Running head: DISCHARGE PLANNING 1

Discharge Planning Project

Taylor Brashears

University of South Florida

DISCHARGE PLANNING 2

Patient Hospitalization

On October 26, 2017, E.D., a 72 year old male, was admitted to Lakeland Regional

Health due to complaints of worsening abdominal pain from his ventral hernia. E.D. has history

of incarcerated hernias, systolic congestive heart failure, coronary artery disease, hypertension,

hyperlipidemia, diabetes mellitus II, chronic obstructive pulmonary disease, chronic kidney

disease, obstructive sleep apnea, and atrial fibrillation. Upon examination, it was determine E.D.

would need a ventral hernia repair, but would need to wait until October 29 due to the Xarelto he

was taking for his atrial fibrillation. On October 29, a successful ventral hernia repair was

performed and E.D. tolerated it well. On October 30 and October 31, the E.D. was monitored for

postoperative complications.

Discharge Diagnosis

The patients admission was due to his ventral hernia impending incarceration. The

patient verbalized he understands why he was hospitalized by stating he, needed to get a hernia

repair because my bowels were getting pushed up and causing problems. Although this

simplified explanation is correct, it is important to explain to the patient that the hernia is a bulge

through an opening in the muscles of the abdomen due to weak abdominal muscles, or a hole in

the abdominal muscles. It is also important to teach him postoperative care for the repaired

hernia. First, that it is normal to have pain during the following days and that over the counter

medication will typically help. Second, that he will need to avoid lifting any objects over fifteen

pounds for the first two weeks following surgery. Third, he should increase his fluids and dietary

fiber to decrease strain during a bowel movement. Finally, that there is a possibility of infection

due to incision on this abdomen, and that he should be watching for signs and symptoms
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including increased pain, swelling, redness, warmth, or fever. If any of these symptoms occur, he

should call his provider right away. There are not any associated core measures.

Medications

Since the patient has not yet been discharged, a reconciled medication list has not been

provided, although the only new medications Percocet and Tylenol for pain. If he were being

discharged a reconciled medication list would be provided, with information such as the last dose

and the next expected dose. Patient teaching would also be provided since the patient verbalized

he did not understand the side effects of the drugs. For Percocet, patient teaching would include

that is a combination of oxycodone and acetaminophen and is used for treating moderate pain.

The common side effects of it include headache, dizziness, constipation, and drowsiness. If

dizziness occurs, moving and changing positions slowly will help. If constipation occurs, a stool

softener or increased fluids and fiber may help. The adverse effects that may occur and need to

be reported to a provider would include a decrease in respiratory rate, slow, shallow breathing, or

lightheadedness. For Tylenol, patient teaching would include that it is used for treating minimal

pain. Common side effects for Tylenol are nausea, stomach pain, and loss of appetite. It is

extremely important to teach that acetaminophen, which is an active drug in both Percocet and

Tylenol can cause liver failure. The maximum amount of acetaminophen a patient can take a day

is 4 grams and he should not exceed this amount. Also for both drugs, it is important to not drink

any alcohol while using them. After explaining all of this to him, it would be necessary to ask

him questions about the information he was told to ensure understanding.

Home Assessment

The patient lives with his wife and stated that he feels safe in his living situation. The

patient has handrails on both sides of the steps leading up to his one-story house, keeps the floor
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free of clutter, and uses a chair in the shower. The patient relies on himself for self-care and

drives himself to wherever his needs are. He stated that if he is not able to, his wife attends to his

needs. The patient does not have any financial concerns confirmed by his statement that his wife

has insurance and they have Medicare.

Follow Up

The patient is not in any need of home health services and does not need any durable

medical equipment at home. The patient currently has one follow up appointment scheduled with

his primary care provider on November 2, 2017 and will also need a follow up appointment with

his surgeon in two weeks on November 13, 2017, although it has not yet been scheduled.

Physical therapy should be included in discharge planning to teach the patient on how to

strengthen the abdominal muscles to prevent another hernia in the future.

Summary

There are multiple considerations to prevent this patient from readmission. The most

important is to keep the surgical site from infection. This includes keeping the site clean,

performing wound care, and immediately reporting any signs and symptoms of infection. Other

considerations are to avoid lifting heavy objects for the next two weeks, increase fluids and fiber,

and perform physical exercise as the therapist instructs.