Question

1. You are a nurse readying your client who is 3 days after surgical hip repair, to transfer to a rehabilitation facility for continued therapy. As your client's history includes dementia and a high potential for infection, communication is in order to ensure optimal continuity of care. The patient's family members are supportive but somewhat divided as to her living arrangements after she has completed her physical rehabilitation.

1. What data in the scenario are pertinent?

2. Describe some of your responsibilities within this situation to ensure continuity of care.

3. After the client completes her physical rehabilitation, what steps are necessary to provide effective discharge planning?

Answer 1

                   In this scenario, a patient with history of Dementia and a high potential for infection presented for surgical hip repair and this the third day of post hip repair and transferring the patient to rehabilitation facility for the physical rehabilitation.

                The data pertained in this scenario is that the family members divided the patient’s living arrangements after the physical rehabilitation for the hip repair surgery as the patient is having dementia and has is in high risk for infection also.

Nurse’s responsibility in a post hip repair patient on physical rehabilitation

               Care and rehabilitation of patients following hip fracture are particularly challenging for trauma services, but units that are able to provide good care for these patients will also be able to provide effective care for the complete range of other fragility fractures encountered. Good multidisciplinary working requires positive attitudes, good communication and sharing of information, an adaptive and flexible approach to collaboration and deep commitment from all concerned to promote quality care and good outcomes for patients.

The primary outcomes of rehabilitation are independence in physical function and quality of life. Poor outcomes of recovery and rehabilitation amount to failure to return to independent living and readmission to hospital. Effective rehabilitation is important in promoting independence and in enabling the patient to reach their potential and return home

• Assessment of frailty
• Establishing goals to maximize mobility and other aspects of function; therapy provided by physiotherapists and occupational therapists has the potential to accelerate the recovery of mobility.
• Providing occupational therapy services to assess the need for aids
• Determining strategies to support and improve independence in activities of daily living
• Medication management to ensure all prescribed medications are necessary, the use of antipsychotics and sedatives is minimized and there is effective pain management
• Secondary fracture and fall prevention.
• Initiate Mobility and exercise after 48 hours of surgery to develop independence for patients
• Mobilization and other activities need to be reintroduced into patients’ activity gradually as their physical recovery from surgery progresses.
• To be successful in rehabilitation goals, motivate the patient to concord with therapy and exercise programs and other activities.
• Provide timely and clear information to reduce stress and uncertainty for patients and potentially improve their outcomes.

Steps to provide effective discharge planning

                 Hospital discharge planning is a process that determines the kind of care the patient need after leaving the hospital. Discharge plans can help prevent future readmissions, and they should make the patient to move from the hospital to home or another facility as safe as possible.

a nurse is employed as a case manager or discharge coordinator whose key role is to support discharge planning and negotiating the different parts of care services and formal and informal care networks, particularly during transfer from one service to another.

· Development of a discharge plan must begin as early as possible during the hospital stay, to ensure that patient education and support are provided to facilitate independence so that the patient can develop an understanding of their health condition and acquire the knowledge and skills needed to self-care independently or with caregiver/family support.

· Determine the most appropriate setting for ongoing care, considering the continuing care, medical, functional and social needs, and decision-making capacity of the patient.

· Advice the patient to do the exercises regularly.

· Instruct the patient to follow aseptic techniques to prevent from the occurrence of infection as patient is having the history of high risk infection.

· Instruct the family members to provide safety environment for the patient o avoid the risk for fall.

· Advice the patient to reach the hospital if any signs of infections such as redness, drainage etc. seen.

· Instruct the patient/family members to take the medication in the proper time for better healing