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Difficulty: MediumCollaboration with Interdisciplinary Team

An older adult client with a new diagnosis of heart failure is being prepared for discharge. The client lives alone on a fixed income, requires eight new daily medications, and does not own a scale for required daily weights. While discussing the transition home, the client begins crying and states, "I cannot afford these pills, and I do not know how I will manage all of this by myself." Which actions demonstrate appropriate interdisciplinary collaboration and care management by the nurse? Select all that apply.

  1. Request a consult with the medical social worker to explore medication assistance programs and home healthcare resources.Answer
  2. B
    Assign the unlicensed assistive personnel (UAP) to review the written dietary restriction instructions with the client.
  3. Refer the client to a registered dietitian for comprehensive meal planning that aligns with a low-sodium diet on a fixed income.Answer
  4. D
    Reassure the client that everything will be fine once they return to the comfort of their own home and establish a routine.
  5. Collaborate with the clinical pharmacist to identify potential ways to simplify the new complex polypharmacy regimen.Answer
  6. F
    Page the primary healthcare provider immediately to conduct a bedside psychiatric evaluation for the client's crying and anxiety.

Answer

The appropriate interdisciplinary actions are to consult the medical social worker, refer the client to a registered dietitian, and collaborate with the clinical pharmacist.
The client has multifaceted discharge needs that require an interdisciplinary approach. The medical social worker is the correct referral to assist with financial barriers regarding medication affordability and securing medical equipment for the home. The registered dietitian is the correct referral to provide specialized education on maintaining a low-sodium diet while on a fixed income. The clinical pharmacist is the correct referral to review the new eight-medication regimen to identify cost-saving alternatives and simplify the dosing schedule for better adherence.

Step-by-Step Solution

1
Analyze the client's specific discharge barriers presented in the scenario.
The client has financial limitations, requires a complex regimen of 8 new medications, needs a specialized low-sodium diet on a fixed income, lacks necessary equipment (a scale), and exhibits situational anxiety about managing care alone.
Identifying the distinct physiological, financial, and psychosocial barriers determines which specialized interdisciplinary team members are required for a safe discharge.
2
Match each identified barrier with the appropriate allied health professional's scope of practice.
The social worker is needed to address financial and resource needs (medication costs, obtaining a scale). The pharmacist is needed to optimize the complex medication regimen. The dietitian is needed to provide specialized nutritional counseling for a heart failure diet on a budget.
Proper utilization of the interdisciplinary team ensures comprehensive care by leveraging the specific expertise of each discipline.
3
Evaluate the remaining options to eliminate unsafe or non-therapeutic nursing actions.
Delegating teaching to a UAP (improper delegation), providing false reassurance (non-therapeutic communication), and immediately paging the provider for a non-emergent psychosocial issue (improper prioritization) are eliminated.
Nursing actions must remain within legal scopes of practice, utilize therapeutic communication, and reflect proper clinical prioritization.

Key Concept

Effective interdisciplinary collaboration involves partnering with allied health professionals—such as social workers, pharmacists, and dietitians—to comprehensively address complex client needs that extend beyond the immediate nursing scope of practice.
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Collaboration with Interdisciplinary Team

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