Judith Hanks Room CASE
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.”
, Judith Hanks Room CASE
You responded correctly to 9 out of 10 evaluations:
Your
Category response
Explanation
Community Assessment Resources in the community will need to be assessed,
including internet program is completed
Increased
acuity
Culture/Belief's/ Norm There is no indication of concerns in this care.
Spiritualit y al
acuity
Resource Identification Increased Judith requires assistance in identifying loc
and web-based resources ab
acuity
Self-management Increased Judith needs to manage her own illnesses and goals will
established fo
acuity
Social Increas The Hanks live in a rural area and are isolated due to the
Determinants of ed lack of transpo
Health acuity
Surveillance There is no indication of concerns in this care.
Norma
l
acuity
Education/CounselingIncreased Judith will need to be educated on the elements of the
telehealth program
acuity peripheral devices, and means to meet goals through
Disease/ Increas behavior change Judith needs to manage the cirrhosis,
Illness ed heart failure, and alcoholism
Prevention acuity
Health Promotion Judith requires resources and education to enhance her
health including
Increas
ed
acuity
Risk Reduction Normal Judith will need ongoing support to reduce risks such as
alcohol intake, in
acuity deconditioned state
, Judith Hanks Room CASE
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
, Judith Hanks Room CASE
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 Increase Janeya’s school and the community should be assessed
Assessment d acuity using community assessment principles.
Culture/Beliefs/ Increase Janeya’s fathers are dealing with family discord and
d family conflict
Spirituality acuity related to their impending marriage.
Disease/Illness Increase Janeya is at risk for shunt malfunction and UTIs
Prevention d acuity
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.”
, Judith Hanks Room CASE
You responded correctly to 9 out of 10 evaluations:
Your
Category response
Explanation
Community Assessment Resources in the community will need to be assessed,
including internet program is completed
Increased
acuity
Culture/Belief's/ Norm There is no indication of concerns in this care.
Spiritualit y al
acuity
Resource Identification Increased Judith requires assistance in identifying loc
and web-based resources ab
acuity
Self-management Increased Judith needs to manage her own illnesses and goals will
established fo
acuity
Social Increas The Hanks live in a rural area and are isolated due to the
Determinants of ed lack of transpo
Health acuity
Surveillance There is no indication of concerns in this care.
Norma
l
acuity
Education/CounselingIncreased Judith will need to be educated on the elements of the
telehealth program
acuity peripheral devices, and means to meet goals through
Disease/ Increas behavior change Judith needs to manage the cirrhosis,
Illness ed heart failure, and alcoholism
Prevention acuity
Health Promotion Judith requires resources and education to enhance her
health including
Increas
ed
acuity
Risk Reduction Normal Judith will need ongoing support to reduce risks such as
alcohol intake, in
acuity deconditioned state
, Judith Hanks Room CASE
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
, Judith Hanks Room CASE
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 Increase Janeya’s school and the community should be assessed
Assessment d acuity using community assessment principles.
Culture/Beliefs/ Increase Janeya’s fathers are dealing with family discord and
d family conflict
Spirituality acuity related to their impending marriage.
Disease/Illness Increase Janeya is at risk for shunt malfunction and UTIs
Prevention d acuity
