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Difficulty: HardEmergency Response Plan

A massive derailment of a high-speed commuter train has resulted in a surge of critically injured casualties arriving at the emergency department. The hospital has activated its emergency operations plan to manage the sudden influx of victims. The charge nurse on a medical-surgical unit is instructed to evaluate current inpatients for safe, early discharge to rapidly expand bed capacity. Which of the following clients should the nurse recommend for immediate discharge? Select all that apply.

  1. A client admitted 3 days ago for an asthma exacerbation who has maintained an oxygen saturation of 97% on room air for the past 24 hours.Answer
  2. B
    A client admitted yesterday with a deep vein thrombosis who is currently receiving a continuous intravenous heparin infusion.
  3. A client who underwent an uncomplicated laparoscopic appendectomy 24 hours ago, has successfully voided, and is tolerating a regular diet.Answer
  4. D
    A client with a mild traumatic brain injury admitted for observation who is suddenly exhibiting increased lethargy and unequal pupils.
  5. A client with lower extremity cellulitis whose intravenous antibiotic therapy was successfully transitioned to an oral regimen this morning.Answer
  6. F
    A client admitted 48 hours ago for a heart failure exacerbation who required an emergency dose of intravenous furosemide one hour ago for worsening dyspnea.

Answer

The clients who should be recommended for immediate discharge are the client with asthma on room air, the client recovering from a laparoscopic appendectomy, and the client with cellulitis who was transitioned to oral antibiotics.
During a mass casualty incident, the hospital emergency operations plan requires rapidly expanding bed capacity by discharging the most stable clients. Clients who are hemodynamically stable, do not require continuous intravenous medications, are tolerating oral intake, and can safely continue their recovery at home are prioritized for early discharge. The client with asthma (stable on room air), the client recovering from a laparoscopic appendectomy (eating and voiding), and the client with cellulitis (transitioned to oral antibiotics) all meet these criteria.

Step-by-Step Solution

1
Identify the primary objective of the scenario.
The goal is to safely discharge the most stable clients to create bed capacity for incoming mass casualty victims.
During an internal or external disaster, hospital emergency operations plans prioritize expanding resources by discharging clients who no longer require acute inpatient care.
2
Evaluate each client's clinical stability and ongoing treatment needs.
Three clients require continuous monitoring or IV therapies, while three are stable on room air or oral medications.
Clients who are hemodynamically stable, eating, voiding, and transitioned to oral medications are the safest candidates for early discharge.
3
Select the appropriate clients for discharge.
The asthma client, the appendectomy client, and the cellulitis client are selected.
These clients have resolving conditions and do not require continuous nursing interventions or life-sustaining therapies.

Key Concept

Discharge Prioritization During a Mass Casualty Incident
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Topics

Emergency Response Plan

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