Judith Hanks Room
Judith Hanks, 64-year-old woman discharged about one year ago from the
hospital following discectomy to repair a herniated disc. During that
hospitalization, Judith’s husband of 9 years, Elton, visited her and found her
behavior very different from her usual behavior. As his with her visit
progressed, Judith began having tactile hallucinations and was very restless.
Finally, Judith’s husband called the hospital nurse into the room and the
nurse found Judith hypertensive and tachycardic and Judith was very
diaphoretic. Judith and her husband both revealed that they were drinking 8-
10 alcoholic beverages per day. As part of that hospitalization Judith went
through alcohol withdrawal and was diagnosed with alcohol-related cirrhosis
and began care for condition. Judith also has a history of heart failure which
was stabilized during the hospitalization. Current medications include:
carvedilol (Coreg) 3.125 mg twice daily, spironolactone (Aldactone) 200
mg/day, Vitamin B Complex (1/day), MVI (1/day) Allergies: Shellfish, adhesive
tape. As part of the management and discharge processes, both members of
the couple pledged to become sober and were generally successful over the
past year with ongoing support group participation at the Alcoholics
Anonymous at a local church. They have both had one or two serious
relapses of using alcohol when life stressors were more than they can
handle. One night, Elton went to a local bar, after an argument with his wife,
and drank all evening. When driving home, he was the cause of a motor
vehicle accident which caused no injuries but damaged his car beyond repair.
Their children decided to take both Judith and Elton’s licenses away and do
errands for them every few weeks. This caused Judith and Elton to not be
able to attend their Alcoholics Anonymous meetings or see their primary care
healthcare provider whose practice is 55 miles from the Hank’s home. Since
her hospitalization, Judith has become deconditioned and she has gained 30
pounds. Her activity is limited to her bed, her bathroom, and her living room
with the television and some comfortable chairs. Because of the Hank’s rural
location, lack of transportation, and Judith’s immobility, the healthcare
provider recommends telehealth management until the Hanks’
circumstances change. The Telehealth Nurse Care Coordinator receives the
referral for Judith’s care. The Telehealth Nurse reviews Judith’s electronic
health record and emails the primary care healthcare provider with
questions. The Telehealth Nurse plans a virtual conference with Judith and
Elton. The Hanks do have a smartphone and a computer but are somewhat
reticent to use a technology-based intervention. They state they are “willing
to give it a try.”
,You responded correctly to 9 out of 10 evaluations:
Your
Category response Explanat
Community Assessment Increased Resources in the community will need to be assessed, including intern
acuity program is completed
Culture/Belief's/Spiritualit Normal There is no indication of concerns in this care.
y acuity
Resource Identification Increased Judith requires assistance in identifying local and web-based resources
acuity
Self-management Increased Judith needs to manage her own illnesses and goals will be established
acuity
Social Determinants of Increased The Hanks live in a rural area and are isolated due to their lack of tran
Health acuity
Surveillance Normal There is no indication of concerns in this care.
acuity
Education/Counseling Increased Judith will need to be educated on the elements of the telehealth prog
acuity peripheral devices, and means to meet goals through behavior chang
Disease/Illness Increased Judith needs to manage the cirrhosis, heart failure, and alcoholism
Prevention acuity
Health Promotion Increased Judith requires resources and education to enhance her health includin
acuity
Risk Reduction Normal Judith will need ongoing support to reduce risks such as alcohol intake
acuity deconditioned state
Janeya Stone Room
Janeya Stone, 5-year-old entering kindergarten in the fall. Janeya’s fathers
meet with her school nurse to plan her care. Janeya’s history includes
hydrocephalus diagnosed at 9-months of age. Janeya had a
ventriculoperitoneal shunt inserted with a positive outcome. At 2 years and
again at 3 years of age, Janeya developed shunt infections that were
successfully treated with intravenous antibiotics. At 4 years of age, Janeya
presented to the pediatrician’s office with signs of increased intracranial
, pressure and was referred to the neurosurgeon An MRI reveals an obstructed
shunt and a shunt revision resolved the neurological symptoms. Six months
ago, a similar event occurred and Janeya’s shunt was found to be kinked
which was relieved with the neurosurgeon pumping the proximal reservoir
and a subsequent shunt survey indicated that the shunt was patent and
functioning. Her fathers were instructed to monitor for signs of shunt
infection and malfunctioning. Her medical history is unremarkable except for
frequent urinary tract infections. Janeya’s fathers are worried because Janeya
has been more tired than usual, appears pale, and doesn’t appear to be
playing as actively as usual. Janeya’s fathers say that their daughter is a very
“picky” eater and that she doesn’t eat any meat, little dairy products, and
prefers carbohydrates. They have had a lot of family stress lately with some
family discord about their relationship, their planned marriage soon, and
raising a young daughter. Their extended family has strong religious beliefs
against same-sex marriage. They live in an urban area and the fathers share
that they have limited access to primary care and other resources. At today’s
visit, Janeya is alert and friendly. The men share her health history and
Janeya appears eager for school to begin and to meet new friends.
