Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
Discharge Planning
The medical team has explained that you are in the end stages of
the disease process and recommends that you should consider
either being admitted to the Palliative Care Unit or receiving hospice
care at home. However, you are in denial about your prognosis and
refuse to consider either option.
You are to do the following during the clinical simulation:
� Complain frequently of intense pain. You are to give your health
care worker an initial pain rating of 6/10. Despite medication,
when assessed, you should rate your pain at increasing levels.
� You are to refuse your pelvic exam
� You will be traveling for a colonoscopy at noon and you request
to be accompanied to the procedure by your RN
� Question the RN about your medications when she comes to
administer them
During the clinical simulation, you may receive further
instruction regarding additional actions that you must
perform.
The RN would receive the following information during
report:
The patient is well known to the unit and has a primary diagnosis of
end stage AIDS. She is noncompliant with the medical plan of care.
She was sent to the ED from the clinic and was subsequently
admitted to “N5”. Vitals: T=103°F, HR=164, BP=71/38. Labs:
CD4= 2, Na=145, K+= 3.7, BUN=12, Creatinine= .75, Hgb=7.6
(pre-transfusion), WBC=6.9, HCT=27.6, most recent weight is 68
lbs. The patient’s admitting diagnosis is anemia with secondary
diagnoses of rule out sepsis and rule out recto-vaginal fistula. The
patient is complaining of generalized body aches. Currently rates
pain at 6/10. Patient sleeps for long periods of time and does not
want to be disturbed. The patient refused bedtime medications.
The medical team is recommending that the patient be admitted to
the Palliative Care Unit or be discharged home with hospice when
ready for discharge. The patient is refusing these options at this
time and the night shift staff believe that she is depressed and in
denial about her prognosis. The patient has friends and family that
provide emotional support, but they too are in denial. A social work
consult has been ordered. The patient is scheduled for a pelvic
exam and a colonoscopy on your shift.
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