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Difficulty: Very hardCollaboration with Interdisciplinary Team

A nurse is coordinating the discharge plan for a client who underwent intermaxillary fixation (wired jaw) for complex facial fractures. The client has a history of opioid use disorder, is currently experiencing persistent nausea, and writes on a bedside whiteboard, "I have no money for those special nutritional shakes, and I am terrified of what will happen if I throw up." Which interdisciplinary collaborative action is the highest priority for the nurse to implement?

  1. Collaborate with the clinical pharmacist to convert the prescribed oral antiemetics to a suppository formulation and consult the medical social worker to assist with funding for the liquid diet.Answer
  2. B
    Request the registered dietitian to provide a meal plan of affordable, soft pureed foods and contact the addiction medicine team to assess for opioid withdrawal.
  3. C
    Delegate the demonstration of emergency wire-cutting procedures to the unlicensed assistive personnel (UAP) while contacting the case manager regarding the client's financial barriers.
  4. D
    Reassure the client by writing, "Do not worry, the nausea is an expected side effect of the anesthesia and will resolve before you are discharged."

Answer

The most appropriate priority action is to collaborate with the clinical pharmacist to change the antiemetic formulation to a suppository and consult the medical social worker for financial assistance with the required liquid diet.
This action directly addresses the highest physiological priority (airway protection) by collaborating with the pharmacist to secure a safe, non-oral medication route for nausea. It simultaneously utilizes the social worker's exact scope of practice to resolve the financial barrier to the client's mandatory liquid diet, ensuring a safe and comprehensive interdisciplinary discharge plan.

Step-by-Step Solution

1
Analyze the client's immediate life-safety risk.
Identified that emesis against a wired jaw (intermaxillary fixation) poses an extreme and immediate aspiration risk, threatening the airway (ABCs).
Airway maintenance is always the highest clinical priority.
2
Determine the safest collaborative intervention to manage the airway threat.
Selected collaborating with the pharmacist to convert oral nausea medications to a non-oral route (suppository).
Oral medications pose an aspiration risk and may not be tolerated or fit through the fixation; a suppository safely bypasses the wired jaw.
3
Address the secondary psychosocial barrier restricting safe discharge.
Selected consulting the medical social worker to arrange emergency funding for the liquid nutrition.
The client must strictly adhere to a liquid diet to prevent choking, and the social worker is the appropriate discipline to navigate financial barriers.
4
Evaluate and reject the alternative actions for safety violations.
Rejected delegating teaching to UAP, rejected recommending pureed foods, and rejected using false reassurance.
Teaching cannot be delegated, pureed foods will cause airway obstruction with a wired jaw, and false reassurance ignores a critical safety concern.

Key Concept

Interdisciplinary Collaboration for Airway Safety and Discharge Planning
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Topics

Collaboration with Interdisciplinary Team

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