Running head: DISCHARGE PLANNING PROJECT

Discharge Planning Project

Amanda Poplin
University of South Florida

DISCHARGE PLANNING PROJECT

Introduction
Patient is a 56 year old male who was admitted to the hospital on September 16, 2015 for
a right kidney transplant. He was initially found to have kidney disease in 2003 after presenting
with back pain resulting from bilateral enlarged cystic kidney; he was diagnosed with autosomal
dominant polycystic kidney disease (ADPKD). Patient has a sister with ADPKD but has no other
family history of the disease otherwise. Past medical history of the patient includes chronic
kidney disease, stage IV (ADPKD), secondary hyperparathyroidism of the renal origin, anemia
of chronic kidney failure, and most recently gastritis and diverticulitis. Although patient was
diagnosed with chronic kidney disease twelve years ago, patient has never been on dialysis and is
pre-emptive. Throughout this hospital stay, his creatinine has been stable in the 4s accompanied
by mild uremic symptoms. The patients only complaint is mild worsening fatigue.
Discharge Diagnosis
The patient has a full understanding of the purpose of his hospitalization, and that
ADPKD is a genetically inherited disease in which 50-75%of patients will require either dialysis
or a renal transplant by the age of 75. The disease process affects the function of the renal cilia
through alteration in the shape of the cilia, which can cause a flow-induced increase in
intratubular calcium (Jaipaul, 2013). This buildup of calcium can lead to cyst formation, which
can result in hematuria when these cysts hemorrhage. Patients with ADPKD are also at risk for
acute pyelonephritis, cyst infections and renal calculi. This patient is being discharged and has
provided a verbal understanding of the disease process, and is well educated on the topic due to
the fact that he is an orthopedic surgeon. Patient teaching for his diagnosis includes maintaining
a clean environment and strict hygiene practices, as well as incentive spirometry, deep breathing
practices and ambulation in order to remain free of infection. Medications for this surgery are
immunosuppressive so that the patient will not reject the foreign kidney, but simultaneously
result in a lower threshold for infection development. Patient education regarding this diagnosis

DISCHARGE PLANNING PROJECT

also includes daily weights, regular monitoring of blood pressure as well as intake and output
amounts. Following renal transplant, the new kidney may not function optimally at first,
resulting in fluid volume excess. Excess may also develop from the use of corticosteroids and
from decreased cardiac output in the transplant recipient (Perrin, 2009). Compliance with these
measures by the patient will allow him to become aware if he has any change in fluid volume,
which would require a follow-up with his primary care provider. There are no core measures for
kidney transplantation to educate the patient about.
Medications
The patient has been given a reconciled list of all his medications, including the ones new
from this admission and refills, and given his background as a surgeon, he has a thorough
understanding of each medication, its indications, and its side effects. The discharge summary for
this patient includes a table that lists the date and time of last dose and next expected dose for
each medication, covering the time period of a week post-discharge. The medications new from
this admission include mycophenolate and tacrolimus, both immunosuppressants to prevent
rejection of the new organ; each of these medications require lifelong therapy. Side effects of
mycophenolate include gastrointestinal bleeding, edema, hyperglycemia and tachycardia.
Tacrolimus side effects are seizures, dizziness, hypertension and gastrointestinal bleeding this
is another reason that it is crucial for the patient to monitor his blood pressure and take note if it
becomes elevated. The patient is continuing famotidine, an anti-ulcer agent, which was
prescribed prior to this admission and a refill has been ordered. Side effects of this medication
include headaches, constipation, and nausea and vomiting. (Vallerand, A.,Sanoski, C., & Deglin,
J., 2015).
Home Assessment
The patient lives at home in a safe and supportive environment with his wife and sixteen
year old son. They live in a two story house in which the patients bedroom is located on the first

DISCHARGE PLANNING PROJECT

floor, so there is no need for him to travel the staircase while in recovery. The patients wife is
unemployed and has accompanied the patient throughout his hospital stay. She has verbally
stated that she will provide transportation for the patient to pick up medication prescriptions and
refills, to attend follow-up appointments, and will be at home with the patient all day to care for
him and provide meals since she is unemployed. The patients son has also agreed to be of
assistance when needed, in order to provide relief for his mother. The patient is not concerned
about finances to cover his care, and is fully confident in his wifes ability to provide
transportation anytime necessary.
Follow Up
The patient will not require post-operation home health services or medical equipment in
the home; the only need he has will be to remain compliant with medications for lifelong therapy
in order to prevent rejection. Frequent follow-up nephrology clinic and lab visits are required,
and have already been scheduled for twice a week throughout the next thirty days, once a week
for the next sixty days, and twice a month after the ninety day period. The patient will be seeing
a nephrologist and transplant doctors for these appointments to monitor his progression. The
patient will also require a social work consult upon discharge to educate the patient and his wife
concerning support groups and local nephrology services in his community. The patient will
require a physical therapy consult before discharge as well to determine if he is stable and able to
ambulate sufficiently.
Summary
In order to prevent readmission of this patient, it is crucial to assess his understanding of
his medications and ensure that he is thoroughly informed of their necessity for lifelong therapy.
The patient will also need to understand the need for monitoring his daily weights as well as
intake and output to assess his renal function. The patient has verbally affirmed his

DISCHARGE PLANNING PROJECT

understanding and his wife has also been educated on his postoperative condition, as well as her
support of maintenance of his health.

DISCHARGE PLANNING PROJECT

References

Jaipaul, N. (2013, September 1). Autosomal Dominant Polycystic Kidney Disease (ADPKD) Genitourinary Disorders. Retrieved September 21, 2015.

Perrin, K. (2009). Care of the Organ Donor and Transplant Recipient, In Understanding the
Essentials of Critical Care Nursing. Upper Saddle River, N.J.: Pearson Prentice Hall.

Vallerand, A., Sanoski, C., Deglin, J. (2015). Immunosuppressants, In Davis's Drug Guide for
Nurses, 14th edition. F.A. Davis Company.