A patient is admitted with acute myocardial infarction on 20th June at 8:00 am. His condition improves on 22nd June and he is discharged on 25th June. The discharge planning begins on

1. A

   20th June

2. B

   22nd June

3. C

   24th June

4. D

   25th June

Appeared in: GMCH - 2015

Explanation

• Discharge planning is a coordinated, interprofessional process that begins the moment a patient is admitted to a hospital.
• Starting on admission (20th June) allows the healthcare team to proactively assess the patient's needs, identify potential barriers to discharge, and develop a comprehensive plan for continuing care.
• Early planning ensures sufficient time for patient and family education, arranging follow-up appointments, and coordinating with community resources, which is crucial for a patient recovering from a myocardial infarction.
• This approach is proven to reduce hospital readmissions, improve patient outcomes, and ensure a safe transition from the hospital to home.

Why Other Options Were Wrong

• Option B: Waiting until the patient's condition improves (22nd June) is too late. This reactive approach delays the assessment of home care needs and educational requirements, leading to a rushed and potentially incomplete plan.
• Option C: Starting planning one day before discharge (24th June) is grossly inadequate, especially for a complex condition like MI which requires significant lifestyle adjustments and education. It does not allow time to arrange for necessary services or ensure the patient has absorbed critical information.
• Option D: The day of discharge (25th June) is for executing the plan, not creating it. On this day, the nurse provides final instructions, confirms transportation, and ensures all prescriptions and follow-up appointments are in hand.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Timing and initiation of the discharge planning process to guide bedside assessment, documentation, and the next nursing action.
• Early and effective discharge planning is a cornerstone of patient safety and quality care. It is a primary nursing responsibility that directly impacts patient outcomes and helps prevent costly and dangerous hospital readmissions.
• For a patient with MI, the nurse's role in discharge planning includes education on the 'M-O-N-A' principles for chest pain at home (if prescribed), medication adherence (especially antiplatelets and statins), dietary changes (low sodium, low fat), and recognizing symptoms that require immediate medical attention.
• What if the patient lived alone and had cognitive impairments? Early discharge planning would be even more critical. The nurse would need to initiate a social work consult on day one to explore options like transfer to a skilled nursing facility, arranging for a home health aide, or using medication reminder systems to ensure safety post-discharge.

How to Approach the Question

• First, identify the core nursing process in the question, which is 'discharge planning'.
• Recall the fundamental principle of this process. Best practices and healthcare standards emphasize that discharge planning is a proactive process that starts early.
• Analyze the timeline provided: Admission on 20th, improvement on 22nd, discharge on 25th.
• Apply the principle to the timeline. Since planning starts at the beginning of the hospital stay, the correct date must be the admission date.
• Select the option corresponding to the admission date (20th June) and eliminate the other options which represent a delayed, reactive, and less safe approach to patient care.

Concept Tested & Keywords

• Concept Tested: Timing and initiation of the discharge planning process
• Stem keywords: acute myocardial infarction, admitted, discharged, discharge planning
• Lead-in keywords: begins on
• Clinical cues: Patient admitted with an acute condition (Myocardial Infarction) requiring significant post-discharge care and education.

Question ID

QNlHwiDBmsB_eobjMbau5t

Copy ID

Reference Book

E6 Nursing Fundamentals Potter Perry 12e Part 1 p. 36-38

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2604-2606