You responded correctly to 8 out of 10 evaluations:
Your
Category response Explanation
Community Assessment Increased Janeya’s school and the community should be assessed using
acuity community assessment principles.
Culture/Beliefs/ Increased Janeya’s fathers are dealing with family discord and family conflict
Spirituality acuity related to their impending marriage.
Disease/Illness Increased Janeya is at risk for shunt malfunction and UTIs
Prevention acuity
Education/ Counseling Increased Janeya’s school nurse requires education.
acuity
Health Promotion Increased Janeya may benefit from health promotion efforts.
acuity
Resource Identification Increased Janeya, her fathers, and the school nurse may benefit from resources.
acuity
, Your
Category response Explanation
Risk Reduction Increased Janeya is not engaging in risk behaviors.
acuity
Self-Management Increased Janeya, her family, and the school nurse may enhance her self-
acuity management.
Social Determinants of Normal Janeya may be vulnerable to social aspects of her environment,
Health acuity including access to care.
Surveillance Normal Public health surveillance is not indicated.
acuity
Kenny Barrett Room
Kenny Barrett, Kenny Barrett is a 64-year-old male recently hospitalized for
management of undiagnosed hypertension. It was determined Kenny’s
hypertension and lower extremity pain was related to vasculitis. Kenny was
diagnosed with Buerger’s Disease. Medications: Atenolol 50 mg daily. Tylenol
325 mg prn pain. NKDA Surgical history: Kenny’s surgical history is positive
for a cholecystectomy and inguinal hernia repair. Social history: Kenny is
widowed. He lives alone in a two-bedroom home in a rural community. Kenny
recently retired and does not work outside of the home. He admits to
struggling financially and being dependent on his savings until he can
receive social security. He smokes one pack per day. The pain in his lower
extremities prohibits his engagement in exercise. Community Assessment:
Kenny lives in a rural community with limited resources. Kenny’s home is on
a dirt road, the nearest neighbor is “one country mile” away. Kenny lives
seven miles from the farm co-op where he can purchase fresh vegetables
and milk. To purchase items not available from the co-op, Kenny must go to
“town” nearly thirty miles from his home. There is a family physician in town,
however, the nearest hospital and specialty clinics are 80 miles. Kenny
receives his prescriptions via mail. Kenny travels via his car, which is
unreliable.
Judith Hanks, 64-year-old woman discharged about one year ago from the
hospital following discectomy to repair a herniated disc. During that
hospitalization, Judith’s husband of 9 years, Elton, visited her and found her
behavior very different from her usual behavior. As his with her visit
progressed, Judith began having tactile hallucinations and was very restless.
Finally, Judith’s husband called the hospital nurse into the room and the
nurse found Judith hypertensive and tachycardic and Judith was very
diaphoretic. Judith and her husband both revealed that they were drinking 8-
10 alcoholic beverages per day. As part of that hospitalization Judith went
through alcohol withdrawal and was diagnosed with alcohol-related cirrhosis
and began care for condition. Judith also has a history of heart failure which
was stabilized during the hospitalization. Current medications include:
carvedilol (Coreg) 3.125 mg twice daily, spironolactone (Aldactone) 200
mg/day, Vitamin B Complex (1/day), MVI (1/day) Allergies: Shellfish, adhesive
tape. As part of the management and discharge processes, both members of
the couple pledged to become sober and were generally successful over the
past year with ongoing support group participation at the Alcoholics
Anonymous at a local church. They have both had one or two serious
relapses of using alcohol when life stressors were more than they can
handle. One night, Elton went to a local bar, after an argument with his wife,
and drank all evening. When driving home, he was the cause of a motor
vehicle accident which caused no injuries but damaged his car beyond repair.
Their children decided to take both Judith and Elton’s licenses away and do
errands for them every few weeks. This caused Judith and Elton to not be
able to attend their Alcoholics Anonymous meetings or see their primary care
healthcare provider whose practice is 55 miles from the Hank’s home. Since
her hospitalization, Judith has become deconditioned and she has gained 30
pounds. Her activity is limited to her bed, her bathroom, and her living room
with the television and some comfortable chairs. Because of the Hank’s rural
location, lack of transportation, and Judith’s immobility, the healthcare
provider recommends telehealth management until the Hanks’
circumstances change. The Telehealth Nurse Care Coordinator receives the
referral for Judith’s care. The Telehealth Nurse reviews Judith’s electronic
health record and emails the primary care healthcare provider with
questions. The Telehealth Nurse plans a virtual conference with Judith and
Elton. The Hanks do have a smartphone and a computer but are somewhat
reticent to use a technology-based intervention. They state they are “willing
to give it a try.”
