Running head: DISCHARGE PLANNING PAPER 1

Discharge Planning Paper

Kimberly Cremerius
University of South Florida College of Nursing















DISCHARGE PLANNING PAPER 2

Discharge Planning Paper
CS is a 68 year-old female that presented to the emergency room at Florida
Hospital Wesley Chapel on 10/13/13 presenting with chest pain. The ECG showed a
non-STEMI. The patient was transported to Florida Hospital Tampa on 10/14/13 for a
CABG procedure that was done on the same day. After surgery the patient developed
blisters on right leg under the dressing over incisions. Six blisters surrounded the incision
and had serous, clear, yellow drainage coming from the open blisters. Absorbent foam
dressing placed on the blisters to absorb drainage and antibacterial topical treatment
applied to prevent infection. Four blisters opened while two remained closed. Appears to
be associated with allergy to adhesive tape that patient was not aware of before
hospitalization.
Discharge Diagnosis
The patient was hospitalized for a non-STEMI myocardial infarction. CS
understands that she had a heart attack and could explain to me the basics of her CABG
procedure. It is important that the patient understand that there are ways to prevent future
heart attacks. These preventions including having a low fat diet, exercising daily, and
maintain a healthy weight. The patient understands these preventative measures and also
can explain the importance of taking her medications as prescribed to prevent future
complications. The core measures that were met during hospitalization include giving
patient aspirin upon arriving to the hospital and prescribing aspirin, beta-blocker, and a
statin for continually use in the hospital and at home. The patient does not smoke so
smoking cessation teaching was not necessary.
Medications
DISCHARGE PLANNING PAPER 3

The patient has a reconciled list of medications including the new prescriptions
and refills that she comprehends the necessity of getting filled and taking as prescribed.
This list shows the last dost that the patient received in the hospital and the time of the
next required dose. When reviewing her list of medications the patient was able to tell me
the reason for each of her medications, focusing specifically on the new prescriptions,
and the most common side effects that she could experience. Carvedilol is a beta-blocker
that she is taking for hypertension. CS knows to check her heart rate before taking
carvedilol and that if her heart rate is under 60 beats per minute not to take the
medication. If she experiences any difficulty breathing or has a fever with a severe rash
CS understands that she should go to the emergency room because these are serious side
effects of the medication. CS understands that she takes aspirin to prevent a future heart
attack and realizes that there is a risk for bleeding when on this medication. CS states that
simvastatin is for high cholesterol and to prevent a future heart attack. We discussed the
need to see her doctor if she has severe muscle tenderness or discolored urine.
Home Assessment
CS lives alone in a condo on the first floor. The living situation is safe; there are
no stairs, throw rugs in her apartment, or other hazards that could cause the patient to fall.
The patient usually drives herself, but after her surgery until she has fully recovered she
will ask members of her church community to help with errands. CS does not have any
immediate family in the area. The patient has United Healthcare insurance and is not
worried about financial aspects of obtaining her medications or attending her follow up
appointments.
Follow Up
DISCHARGE PLANNING PAPER 4

CS requires home health services once a week to check in, make sure she is
recovering, and has the supplies she needs. She agreed to this arrangement and set up for
a home health nurse to come by after discharge. She requires a walker until she regains
her strength she lost after her surgery. CS scheduled follow up appointments with her
primary physician on 10/30/13 and her cardiologist on 11/7/13. Physical therapy has been
notified to discuss her therapy schedule after discharge.
Summary
The most important considerations for CS to prevent readmission include taking
her medications on time as prescribed every day, attending her follow up appointments,
and continuing her physical therapy to continue to regain her strength. If the patient
follows through with these three tasks, her condition will continue to improve.