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Similar to nursing process/management
Assessment: of the patient as to their requirements based on what they could do before.
-symptoms reported following discharge from ward/clinical unit e.g. fever, increased incisional drainage, unrelieved pain, discomfort
Discussion: with the patient or his/her support person representative regarding what is required [self needs discussed][need to identify who that person is or if there is a support person]
-required
medications, when and how to take, side effects
-care of incision site, dressings, bathing recommendations
-activities allowed and prohibited, and when they can start again e.g. driving car, returning to work
-dietary modifications, restrictions
Planning: for transition to home or transfer to another care facility
Determining if home care is required in form of services or other support is needed
-when discharged home, patients are expected/encouraged to do self care,
assisted by family or carer.
wound dressing, catheter, drain care, physical therapy, antibiotics, medication etc
Referrals to home care agency and/or appropriate support organizations in the community, identifying who this may be.
Arranging for follow-up appointments or tests.
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