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Use the following scenario to answer the following questions:   …

G.W.’s parents have met with the social worker and case manager to facilitate the discharge home; the patient intends to return to Minnesota and live with his parents on their farm post-discharge. Nursing staff have observed the patient’s mother crying and leaving the room after G.W. has made critical comments towards her when she’s attempted to provide nursing cares. Nursing staff have spent time attempting to educate the patient’s father and mother on the essential nursing cares that will need to occur when G.W. returns home: daily skin checks, changing the foley catheter, completing peri-care, the bowel program. However, every time a teaching session is planned the family goes to their hotel room early or doesn’t show up. Despite repeated encouragement to engage in patient care, the patient’s mother and father have remained disengaged.

G.W. is unable to move his arms or legs and does not have sensation below his nipple line. He has a tracheostomy in place receiving 5L O2 at 28% trach mist. He is on contact precautions secondary to a MRSA (Methicillin Resistant Staphlococcus Aureus) colonization in his sputum. The Pulmonologist believes this is due to nursing staff missing frequent Chlorhexadine gluconate mouthwash doses. Chlorhexadine gluconate is ordered as BID mouthwashes with oral care. G.W. frequently refused doses and the nursing staff reprimanded reported they didn’t understand the rationale as to why the mouth wash was being given. G.W. needs frequent suctioning via his tracheostomy due to copious secretions. He often calls nursing staff multiple times within the hour to be suctioned; if nursing is unavailable then he requests the respiratory therapist to arrive immediately.

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