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Difficulty: Very hardCollaboration with Interdisciplinary Team

A nurse is coordinating an interdisciplinary discharge plan for a 78-year-old client with advanced primary progressive multiple sclerosis. The client is scheduled to return home tomorrow. During morning rounds, the nurse notes that the client has developed new-onset sudden confusion, profound dysphagia with coughing during sips of water, and an increasing inability to hold eating utensils due to loss of intrinsic hand muscle strength. The client's spouse is crying at the bedside, stating, "I have no idea how we will afford the 24-hour home care the doctor recommended." Which interprofessional action plan represents the most appropriate utilization of team resources and clinical prioritization?

  1. Defer the discharge and immediately notify the primary healthcare provider of the acute cognitive changes, while consulting a Speech-Language Pathologist for a swallow evaluation and a Medical Social Worker to explore caregiver funding options.Answer
  2. B
    Document the confusion as a normal age-related cognitive decline expected in older adults, and consult an Occupational Therapist to immediately fit the client for customized hand splints.
  3. C
    Delegate the initial assessment of the client's swallowing tolerance to the Unlicensed Assistive Personnel (UAP) during breakfast, and consult a Physical Therapist to implement fine motor coordination exercises.
  4. D
    Provide reassurance by telling the spouse, "Do not worry, everything will work out once you are home," and direct the Unit Chaplain to resolve the family's financial crisis regarding the home care costs.

Answer

The correct plan is to defer the discharge, notify the provider of the acute cognitive changes, consult a Speech-Language Pathologist for the dysphagia, and consult a Medical Social Worker for financial assistance.
The correct response synthesizes multiple high-level clinical judgments. First, it recognizes that new-onset confusion is an acute medical event (delirium) that makes the client medically unstable for discharge, necessitating immediate provider notification. Second, it correctly identifies the Speech-Language Pathologist as the expert for managing dysphagia to prevent aspiration. Finally, it correctly identifies the Medical Social Worker as the appropriate professional to assist the family with the financial burden of complex home care.

Step-by-Step Solution

1
Analyze the client's clinical presentation to prioritize immediate safety needs.
Identified 'new-onset sudden confusion' as an acute, potentially life-threatening change (delirium) requiring immediate provider notification, superseding the planned discharge.
Sudden confusion in older adults is never normal and typically indicates an acute underlying pathology such as infection (UTI), hypoxia, or medication toxicity.
2
Evaluate the client's functional deficits to determine the appropriate allied health referrals.
Matched 'profound dysphagia with coughing' to the Speech-Language Pathologist (SLP).
The SLP specializes in evaluating swallowing mechanics and preventing aspiration, which addresses the client's immediate airway safety during meals.
3
Address the psychosocial and environmental barriers expressed by the spouse.
Matched the inability to afford 24-hour home care to the Medical Social Worker.
Social Workers and Case Managers are specifically trained to navigate healthcare funding, insurance benefits, and community resources to facilitate safe discharges.
4
Eliminate options that contain inappropriate delegation, incorrect scope of practice, or non-therapeutic communication.
Discarded options that delegated initial swallow assessments to UAPs, assigned fine motor tasks to PTs instead of OTs, assigned financial planning to Chaplains, or used false reassurance.
Safe and effective care environments require strict adherence to the RN scope of practice, accurate interdisciplinary collaboration, and therapeutic communication.

Key Concept

Interprofessional Collaboration, Scope of Practice, and Clinical Prioritization
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Topics

Collaboration with Interdisciplinary Team

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