections like keeping a clean environment, avoiding contact with
the stray animals.
Normally the multidisciplinary team required for the treatment of Schizostomiasis
involves the infectious diseases specialist who would be trained to diagnose and make distinction
between the two types of infection – the schizostomiasis and HIV infection (Wei-Cheng et
al.2018). A nurse should be at the bedside of the patient, addressing each and every needs of the
patient starting from the administration of the medications to catering to all the needs of the
patient. A counselor or a mental health provider can provide emotional support to the patient as
well as his family members who had been undergoing treatment due to HIV (Sherman, Elrod,
Allen and Eckardt 2014). Some of the other members includes a dietician and a social care
workers, who are often termed as the navigators of the patients.

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Discharge plan for Dillon
Case history
A 31 years old Dillon Hunt has been referred to hospital with HIV infection. He had been
admitted in to the hospital on (date) and was diagnosed with an abnormally low CD4 count
(0.42). He was commenced with an antiretroviral therapy (ART) with stavudine, lamivudine,
and efavirenz. His CD4 count is currently (0.52) and the doctor in charge has approved his
discharge under a 7 days continuous follow up.
Medical History
Previously admitted with the history of acute schistosomiasis, caused due to bathing in a
waterfall in Mali. He was diagnosed with Lymphadenopathy and a mild hepatomegaly had
developed. Laboratory tests showed Schistosomiasis serology had now become positive, as
well as one live and several dead Schistoma mansoni eggs were found in his stools. He had
received treatment for syphilis.
Allergy history
Patient is allergic to praziquantel (Biltricide), in response to which he developed a severe
allergic reaction with rigor, fever and a drug-related rash.
Subjective data
Fatigue, diarrhea, fever and lymphadenopathy
Objective data
Decreased CD4 count
Analysis
Restored CD4 count. Compliance hospital stay due to cost.

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Planning
After 15-30 minutes health teaching the patient will be capable of enumerating the activities
that will enhance his independent living with safety and precaution.
Interventions
 Patient administered with antiretroviral therapy (ART) with Stavudine, Lamivudine,
and Efavirenz.
 The patient was educated about the preventive measures like practicing of safe sexual
contact, refraining from risky sexual contact, and refrain from taking any kind of drugs
using the same needles.
 Advised the patient to adhere to medications prescribed in the prescription.
 Encouraged the patient to follow nutritious diet recommended by the dietician. Diet
rich in vegetables, whole grains, low fat sources of proteins recommended. Limited use
of sweets, soft drinks and foods with added sugar.
 Provided referrals to social services and support groups for assisting them
psychologically and financially
Evaluation
Goal has been met. 0.51 CD4 count.
What is the significance of involving the patient with a LTC and their family in the
discharge process? Make clear reference to Dillon’s circumstances and conditions and the
concept of empowerment
When being discharged from the a hospital, a participative patients has a positive impact
on the establishment of a self and secure care, that increases patient satisfaction and reduces the
risk of readmission and strengthens the role of the patient in an organization. A discharge
planning aims to ensure a care continuity of the patient and identify the social care needs. It
involves both the patient, carer and the family (Bångsbo, Dunér and Lidén 2014). Involving the

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patent in a discharge planning process is very much dependent on the empowerment of the
patient, the patient having the communicative ability for influencing the decision making as per
his individual needs and the ability to exhibit interest in this situation. Again, involving the
patient and the family in the decision making progress is in compliance with the ethical principle
of autonomy, which is one important aspect of a patient centered care. Furthermore, it is evident
from the case study, that Dillon’s wife and his 9 months old daughter has been diagnosed with
HIV infection , hence it is Dillon’s responsibility to provide emotional support to both of them,
for which self-empowerment is required. Self-empowerment can be defined as a process by
which patients have greater control over the actions and the decisions affecting their health
(Horwitz et al. 2017). Dillon should be educated about the self-care activities like adherence to
the medical regimen, diet and exercise, mandatory reporting to the doctor, following a 7 days
follow up. Dillon should also monitor that his family is being treated carefully and will also
serve as a prime support in their distress.
Importance of communication during the discharge process and strategies for the specific
scenario
Communication the key aspect of an effective discharge planning. Timely and accurate
discharge communication is necessary in continuing the patient care between the hospitals and
the primary care physicians. The discharge summary is the common method that is practiced for
the documentation of the patient records and communicating the diagnostic findings of the
patient. The communication and information tool can enhance the quality and the continuity of
care. Effective discharge summaries have been found to be effective in reducing the adverse drug
events the, hospital readmission, occurrence of post discharge readmission and post discharge
complications (Newnham et al., 2017).

