Question

You are working on a postsurgical unit and have been given an order to discharge a 72-year-old male who has just had a total hip replacement. Per hospital policy, you obtain a set of vital signs before discharging him home and note his temperature to be 100.9˚F. Upon assessing the patient, he tells you that he feels a bit “chilled.” You notify the practitioner of the elevated temperature and the patient’s comments, but you are told to continue with the discharge. Write a one page paper on the following items:

1. After notifying the practitioner about the elevated temperature, do you need to gather additional information about the patient’s condition before you discharge him?

2. What do you do if the patient appears to be too ill for discharge? Is there anyone else you can contact?

3. If you discharge the patient and he develops sepsis or a serious illness, are you responsible or is the health care practitioner responsible?

Answer 1

1) Even though it is common to have elevated temperature after the surgery , care must be taken to understand if this occurs several days after the surgery. It implies that there are chances of infection like sepsis. Other than vitals the nurse can

a) Assess the wound site for any changes like redness, presence of foul smelling fluid ,bleeding and warmth over the wound.

b) Check for increase in pain. Pain might indicate infection deep inside the wound.

2) If the patient appears to be too ill collect the necessary assessment and approach his doctor but if he is still adamant about the discharge inform your superior who can in turn talk to the doctor or approach the management if necessary. Meanwhile tend to the patient and watch him closely for necessary management.

3) Both the nurse and the doctor are responsible as it was important to provide a thorough check up before discharging the patient. A nurse has all the right to advocate for her patient if she had found him in any discomfort or was showing any signs of infection . Moreover the patient is old and his defense mechanism is less so the doctor had to make sure whether he was fit for discharge. This surgery has potential problems like infection in the bone which is a serious problem and can cost the patient.