Discharge Planning for Elderly Patients

This document provides a case study on Ivan, an elderly patient who requires discharge planning. The assignment discusses three strategies for improving Ivan's health, including referral to occupational therapy (OT), referral to community services, and referral to a community nurse for diagnostic change. The document also includes references from various nursing journals and books.

Mr Jankovic case study

TABLE OF CONTENTS
TASK 1............................................................................................................................................3
1. Analyzing the way the psychopathology of obesity and its link to Ivan’s arthritis...............3
2. Communication issues identified in case study ....................................................................3
3. Importance of pre-operative checklist and the way they link to patient safety .....................3
4. Identification of three risks to Mr Jankovic linked to his obesity pose when having a
General Anesthetic......................................................................................................................4
5. Role of registered nurse in ensuring the safety of IVAN .......................................................4
6. The explanation about the incidence in case study and highlighting the key areas of
nursing management. .................................................................................................................5
7. Identification of three nursing problems and Justify Evans post surgical phase .................5
8. Setting the smart goals for the each problem stated above ....................................................5
9. Identification of two nursing intervention for the problems and Justification for the same . .6
10. Determining the two techniques which can be utilized for evaluating the outcome of each
intervention.................................................................................................................................6
11. Two assessment could be perform for addressing the issues faced by the Ivan and actions
which can be taken by nurses in order to support him ...............................................................6
12. Identification of the three assessment that could be done ...................................................7
13. Importance of discharge planning and three strategies which could be put into actions for
elderly people..............................................................................................................................7

TASK 1
1. Analysing the way the pathophysiology of obesity and its link to Ivan’s arthritis.
There is direct relationship between pathophysiology of obesity and its link to Ivan’s
arthritis. The psychopathology of obesity is multi factorial. Pathophysiology of obesity can
damage the structural joints which might result from metabolic as well as mechanical variables
including rise in forces about the Joint, decline in strength of muscle and alerted bio mechanics
during the time of routine body functioning (Orton, Forsman and Eldh,2019.). Obesity also
increase the risk of arthritis. It is through the metabolic path ways through which the obesity has
negatively effected the joints of I Vans which has resulted into arthritis to Evan. Increasing the
weight lead to the causing mechanical stress on joint, wear and tear increase as cartilage wears
down to bone. Weight plays crucial role in Joint stress. When people are overweight it puts stress
on their joints, especially their weight-bearing joints, like the knees and the hips. Every pound of
excess weight exerts about 4 pounds of extra pressure on the knees it is a reason people who are
overweight have chances of getting prone to arthritis.
2. Communication issues identified in case study
In context of case study of Ivan, Ivan considered to be as confused and when you
investigate further, he is quite drowsy, has slurred speech and does not give comprehensible
answers to questions asked by other person. An individual asking questions to him can’t decide if
he is orientated or not , it is the main communication issue identified in the case study.
3. Importance of pre-operative checklist and the way they link to patient safety
The pre-operative checklist is important in order to avoid medical errors and it also
assists medical practitioner in ensuring the safety of patients. Preoperative checks assist in
improving the outcomes. Communication error errors are common in operating room, it leads to
complications which also includes infections, pre-operative checklist is important as it assist in
eliminating the communication failure as well as supports in minimizing the chances of
complications. According to the Initial data from the World Health Organization Surgical Safety
Checklist shows that there is great decline in the morbidity as well as morality which has been
possible due to the implementation of per-operative checklist.
Pre-operative checklist could support Ivan in reducing the anxiety and assist the patients in
preparing themselves for surgery. It is the Pre-operative checklist in identifying the risk or safety
issue (Fischer, Jones and Verran, 2018). In addition to this, it also helps medical professional in