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In this case study, it is evident that both the patient and his wife and his 9 month child has
been diagnosed with HIV infection. Hence, the care procedure should address both the patients
and families. Dillon should be clearly informed of his present health conditions and the treatment
regimen that should be followed, including the medicines, diets and the community services
meant for supporting the HIV survivors. Both the patient and the clinician needs to be involved
in the care process. All the reports should be assessed by the discharge nurses and the doctors
before the discharge of the patient.
Conclusion
The discharge planning of Dillon is complex, due to his susceptibility to both the
infection. Furthermore, his wife and his child has also contracted the disease because of him.
Hence, any treatment regimen considered was made considering his wife and his child. The main
intervention is the administration of ART, along with a regular follow up, health literacy about
the preventive measures, the diet plan. One of the important part of the discharge planning is the
referral to social groups and community services for receiving financial and psychosocial
support.

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References
Antoniou, T., Graves, E., Plumptre, L., Stewart, A., and Chan Carusone, S. 2019. Antiretroviral
Prescription Pick-up and Physician Follow-up After Hospital Discharge Among Medically
Complex People With HIV. Open forum infectious diseases, 6(2), ofz009.
Bångsbo, A., Dunér, A., and Lidén, E. 2014. Patient participation in discharge planning
conference. International journal of integrated care, 14, e030.
Chai, J.Y., 2013. Praziquantel treatment in trematode and cestode infections: an update. Infection
& chemotherapy, 45(1), pp.32-43.
Gonçalves‐Bradley, D.C., Lannin, N.A., Clemson, L.M., Cameron, I.D. and Shepperd, S., 2016.
Discharge planning from hospital. Cochrane database of systematic reviews, (1).
Horwitz, L.I., Moriarty, J.P., Chen, C., Fogerty, R.L., Brewster, U.C., Kanade, S., Ziaeian, B.,
Jenq, G.Y. and Krumholz, H.M., 2013. Quality of discharge practices and patient understanding
at an academic medical center. JAMA internal medicine, 173(18), pp.1715-1722.
Hunter, T. and Birmingham, J., 2013. Preventing readmissions through comprehensive discharge
planning. Professional case management, 18(2), pp.56-63.
Newnham, H., Barker, A., Ritchie, E., Hitchcock, K., Gibbs, H. and Holton, S., 2017. Discharge
communication practices and healthcare provider and patient preferences, satisfaction and
comprehension: a systematic review. International Journal for Quality in Health Care, 29(6),
pp.752-768.

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Patel, T. A., Lukawska, J., Rowe, J., and Bailey, R. L. 2016. Treatment of Schistosomiasis in a
Patient Allergic to Praziquantel: A Desensitization and Treatment Protocol. The American
journal of tropical medicine and hygiene, 95(5), 1041–1043.
Penfold, S., Simms, V., Downing, J., Powell, R.A., Mwangi-Powell, F., Namisango, E.,
Moreland, S., Atieno, M., Gikaara, N., Kataike, J. and Kwebiha, C., 2014. The HIV basic care
package: where is it available and who receives it? Findings from a mixed methods evaluation in
Kenya and Uganda. AIDS care, 26(9), pp.1155-1163.
Shepperd, S., Lannin, N.A., Clemson, L.M., McCluskey, A., Cameron, I.D. and Barras, S.L.,
2013. Discharge planning from hospital to home. Cochrane database of systematic reviews, (1).
Sherman, E.M., Elrod, S., Allen, D. and Eckardt, P., 2014. Pharmacist testers in multidisciplinary
health care team expand HIV point-of-care testing program. Journal of pharmacy practice,
27(6), pp.578-581.
Waring, J., Marshall, F., Bishop, S., Sahota, O., Walker, M., Currie, G., Fisher, R. and Avery, T.,
2014. Hospital discharge and patient safety: reviews of the literature. In An ethnographic study
of knowledge sharing across the boundaries between care processes, services and
organisations: the contributions to ‘safe’hospital discharge. NIHR Journals Library.
Wei-Cheng, D., Yue-Yun, Z., Guo-Jian, D., Jia-Xin, L., Yong-Hui, Z., Hong-Bo, W., Feng-Qiu,
L., Huai-Yu, B. and Guang-Hui, R., 2016. Discussion on multidisciplinary treatment mode of
advanced schistosomiasis and its standardized implementation. Zhongguo xue xi chong bing fang
zhi za zhi= Chinese journal of schistosomiasis control, 29(1), pp.102-104.

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WHO, (2019). HIV/AIDS TREATMENT AND CARE Clinical protocols for the WHO European
Region. Access date: 4.3.2020. Retrieved from:
https://www.who.int/hiv/topics/idu/care/E90840.pdf