Interprofessional Collaboration for Community Support

1. Mr. Lavoie, 82, is hospitalized for pneumonia. He lives alone in a third-floor apartment without an elevator and has no family nearby. The LPN notices that during his morning walk, he becomes easily short of breath and needs help with transfers. Mr. Lavoie expresses fear about returning home, saying, “I don’t think I can manage the stairs anymore.” The nurse also learns that he has difficulty preparing meals and has missed multiple medication doses before admission. The healthcare team discusses discharge planning during the morning huddle. Which professional should the LPN contact first to ensure a safe and appropriate discharge plan? *
2. A 54-year-old man who recently immigrated to Canada is admitted for uncontrolled Type 2 diabetes. He tells the LPN he has no family doctor, no health insurance card yet, and struggles financially. At discharge teaching, he says, “I don’t know where to go after this. I don’t even have a clinic.” He reports difficulty affording medications and fears he will return to the hospital if he cannot continue care. What is the LPN’s best advocacy action? *
3. A 17-year-old pregnant teen, Marie-Ève, comes to the CLSC for prenatal teaching. She reveals to the LPN that she left home due to conflict with her parents and is now living with a friend. She has no financial support, does not attend school, and struggles to buy nutritious food. She becomes tearful and says she feels overwhelmed. Her partner is not involved, and she has no transportation to attend medical appointments regularly. Which community service would be most appropriate to support her needs? *
4. Mrs. Anderton, 68, is recovering from an ischemic stroke that left her with right-sided weakness and expressive aphasia. She requires help with dressing, mobility, and communication. Her husband is elderly and unable to provide full physical care. During the LPN’s assessment, the husband says, “I’m scared—I don’t know how to take care of her at home.” The physiotherapist recommends mobility aids, while the speech therapist suggests ongoing therapy sessions after discharge. Which referral best ensures continuity of care after hospitalization? *
5. A 43-year-old man underwent abdominal surgery following perforated appendicitis. During the LPN’s discharge preparation, he confides that he was recently evicted and has been staying in temporary shelters. He fears he will have nowhere to go after discharge. The LPN notes that he has an abdominal incision requiring wound care and follow-up appointments, which he may not attend without stable housing. What is the most appropriate action to coordinate safe discharge? *
6. Mr. Tremblay, 79, has been hospitalized for a hip fracture. He lives alone in a rural area and has limited mobility. The LPN notes that he uses a walker at home and struggles with daily tasks such as cooking and bathing. He expresses worry about managing alone once discharged. Which professional should the LPN involve first to support Mr. Tremblay’s safe return home? *
7. Sophie, 24, delivered her first baby three days ago. During postpartum assessment, she reports feeling sad, anxious, and overwhelmed. She has limited family support and lives in a neighborhood far from the hospital. She is worried she may not cope once discharged. Which referral best addresses Sophie’s psychosocial needs? *
8. Mr. Boucher, 86, has mild dementia and was admitted for a urinary tract infection. He lives with his spouse, who is elderly and has health limitations. The LPN notices that medication adherence and daily self-care are challenging at home. The physician recommends discharge planning that considers ongoing supervision. What is the most appropriate next step to support safe discharge? *
9. Mr. Chen, 52, is hospitalized for exacerbation of congestive heart failure. He lives alone and relies on public transit. He reports missing follow-up appointments due to lack of transportation. The LPN notes that he needs medication management and dietary education post-discharge. Which action best supports continuity of care after discharge? *
10. Émilie, 15, is hospitalized for severe asthma exacerbation. She has missed several weeks of school and feels socially isolated. Her parents are supportive but unsure how to manage her condition at home. The LPN notes she will require ongoing asthma education and support to return to school safely. Which professional should the LPN contact to help with Émilie’s school reintegration and disease management? *