Patients in the acute care setting may be discharged to an extended-care facility. Patients requiring relatively shortterm rehabilitation and those needing long-term care/permanent nursing care are included in this group. The level of care and needs of the patient (e.g., physical, occupational, rehabilitation therapy; IV and respiratory support) are frequently the deciding factors in the choice of placement. Additionally, visual impairments, memory/mental impairment, and physical immobility lead to a loss of independence for many individuals. Although elderly people are the primary population in extended-care facilities, increasing numbers of younger individuals are requiring care for debilitating conditions when they cannot be managed in the home setting.
RELATED CONCERNS
AIDS
Cancer
Cerebrovascular accident (CVA)/ stroke
Craniocerebral trauma (acute rehabilitative phase)
End of life/hospice care
Multiple sclerosis
Psychosocial aspects of care
Spinal cord injury (acute rehabilitative phase)
Surgical intervention
Ventilatory assistance (mechanical)
Patient Assessment Database
Data depend on underlying physical/psychosocial conditions necessitating continuation of structured care.
TEACHING/LEARNING
Discharge plan Projected mean length of stay:Depends on underlying disease/condition and individual considerations: care needs. Therefore, this may be a temporary or permanent placement.
May require assistance with treatments, self-care activities, homemaker/maintenance tasks, or alternative living arrangements (e.g., group home)
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES (DEPENDENT ON AGE, GENERAL HEALTH, AND MEDICAL CONDITION)
CBC: Reveals problems such as infection, anemia, other abnormalities.
Chemistry profile: Evaluates general organ function/imbalances. Age-related changes include decreased serum albumin, up to 20% increase in alkaline phosphatase, decreased urine creatinine clearance.
Urinalysis: Provides information about kidney function; determines presence of UTI or DM. Note: Bacteria is common in some populations, especially the elderly and bedridden, reflecting urinary stasis.
Pulse oximetry: Determines oxygenation, respiratory function.
Communicable disease screens: To rule out tuberculosis (TB), HIV, venereal disease, hepatitis.
Drug screen: As indicated by usage to identify therapeutic or toxic levels.
Visual acuity testing: Identifies cataracts/other vision problems.
Tonometer test: Measures intraocular pressure.
Chest x-ray: Reveals size of heart, lung abnormalities/disease conditions, changes of the large blood vessels and bony structure of the chest.
ECG: Provides baseline data; detects abnormalities, e.g., ST-segment and T-wave changes, atrial and ventricular dysrhythmias, and various heart blocks are common in the elderly.
NURSING PRIORITIES
1. Promote physiological and psychological well-being.
2. Provide for security and safety.
3. Prevent complications of disease and/or aging process.
4. Promote effective coping skills and independence.
RELATED CONCERNS
AIDS
Cancer
Cerebrovascular accident (CVA)/ stroke
Craniocerebral trauma (acute rehabilitative phase)
End of life/hospice care
Multiple sclerosis
Psychosocial aspects of care
Spinal cord injury (acute rehabilitative phase)
Surgical intervention
Ventilatory assistance (mechanical)
Patient Assessment Database
Data depend on underlying physical/psychosocial conditions necessitating continuation of structured care.
TEACHING/LEARNING
Discharge plan Projected mean length of stay:Depends on underlying disease/condition and individual considerations: care needs. Therefore, this may be a temporary or permanent placement.
May require assistance with treatments, self-care activities, homemaker/maintenance tasks, or alternative living arrangements (e.g., group home)
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES (DEPENDENT ON AGE, GENERAL HEALTH, AND MEDICAL CONDITION)
CBC: Reveals problems such as infection, anemia, other abnormalities.
Chemistry profile: Evaluates general organ function/imbalances. Age-related changes include decreased serum albumin, up to 20% increase in alkaline phosphatase, decreased urine creatinine clearance.
Urinalysis: Provides information about kidney function; determines presence of UTI or DM. Note: Bacteria is common in some populations, especially the elderly and bedridden, reflecting urinary stasis.
Pulse oximetry: Determines oxygenation, respiratory function.
Communicable disease screens: To rule out tuberculosis (TB), HIV, venereal disease, hepatitis.
Drug screen: As indicated by usage to identify therapeutic or toxic levels.
Visual acuity testing: Identifies cataracts/other vision problems.
Tonometer test: Measures intraocular pressure.
Chest x-ray: Reveals size of heart, lung abnormalities/disease conditions, changes of the large blood vessels and bony structure of the chest.
ECG: Provides baseline data; detects abnormalities, e.g., ST-segment and T-wave changes, atrial and ventricular dysrhythmias, and various heart blocks are common in the elderly.
NURSING PRIORITIES
1. Promote physiological and psychological well-being.
2. Provide for security and safety.
3. Prevent complications of disease and/or aging process.
4. Promote effective coping skills and independence.
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