Discharge Planning

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DISCHARGE PLANNING DISCHARGE GOALS: 1. 2. 3. 4. 5. 6. Dealing with current situation realistically. Pain relieved/controlled. Complications prevented/minimized. Mobility/function regained or compensated for. Surgical procedure, prognosis, and therapeutic regimen understood. Plan in place to meet needs after discharge. M ± Medications  Take home medication as prescribed by the Physician.  Report any side effects & adverse reactions as indicated by the health care provider.  Avoid administerin
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  DISCHARGE PLANNING DISCHARGE GOALS: 1. Dealing with current situation realistically.   2. Pain relieved/controlled.   3. Complications prevented/minimized.   4. Mobility/function regained or compensated for.   5. Surgical procedure, prognosis, and therapeutic regimen understood.   6. Plan in place to meet needs after discharge . M ± Medications  Take home medication as prescribed by the Physician.  Report any side effects & adverse reactions as indicated by the healthcare provider.  Avoid administering narcotics or analgesics for phantom pain becausethese are ineffective for phantom limb pain but are effective for surgicalstump pain. Check with physician about administration of other medications. E ± Environment/Exercise  Instruct patient to stay in calm, quiet environment.  Home environment must be free from slipping or accident hazards.  Reinforce the need to continue exercises at home. Active ROM exercisesincrease muscle mass, tone, & strength pressure joint mobility & improvecardiac & respiratory function.  Encourage/advise patient to use/wear a clean cotton T-shirt to preventcontact between the skin & shoulder harness & to promote absorption of perspiration.  Teach patient to massage the residual limb to mobilize the surgicalincision site, decrease tenderness & improve vascularity.  Instruct patient to avoid the use of lotions/powders. Although a smallamount of lotion may be indicated if skin is dry, emollients/creams softenskin and may cause maceration when prosthesis is worn. Powder maycake, potentiating skin irritation. T ± Treatment   Inform patient to have a follow-up check up after 1- 2 weeks.  Inform patient to return after 1 week for removal of sutures.  Advise client that phantom pain may begin right after surgery or not until2-3 months later. This explanation will help to reduce fears associated w/unknown situations.   Inform patient to clean/wash & dry the healed residual limb at least twicedaily.  Encourage massage therapy after 2 weeks post-op to override sensationof phantom pain. H ± Health Teachings  Encourage patient to verbalize/describe the effects of amputation on self-image &, accept grieving as part of coping process.  Explain that stress, anxiety, fatigue, depression, excitement & weather changes may intensify phantom limb pain. Psychological stressors do notcause phantom limb pain but can trigger or increase it.  Encourage client to have warm bath to soothe & reduce pain on thesurgical site.  Instruct patient to increase intake of protein-rich foods to promote faster wound healing.  Instruct to promote adequate fluid intake.  Discourage patient to participate in strenuous activities that mightprecipitate stress and trauma to the wound.  Encourage to elevate the amputated area to reduce pain & swelling.  Identify techniques to manage phantom pain, e.g., good stump care,properly fitted prosthesis, gentle massage/ pressure to stump. Emphasizestress management and relaxation training, and discuss variousmedications that may be used for pain management. Reduces muscletension and enhances control of situation and coping abilities.  Explain measures that have been effective in alleviating phantom limbpain. (e.g., applying heat & pressure to stump, massage therapy after 2wks post-op). Stimulation causing a second sensation may serve tooverride the phantom sensation.  Teach the patient/significant others the correct method of bandagingbecause an improperly applied elastic bandage contributes to circulatoryproblems & a poorly shaped residual limb.  Identify community and rehabilitation support, e.g., certified prosthetist-orthotist, amputee groups, home care service, homemaker services, asneeded. Facilitates transfer to home, supports independence, andenhances coping. O ± Observable Signs and Symptoms  Instruct patient to monitor the incision, dressing & drainage for indicationsof infection (e.g., change in color, odor, or consistency of drainage;increasing discomfort), & report immediately to physician if any of thissigns are seen & observed.  Instruct patient to monitor & report promptly the signs of complications(e.g., uncontrolled pain; signs of local or systemic infection; residual limbskin breakdown) to the physician.      Advise client to consult w/ pain specialists if phantom limb pain isunmanageable. Phantom limb pain causes disability & loss of  employment. D ± Diet/ Nutrition  Stress importance of well-balanced diet, such as protein-rich foods, andadequate fluid intake.   Provides needed nutrients for tissueregeneration/healing, aids in maintaining circulating volume and normalorgan function, and aids in maintenance of proper weight (weight changesaffect fit of prosthesis).  Recommend cessation of smoking.   Smoking potentiates peripheralvasoconstriction, impairing circulation and tissue oxygenation.  Instruct to increase fluid intake.   Inform patient that there are no restrictions in the diet except for foods thatcould interact & delay absorption of some medications, & those that areincluded in his food-allergy list.  PROGNOSIS Surgical technique, postoperative rehabilitation and prosthetic design haveimproved greatly since mid-1900s, allowing most individuals who undergo amputation toreturn to high levels of functioning after reconstruction and rehabilitation. Amputationsusually succeed in arresting the spread of infection or cancer. The projected meanlength of inpatient stay, according to Diagnosis-related Group (DRG), is 5.8 ± 12.7 days.In the case of our patient, prognosis is good because he follows the instructions given tohim by his health care providers & his recovery is fast. He stayed in the hospital for onlya short-period of time for only 2 days. Although loss of part of an extremity alwaysproduces some degree of permanent disability, individuals undergoing amputation oftenreduce the ability to perform tasks involving manual dexterity. Even though, prostheticdevices are experimented/ created, it cannot be compared to the function of the srcinalbody parts amputated on the patient¶s body.
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