Patient Was Admitted Due to a Broken

¶ … patient was admitted due to a broken hip which required a total hip replacement (THR). This injury has required two weeks of in-hospital rehabilitation to this point, and Mr. Trosak will probably need more physical rehabilitation to completely recover from the injury. Since there are secondary concerns (such as some loss of cognitive function (text, 462)) after a fall, it will be necessary to monitor MR. Trosak. The falling incident could also reoccur due to the fact that the patient resides on the second floor of his apartment building. It will be necessary to ensure that Mr. Trosak understands the risk of a recurrence, and that he has sufficient assistance.

Prior to being hospitalized for the fall, Mr. Trosak was not taking any prescription medication, and he has not had a physical examination for more than ten years. While admitted, the patient was found to have chronic hypertension, which is currently being controlled with medication, and he was also diagnosed with non-insulin dependent diabetes. Due to these conditions, Mr. Trosak is required to take daily medications which also need to be monitored. Both Mr. Trosak and his family did not exhibit concern regarding the necessity to take the medication daily. This is a concern since both of these conditions can result in the patient having further medical issues. Mr. Trosak's ability to take the medication at the prescribed time and being daily consistent with administration needs to be monitored also.

Another issue that is important from a healthcare perspective is Mr. Trosak's ability to attend appointments and take care of himself independently. Mr. Trosak's son and daughter-in-law have extensive work schedules which would make it difficult for them to provide the care that the patient may need. The patient has mobility issues which would make it difficult for him to both navigate challenges in his daily life, and make it to necessary healthcare appointments independently.

A team of healthcare professionals should be put in place which includes all of the necessary components for Mr. Trosak's continued recovery. A personal physician who can monitor the medication and provide necessary post-hospitalization care is necessary because Mr. Trosak nor his family have the ability to provide this function. Since the patient has not had a regular physician for more than ten years, it is necessary to help him build a relationship with someone that he trusts in this role. Mr. Trosak will also need to continue to attend rehabilitation appointments. Although there is some debate regarding the efficacy of rehabbing after a THR (Vanwanseele, 2009), it is still considered to be the preferred course of action. Mr. Trosak has never before had mobility issues and this means that he needs understand what he can and cannot do safely. Also, it is necessary that he continue to rehab the leg because of his living situation. Since he lives in a second floor apartment it is important for him to have better mobilbity. Mr. Trosak will also need a social worker or nurse case manager to help him navigate the required appointments and resources available to him. It is difficult for any person to know all that is available to them when they become disabled, and the case manager could continue to monitor all facets of Mr. Trosak's care to ensure that it is optimum for his recovery.

Since maintaining the patients safety is of primary importance, a realistic assessment is necessary. Looking at the safety assessment there are two main issues which present themselves regarding discharge placement. The apartment in which Mr. Trosak currently resides is unfit for his ongoing needs, and the expired food and medications reveal some possible dementia issues. Because getting to the apartment presents significant risk of another fall, and because the space is small and cluttered, it is necessary to suggest a better living arrangement. This could mean finding a ground floor apartment or looking into assisted living facilities. Mr. Trosak's mental capabilities will also have to be assessed. If he is unable to properly maintain his medications and food stuffs, an assisted-living facility may be necessary.

Discharge Plan of Care

The family seems very supportive of Mr. Trosak, but there expectations of their ability to care for him after he is discharged may be unrealistic. Both the patients son and his daughter-in-law work many hours (60-hour work weeks) and this leaves them little time to actually be in hand when Mr. Trosak will need their assistance. The family should understand the level of care that the patient will need, so that they can make a realistic assessment of their actual ability to care for Mr. Trosak. The fact that they are willing is laudable, but they may not have grasped the reality of the situation. Since the patient is living in a second floor apartment and will probably need supervision when he tries to negotiate the stairs, the family would have to spend significant time with him. Also, the family would likely have to perform errands, such as grocery shopping, for him. Mr. Trosak also wants to continue to run the family bakery which may not be possible without a great deal of assistance.

Issues regarding physical ability are prominent in recovery, but there is also a danger from the isolation which would occur if Mr. Trosak is left alone in his apartment without the ability to procure adequate social stimulation. Mr. Trosak has been around people his entire life because he ran a bakery, and it will be a difficult transition if he is unable to interact with others because of his disability. The lack of mobility and interaction would lead to severe depression which could significantly affect the patients recovery (Smith & Segal, 2011). The patient's family needs to understand that a placement which gives Mr. Trosak the greatest ability to interact on a daily basis, and feel safe with his disability is needed.