A patient, 88 years old, four days post-op hip replacement, is the main caregiver for her husband with dementia. The physician has written an order for discharge today. What should the nurse do first?

• A. Notify the physician immediately to cancel discharge
• B. Tell the nurse manager she cannot be discharged
• C. Call the patient’s husband to discuss
• D. Verify insurance coverage

Answer: (B)

Safety and support for discharge planning is the key idea here. An 88-year-old patient who is four days post-op and also the main caregiver for a husband with dementia faces a high risk if discharged without adequate home support. The nurse’s first action is to elevate the situation within the care team by informing the nurse manager to halt the current discharge plan and trigger a formal discharge-planning review. This brings in the right resources—social work, case management, home health or respite services, and family education—to assess whether safe alternatives are needed, such as delaying discharge or arranging in-home support and post-disurgical care.

Calling the physician to cancel discharge is a possibility, but the nurse should first coordinate through the nurse manager and the discharge-planning team to ensure a safe, supported plan is developed rather than making an immediate unilateral clinical decision. Discussing with the patient’s husband directly bypasses patient autonomy and the appropriate channels for discharge planning. Checking insurance matters is important for coverage, but it doesn’t address whether there is a safe plan for the patient to go home. The priority is to secure a safe plan for both patient and caregiver before discharge.