See attached

Overview

After reading the following articles: Your patient in this focused exam case study is a 58-year-old male who has a family history of high blood pressure and high cholesterol and begins experiencing chest pain. How you develop his discharge plan? What components would you include and why?

Brown, M. M. (2018). Transitions of Care. In Chronic Illness Care (pp. 369-373). Springer, Cham. 

Sexson, K., Lindauer, A., & Harvath, T. A. (2017). Discharge planning and teaching. AJN The American Journal of Nursing, 117(5), 58-60.

References:

· Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references.

Words Limits

· Initial Post: Minimum 200 words excluding references

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58 AJN ▼ May 2017 ▼ Vol. 117, No. 5 ajnonline.com

Discharge Planning and Teaching
Educating family caregivers on ways to prevent drug-related
problems.

Managing medications after hospital discharge can be a daunting task for the estimated 34 million adults caring for family members
older than age 50.1 What seems relatively simple to
nursing professionals can be overwhelming to family
caregivers coordinating and administering medica-
tions at home. This is particularly true when multiple
medications are required, or when the caregiver must
manage complex dosing regimens or administration
challenges, such as providing medications to someone
with swallowing difficulties.

Family caregivers and patients frequently report
that they are uncertain about the goal of using a given
medication and fear the occurrence of adverse effects.2, 3

This can lead to drug-related problems stemming from
errors in administration or a person’s inability to ad-
here to a medication regimen, ultimately contributing
to poor outcomes. As many as 46% of older adults ex-
perience drug-related problems after leaving the hospi-
tal,4 and researchers have estimated that more than
19% of Medicare patients are readmitted to the

hospital within 30 days, at an annual cost of $17.4
billion.5

Nurses have an important opportunity to reduce
drug-related problems and readmission through dis-
charge planning and teaching. In this article, we pro-
vide evidence-based recommendations to facilitate
caregiver discharge teaching, with the goal of reduc-
ing the risk of harm to elders and the amount of stress
experienced by their caregivers.

BACKGROUND AND EVIDENCE
Hospital admissions often result in changes in the pa-
tient’s treatment regimen, with hospitalists frequently
adding new medications and discontinuing others.6, 7

After returning home, patients and caregivers may be
confused about whether to resume home medications,
continue hospital medications, or make adjustments
based on the patient’s response.8

Medication nonadherence is a complex problem
in older patients. Pasina and colleagues followed up
with patients 15 to 30 days after hospital discharge
and again three months after discharge to learn about
their treatment regimens and medication adherence.9

369© Springer International Publishing AG 2018
T.P. Daaleman, M.R. Helton (eds.), Chronic Illness Care, https://doi.org/10.1007/978-3-319-71812-5_30

Transitions of Care

Mallory McClester Brown

With an aging population and advances in medical science,
people with advanced diseases are living longer, and chronic
care now dominates the health-care system. Effective man-
agement of patients with chronic diseases requires a well-
developed care continuum that emphasizes patient safety.
Fragmentation and discoordination of health care is a signifi-
cant cause of inappropriate care and increased health-care
costs.

One in five Medicare patients hospitalized in the United
States is readmitted within 30 days of discharge [1, 2] and
34% are readmitted within 90 days [16]. Seventy-five per-
cent of those rehospitalizations were likely avoidable [2].
“Readmission” is defined by the Centers for Medicare &
Medicaid Services (CMS) as hospitalization within 30 days
of discharge from a prior acute care admission to a hospital
[17]. Cost secondary to readmission is $17 billion for
Medicare alone [16]. Poorly executed care transitions nega-
tively affect patients’ health, well-being, and family
resources, unnecessarily increase health-care system costs
(IHI [5]), and raise the probability of readmission [14–16].
Medicare reimbursement penalties have been instituted by
the Patient Protection and Affordable Care Act for hospitals
with high levels of readmissions in recent years, making the
topic of readmissions timely and valuable [2]. Policymakers
and providers recognize that avoiding rehospitalizations
improves quality of care and reduces health-care costs.
Readmissions can be reduced by developing a system that is
anticipatory rather than reactionary.

Transitions of Care Defined

Transitions of care is defined as the set of actions taken to
ensure coordination and continuity of health care as patients
are transferred among various care settings [3]. Transitions

of care, when done well, take the patient’s safety, goals, and
well-being into account. High-quality transitions reduce the
use of resources by decreasing emergency room utilization
and the need for rehospitalization, decreasing cost to the
health-care system, and increasing patient, family, and pro-
vider satisfaction.

As an example, consider a frail 70-year-old female with
congestive heart failure who is admitted to the hospital for a
hip fracture. If she tolerates the procedure, does not have
postoperative complications, and stabilizes medically, her
care will be transitioned to a skilled nursing facility (SNF)
for rehabilitation. Once at the SNF, if she decompensates
medically and becomes delirious or has an exacerbation of
her congestive heart failure, she will likely be sent back to
the emergency room and probably readmitted to the hospital.
However, if he

Physical Examination & Health Assessment

8TH EDITION

CAROLYN JARVIS, PhD, APRN, CNP
Professor of Nursing
Illinois Wesleyan University
Bloomington, Illinois
and
Family Nurse Practitioner
Bloomington, Illinois

With Ann Eckhardt, PhD, RN
Associate Professor of Nursing
Illinois Wesleyan University
Bloomington, Illinois

Original Illustrations by Pat Thomas, CMI, FAMI

East Troy, Wisconsin

2

Table of Contents

Cover image

Title Page

Chapter Organization

Structure and Function

Subjective Data

Objective Data

Health Promotion and Patient Teaching

Documentation and Critical Thinking

Abnormal Findings

Copyright

Dedication

About the Author

Contributors

Reviewers

Preface

Acknowledgments
Unit 1 Assessment of the Whole Person

Chapter 1 Evidence-Based Assessment

Culture and Genetics

References

Chapter 2 Cultural Assessment

Developmental Competence

3

References

Chapter 3 The Interview

Developmental Competence

Culture and Genetics

References

Chapter 4 The Complete Health History

Culture and Genetics

Developmental Competence

References

Chapter 5 Mental Status Assessment

Structure and Function

Objective Data

Documentation And Critical Thinking

Abnormal Findings

Abnormal Findings for Advanced Practice

Summary Checklist: Mental Status Assessment

References

Chapter 6 Substance Use Assessment

Subjective Data

Objective Data

Abnormal Findings

Bibliography

Chapter 7 Domestic and Family Violence Assessment

Subjective Data

Objective Data

Abnormal Findings

References

Unit 2 Approach to the Clinical Setting

4

Chapter 8 Assessment Techniques and Safety in the Clinical Setting

Developmental Competence

References

Chapter 9 General Survey and Measurement

Objective Data

Documentation and Critical Thinking

Abnormal Findings

References

Chapter 10 Vital Signs

Objective Data

Documentation and Critical Thinking

Abnormal Findings

References

Chapter 11 Pain Assessment

Structure and Function

Subjective Data

Objective Data

Documentation and Critical Thinking

Abnormal Findings

References

Chapter 12 Nutrition Assessment

Structure and Function

Subjective Data

Objective Data