development of an effective plan for mitigating the risk or safety issues during the time of
surgery.
4. Identification of three risks to Mr Jankovic linked to his obesity pose when having a General
Anaesthetic
The three risk to Mr Jankovic linked to his obesity pose when having a General
Anesthetic includes :
- High risk of intubation difficulties due to higher grade : Such type of risk involves
infection as well as bleeding. In addition to this, other type of risk associated
with intubation includes trauma to vocal cord, thyroid gland etc.
- High risk of anaesthetic comp due high dose need cause of obesity : It includes
increase in blood pressure, which might lead to over bleeding during surgery.
- In addition to this, there is high risk related to increase in breathing problem.
- Increase in time related to the regaining consciousness after surgery (Bonner,
Mills and Douglas, 2018. ).
5. A) Role of registered nurse in ensuring the safety of IVAN
Role of registered nurses in ensuring the safety of patients
 Role of registered nurse is to assist medical professional in giving proper treatment to
patients.
 It is the duty of registered nurse to inform patient and their families about the next
procedure of treatment.
 Role of the registered nurse is to diagnose the patient and to inform the doctor about the
side effects of medication suffered by patients.
5 B). Responsibilities of registered nurse in context of medicine administrations
According to the NSQHS standards, The registered nurse is mainly responsible for
providing the correct as well as timely dosage to patients.
In addition to this, according to the standard 4th of medication safety, responsibility of nurse is to
ensure competent clinicians safety practices are conducted. Nurses are also responsible for
ensuring the proper disposable as well as administration of medicines. They are also accountable
for monitoring the side effects of medicines on patient health (Urden, Stacy and Lough, 2019).

In context of Evan case scenario, nurse has given the wrong dosage to Evan. The
medication which nurse has to give to the patient on the next bed has been given to the IVAN
which further has adverse effect on IVAN health. The role of registered nurse is to escalate
treating team as well as nursing team leader. The responsibilities of registered nurse is to ensure
that all the patients receives direct care. In addition to this, it is the responsibility of registered
nurse to provide oversight to medical assistants to nursing leaders and ensure an effective patient
care.
6. The explanation about the incidence in case study and highlighting the key areas of nursing
management.
In context of case study of IVAN, Mr Ivan Jankovic has been admitted in the hospital for
Hip replacement. Before the stage of surgery , he has been provided with medication. But there
was instance, the medicine which is required to be given to other patients has been provided
wrongly given to Ivan which has adverse effect on Evans health. Due to the wrong medication
Ivan ha become aggressive just before the post operative period (Weiss, Tappen and Grimley,
2019.). In context of given case study the two key ares of nursing management include patient
safety and family education. According to the NSQHS standards , patient safety is a key are of
nursing management. Nurses are required to ensure the safety of patient. They are mainly
responsible for diagnosing the patient and informing the medical professional about any side
effect of the medication on Ivan health (Webb, Nyatanga and Snelling, 2018). It is duty of nurses
to inform Ivan family about all side effects of medications and also about the way they should
deal with patient.
7. Identification of three nursing problems and Justify Evans post surgical phase
Priorities of the nursing problems includes difficulty in communication due to language barriers.
In addition to this, nurses also faced the issue in dealing with modalities of patient care such as
support, comfort, prevention of trauma, promotion of recovery, health screening, appraisal and/or
assessment, health education, and coordination of health care (Desborough, Bagheri and
Banfield, 2018). In context of Given case study the reason for the different issues faced by Ivan
include pain related to hip replacement, difficulty in movement of body, high blood pressure
related to HX etc.

8. Setting the smart goals for the each problem stated above
The three goals for each problems stated above in context of given case scenario of Ivan are :
 To reduce the pain 5/10 to 2/10 within thirty minutes by giving Ivan with pain killer
medicines.
 To arrange physio r/v in the shift
 To assist Ivan in minimizing the symptoms of Post op delirium within one hour by
providing him with the proper intervention.
 To minimize the blood pressure from 170/80 to normal limit within thirty minutes of
medications.
9. Identification of two nursing intervention for the problems and Justification for the same
In context of given case scenario, Ivan will be provided with proper medications and
exercises will be suggested to him. In addition to this, nurse will assist Ivan in changing his
positions. Physio or exercise will help Ivan in improving his health. Medications will help in
getting the relief from pain. In relation to the Post op delirium, the lighting will be reduced if
such intervention fails then in such case medication intervention will be given to Evan.
10. Determining the two techniques which can be utilized for evaluating the outcome of each
intervention.
Short term goals are:
-reduce pain 5/10 to 2/10 within 30mins by admistering pain relief (pain)
- reduce blood pressure from 174/80 to within normal limits (120/80) within 30mins of
medication administration (blood pressure) (Desborough, Bagheri and Banfield, 2018.). I will
ask Ivan whether he is having pain or not. I will measure the blood pressure.
11. Two assessment could be perform for addressing the issues faced by the Ivan and actions
which can be taken by nurses in order to support him
In context of Given case study, Ivan is facing the issue in passing the urine , the two
assessment which can be performed include Bladder scan and comparing input as well as output.
The other assessment is bPh blood test (van der Riet,, Levett-Jones and Aquino-Russell,2018.).
The nursing staff in hospital is required to positively influence Ivan for taking high amount of
fluids. In addition to this, collaborative intervention strategy can be adopted by nurses.