,You responded correctly to 9 out of 10 evaluations:
Your
Category response Explanat
Community Assessment Increased Resources in the community will need to be assessed, including intern
acuity program is completed
Culture/Belief's/Spiritualit Normal There is no indication of concerns in this care.
y acuity
Resource Identification Increased Judith requires assistance in identifying local and web-based resources
acuity
Self-management Increased Judith needs to manage her own illnesses and goals will be established
acuity
Social Determinants of Increased The Hanks live in a rural area and are isolated due to their lack of tran
Health acuity
Surveillance Normal There is no indication of concerns in this care.
acuity
Education/Counseling Increased Judith will need to be educated on the elements of the telehealth prog
acuity peripheral devices, and means to meet goals through behavior chang
Disease/Illness Increased Judith needs to manage the cirrhosis, heart failure, and alcoholism
Prevention acuity
Health Promotion Increased Judith requires resources and education to enhance her health includin
acuity
Risk Reduction Normal Judith will need ongoing support to reduce risks such as alcohol intake
acuity deconditioned state
Janeya Stone Room
Janeya Stone, 5-year-old entering kindergarten in the fall. Janeya’s fathers
meet with her school nurse to plan her care. Janeya’s history includes
hydrocephalus diagnosed at 9-months of age. Janeya had a
ventriculoperitoneal shunt inserted with a positive outcome. At 2 years and
again at 3 years of age, Janeya developed shunt infections that were
successfully treated with intravenous antibiotics. At 4 years of age, Janeya
presented to the pediatrician’s office with signs of increased intracranial
, pressure and was referred to the neurosurgeon An MRI reveals an obstructed
shunt and a shunt revision resolved the neurological symptoms. Six months
ago, a similar event occurred and Janeya’s shunt was found to be kinked
which was relieved with the neurosurgeon pumping the proximal reservoir
and a subsequent shunt survey indicated that the shunt was patent and
functioning. Her fathers were instructed to monitor for signs of shunt
infection and malfunctioning. Her medical history is unremarkable except for
frequent urinary tract infections. Janeya’s fathers are worried because Janeya
has been more tired than usual, appears pale, and doesn’t appear to be
playing as actively as usual. Janeya’s fathers say that their daughter is a very
“picky” eater and that she doesn’t eat any meat, little dairy products, and
prefers carbohydrates. They have had a lot of family stress lately with some
family discord about their relationship, their planned marriage soon, and
raising a young daughter. Their extended family has strong religious beliefs
against same-sex marriage. They live in an urban area and the fathers share
that they have limited access to primary care and other resources. At today’s
visit, Janeya is alert and friendly. The men share her health history and
Janeya appears eager for school to begin and to meet new friends.
You responded correctly to 8 out of 10 evaluations:
Your
Category response Explanation
Community Assessment Increased Janeya’s school and the community should be assessed using
acuity community assessment principles.
Culture/Beliefs/ Increased Janeya’s fathers are dealing with family discord and family conflict
Spirituality acuity related to their impending marriage.
Disease/Illness Increased Janeya is at risk for shunt malfunction and UTIs
Prevention acuity
Education/ Counseling Increased Janeya’s school nurse requires education.
acuity
Health Promotion Increased Janeya may benefit from health promotion efforts.
acuity
Resource Identification Increased Janeya, her fathers, and the school nurse may benefit from resources.
acuity
, Your
Category response Explanation
Risk Reduction Increased Janeya is not engaging in risk behaviors.
acuity
Self-Management Increased Janeya, her family, and the school nurse may enhance her self-
acuity management.
Social Determinants of Normal Janeya may be vulnerable to social aspects of her environment,
Health acuity including access to care.
Surveillance Normal Public health surveillance is not indicated.
acuity
Kenny Barrett Room
Kenny Barrett, Kenny Barrett is a 64-year-old male recently hospitalized for
management of undiagnosed hypertension. It was determined Kenny’s
hypertension and lower extremity pain was related to vasculitis. Kenny was
diagnosed with Buerger’s Disease. Medications: Atenolol 50 mg daily. Tylenol
325 mg prn pain. NKDA Surgical history: Kenny’s surgical history is positive
for a cholecystectomy and inguinal hernia repair. Social history: Kenny is
widowed. He lives alone in a two-bedroom home in a rural community. Kenny
recently retired and does not work outside of the home. He admits to
struggling financially and being dependent on his savings until he can
receive social security. He smokes one pack per day. The pain in his lower
extremities prohibits his engagement in exercise. Community Assessment:
Kenny lives in a rural community with limited resources. Kenny’s home is on
a dirt road, the nearest neighbor is “one country mile” away. Kenny lives
seven miles from the farm co-op where he can purchase fresh vegetables
and milk. To purchase items not available from the co-op, Kenny must go to
“town” nearly thirty miles from his home. There is a family physician in town,
however, the nearest hospital and specialty clinics are 80 miles. Kenny
receives his prescriptions via mail. Kenny travels via his car, which is
unreliable.
