Running head: DISCHARGE PLANNING 1

Discharge Planning Project

Deanne Buchholtz
University of South Florida
College of Nursing
NUR4516L
11/18/13













DISCHARGE PLANNING 2
Discharge Planning Project
The patient is an 80 year old male who presented to the ED on 11/6/13, with a chief
complaint that he could not seem to catch a breath. The patient was escorted by his wife.
Auscultation of bilateral upper lung lobes revealed wheezing and diminished lung sounds. The
ED physician ordered a CBC, which showed elevated WBC and Segs (indicative of infection),
and a CXR, which displayed the presence of a granuloma secondary to Aspergilis exposure. The
patient was admitted on 11/6/13 and diagnosed with pneumonia on 11/7/13. The patient has
history of interstitial lung disease, asthma, COPD, and DMII. Current treatment is IV rocephin
and frequent monitoring. A second CBC was drawn 11/8/13, revealing stable WBC and Segs,
while CXR showed moderate improvement.
Discharge Diagnosis
The patient understands that he was hospitalized due to difficulty breathing related to his
development of pneumonia, as well as his advanced age and history of lung-related
comorbidities. The teaching specific to this disease process involves instruction to turn, cough,
and deep breathe, and also instruction on the use of an incentive spirometer to expand the lungs
and promote oxygen exchange. Furthermore, treatment of the patients pneumonia requires
adherence to the full dose of antibiotic, even once infection symptoms have dissipated. Teaching
also includes management of asthma symptoms with medication and an inhaler. Core measures
specific to this patients pneumonia diagnosis are listed in the table on the following page and
have been met (The Joint Commission, 2011).



DISCHARGE PLANNING 3
Medications
There is a reconciled list of the patients medications. New medications include an at-
home antibiotic regimen. The list includes information on last dose and next expected dose
The patient states that he understands all medication indications, dosage, and side effects.

Home Assessment
Currently, the patient lives with his daughter and son-in-law. He states that he does feel
safe in the home and is well-cared for. Both the daughter and her husband work outside the
home. Reliable mechanisms of care include the familys maid, whom was hired not only to care
for the house, but also to grocery shop and provide transportation for the patient to appointments.
On weekends, the patient is included in family activities as he feels physically able. The patient
DISCHARGE PLANNING 4
states he has no financial concerns regarding access to medications and follow-up appointments
with his health provider.
Follow Up
There are no recommendations for home health services required. The patients
pneumonia is related to Aspergilis exposure, and otherwise seems well-controlled by medication
and oxygen. Durable medical equipment includes oxygen tanks, nasal cannulas, and oxygen
masks. The patient is scheduled for a follow-up appointment with the provider two weeks post
discharge. At this time the dose should be complete and the patient will undergo a CXR to
determine status of infection. No appointments with a specialist have been scheduled, however,
if ILD exacerbation persists, the patient is recommended to seek further treatment with a
pulmonologist. A respiratory therapist should also be included in the discharge planning team to
assist in patient teaching regarding ILD, asthma, and COPD management.

Summary
The most important consideration to make in order to avoid readmission for this patient is
compliance to the at-home antibiotic regimen to prevent recurrence of pneumonia symptoms.
Proper maintenance of the patients ILD, asthma, and COPD with medication, oxygen, deep
breathing exercises, and rest will promote optimal health at this stage of disease. Call the
provider if pneumonia symptoms do not resolve or if patient continues to have difficulty
breathing.


DISCHARGE PLANNING 5
Resources

PN Measure Set, 2011. Pneumonia Measures. The Joint Commission. Retrieved from:
http://www.jointcommission.org/pneumonia/