12. Identification of the three assessment that could be done
The main reason because of which Ivan is facing the issue in speaking might be
complications which has taken during his surgery in the past due to medication eror. In addition
to this, one of the reason could be breathing problem due to high blood pressure. The three
Assessments that could be conducted include ECG, City scan, Vascular/ circulation observation
sheet.
13. Importance of discharge planning and three strategies which could be put into actions for
elderly people
The main objective of discharge planning is to make sure continuity of quality care
between the community as well as hospital. Proper discharge planning is very much crucial for
making arrangement for ongoing health care setting. It is the proper discharge planning which
assists patients as well as their families in determining their rights. Discharge planning also
enables an individual family to develop the understanding about the services which are required
to be provided to patients in order ton assist them in improving their health. In context of given
case scenario, Discharge planning has assisted Ivan wife in identifying the strategies which can
be applied by her in order to help patient in improving his health (McMurray, Yang and Connor,
2018.).
The three strategies which can be implemented for the elderly people include :
Referral to OT : Such types of strategies includes installation of rails, no slip mats etc. The
medical professional or staff in hospital provides Ivans with suggestion related the
Musculoskeletal Physiotherapy. They can also refer Ivan to MATS specialist physiotherapy
clinic.
Referral community services : Such type pf services include domestic assistance to elderly
people and taxi vochures. In context of Ivan community nurse is required to make special
arrangements in order to assess the need for personal care service by an individual.
Referral to community nurse for Dx change : In context of Ivan nursing staff in health and social
care can suggest Ivan to conduct further diagnostic test.

REFERENCES
Books and Journals:
Webb, W.A., Nyatanga, B. and Snelling, P., 2018. Nursing management of people experiencing
homelessness at the end of life. Nursing Standard (2014+), 32(27), p.53.
Orton, M.L., Forsman, H. and Eldh, A.C., 2019. Nursing management matters for registered
nurses with a PhD working in clinical practice. Journal of nursing management.
Fischer, S.A., Jones, J. and Verran, J.A., 2018. Consensus achievement of leadership,
organisational and individual factors that influence safety climate: Implications for nursing
management. Journal of nursing management, 26(1), pp.50-58.
Urden, L.D., Stacy, K.M. and Lough, M.E., 2019. Priorities in critical care nursing. Elsevier
Health Sciences.
Weiss, S.A., Tappen, R.M. and Grimley, K., 2019. Essentials of Nursing Leadership &
Management. FA Davis.
Bonner, A., Stone, C., Mills, K. and Douglas, C., 2018. Chronic Disease Multi-Morbidity: Nurse
Practitioners Reforming Healthcare Delivery in Australia.
Desborough, J., Bagheri, N. and Banfield, M., 2018. Developing a positive patient experience
with nurses in general practice: An integrated model of patient satisfaction and
enablement. Journal of advanced nursing, 74(3), pp.564-578.
van der Riet, P., Levett-Jones, T. and Aquino-Russell, C., 2018. The effectiveness of
mindfulness meditation for nurses and nursing students: An integrated literature
review. Nurse education today, 65, pp.201-211.
McMurray, A., Yang, L. and Connor, M., 2018. The primary health care nurse of the future:
Preliminary evaluation of the Nurse Navigator role in integrated care. Collegian, 25(5),
pp.517-524.