Community Health - Swift River Cases Scenarios; Judith Hanks Room(ALL CORRECT ANSWERS)

Community Health - Swift River Cases Scenarios; all answered and graded. 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 Explanation Community Assessment Increased acuity Resources in the community will need to be assessed, including internet program is completed Culture/Belief's/Spiritualit y Normal acuity There is no indication of concerns in this care. Resource Identification Increased Judith requires assistance in identifying local and web-based resources ab acuity Self-management Increased Judith needs to manage her own illnesses and goals will be established fo acuity Social Determinants of Increased The Hanks live in a rural area and are isolated due to their lack of transpo Health acuity Surveillance Normal acuity There is no indication of concerns in this care. Education/Counseling Increased Judith will need to be educated on the elements of the telehealth program Disease/Illness Prevention acuity Increased acuity peripheral devices, and means to meet goals through behavior change Judith needs to manage the cirrhosis, heart failure, and alcoholism Health Promotion Increased acuity Judith requires resources and education to enhance her health including Risk Reduction Normal Judith will need ongoing support to reduce risks such as alcohol intake, in 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 acuity Janeya’s school and the community should be assessed using 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 Prevention Increased acuity Janeya is at risk for shunt malfunction and UTIs Education/ Counseling Increased acuity Janeya’s school nurse requires education. Health Promotion Increased acuity Janeya may benefit from health promotion efforts. Resource Identification Increased acuity Janeya, her fathers, and the school nurse may benefit from resources. Category Your response Explanation Risk Reduction Increased acuity Janeya is not engaging in risk behaviors. Self-Management Increased acuity