Running head: DISCHARGE PLANNING 1

Discharge Planning for the Palliative Care Patient

Taylor Brown

University of South Florida

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Introduction

Patient DM is a 64-year-old female who was released from a long-term care

facility on September 1st, but presented to the ED on September 6th for acute mental

status change and failure to thrive. These symptoms include a weight loss of 5

pounds, increased groaning, fatigue and general discomfort as articulated by her

primary caregiver, her daughter. DMs past medical history includes one CVA in May

2017 and one in July 2017, CHF, HTN, stage 3 CKD, non-specified seizure disorder,

and atrial flutter. These strokes left the patient non-verbal, unable to follow simple

commands and non-ambulatory. DMs surgical history includes cardiac defibrillator

placement, mitral valve repair, and hernia repair. The patient has also been

diagnosed with a UTI and inability to regulate fluid and electrolytes related to her

kidney disease.

Discharge Diagnosis

It is unclear if the patient understands their hospitalization. Since the patient

is non-verbal and is also unable to use communication boards, the nurse must rely

on family members for key information and degrees of change in the patients

overall appearance and personality. Since, the patient is unable to

understand/follow simple commands and cannot speak, this is indicative of both

receptive and expressive aphasia following her two strokes (Aphasia, 2015). Since

the patient has been non-verbal for about 3 months now, the family is already able

to identify signs and symptoms of fatigue and stress, such as the increased groaning

and fatigue that brought on this hospital admission.

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Although the patient herself will not be able to comprehend or at least

demonstrate comprehension of her medications, it is important for the nurse to

teach the family about her medications. The most serious of her medications is the

Primakor drip, which increases cardiac output for the heart failure patient.

According to the Davis Drug Guide (2015), common side effects include headache,

tremor, chest pain, hypotension, hypokalemia and thrombocytopenia. The most

serious side effect is ventricular arrhythmias. If the patient were going home with

an IV, there would be additional teaching for the patients family about maintenance.

Since, we are recommending palliative care at this time, it is not necessary.

Bumentanide is a loop diuretic that requires patient education. The indication of this

medication is to avoid fluid volume overload, or in laymen terms to decrease the

fluid build up that occurs in CHF. The most important part of this medication is that

it depletes potassium through the urine (Vallerand, Sanoski, & Deglin, 2015).

According to MedLine Plus (2015), symptoms of hypokalemia include constipation,

heart palpitations, fatigue, muscle damage, muscle weakness or spasms, and tingling

or numbness. These medications are especially important in an end of life scenario

as they may be prolonging the patients life. Additional medications include the

heart medications amiodarone and carvedilol, pain medications and finally the

antihyperlipedmia drug atorvastatin.

Home assessment

The hospital stay was brought on by an extreme decline in the patients

condition after leaving her LTCF and returning home. Assessment of the patient as a

whole indicated that her health in severe decline and will never recover fully.
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Instead of a home assessment, it is important to assess the familys readiness for a

transfer to palliative care and explain why it is necessary. The nurse herself should

help the family understand why this is an end of life scenario and advocate for the

patient. To aid in explaining the need for palliative care, the nurse should consult the

hospital Chaplain. Since the patients family is hesitant to accept an end of life

diagnosis, a Chaplain has much insight on dealing with grieving and denial-ridden

families. This particular patient practices Catholicism so the nurse should consult

pastoral services for a priest if available. Palliative care would provide relief for the

caregiver, as she expressed personal issues regarding the stressfulness of a

completely dependent individual. Palliative care facilities would life the stress of

medications, food, ADLs, etc. from the family while also making the patient

comfortable at the end of her life.

Follow up

Follow up will include identifying the best option for a palliative care facility.

It is important to take into account the familys location, financial situation and their

ability to afford palliative care. The best resource for choosing this type of facility is

the National Hospice and Palliative Care Organization. They have FAQ forms, a

hotline and many additional outreach tools. This organization also offers a lot of

support for the family, including grief and bereavement counseling.

Summary

Palliative care is a very sensitive topic for patients and their families. Denial

is common in families who have a family member at the end of their life. It is

important for the nurse to advocate for their patients and help the family
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understand why this is their best option. In the specific case, caregiver role strain is

evident. Palliative care will lift this stress from both the patient and her family and

may also normalize death as they appreciate the life that she had before she relied

on hospital care. As nurses, advocating for our patients is vital is being a holistic

nurse. Whether our patients lives are just beginning or coming to an end, they

deserve the best care possible.

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References

Aphasia. (2015). Retrieved October 18, 2017, from http://www.stroke.org/we-can-

help/survivors/stroke-recovery/post-stroke-conditions/physical/aphasia

MedLine Plus. (2015). Low potassium level. Retrieved from

https://medlineplus.gov/ency/article/000479.htm

Vallerand, A., Sanoski, C., & Deglin, J. (2015). Davis's Drug Guide for Nurses (15th ed.).

Philadelphia, PA: F.A. Davis Company.