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Difficulty: HardCollaboration with Interdisciplinary Team

A client is preparing for discharge to a rural residence following a total laryngectomy and placement of a permanent tracheostomy. The client's spouse is visibly distressed, stating, "I am terrified I will not know how to suction the stoma if it gets blocked," and mentions they have no reliable transportation for clinic visits. Which of the following actions by the nurse represents the most appropriate interdisciplinary prioritization?

  1. A
    Consulting the social worker to immediately secure transportation vouchers for upcoming outpatient follow-up appointments.
  2. B
    Delegating the unlicensed assistive personnel to print out and review the tracheostomy care instructional materials with the spouse.
  3. Collaborating with the discharge planner to initiate a home health nursing referral for ongoing stoma assessment and caregiver education.Answer
  4. D
    Requesting the facility chaplain to visit the spouse and provide reassurance that managing airway clearance will become easier over time.

Answer

The most appropriate action is collaborating with the discharge planner to initiate a home health nursing referral for ongoing stoma assessment and caregiver education.
Based on the ABCs (Airway, Breathing, Circulation), the highest priority in this scenario is ensuring the client's airway remains patent. Because the spouse lacks the knowledge to perform suctioning and the client lives in a rural area without transportation, collaborating with a discharge planner to arrange home health nursing is the most comprehensive and safe interdisciplinary intervention. It brings skilled nursing education and assessment directly to the client's home.

Step-by-Step Solution

1
Analyze the scenario to identify the client's most critical needs.
The client has a new permanent tracheostomy (airway), the spouse lacks knowledge on suctioning (safety risk), and there is a transportation barrier.
Applying Maslow's Hierarchy of Needs and the ABCs (Airway, Breathing, Circulation) ensures that life-threatening physiological needs are prioritized over psychosocial or logistical needs.
2
Evaluate the interdisciplinary roles to address the identified priority.
A home health nurse is required to provide skilled assessment and education in the client's rural home, directly mitigating the airway risk and overcoming the transportation barrier.
Caregiver education for invasive procedures like tracheostomy suctioning requires a registered nurse; it cannot be delegated or bypassed with simple reassurance.
3
Select the option that appropriately coordinates this care.
Collaborating with the discharge planner or case manager to arrange home health services is the correct interdisciplinary intervention.
The discharge planner coordinates community resources for skilled nursing needs.

Key Concept

Prioritizing interdisciplinary referrals based on airway safety and appropriate scope of practice in complex discharge planning.
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Collaboration with Interdisciplinary Team

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