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NURBN 3033 Primary Health 4: Nursing People Living with Chronic Conditions

Question

Answered

Question:

Analyse and Develop a Self-Management Plan

Need to choose one of the case study given and complete the template accordingly.
  1. Introduction and SMART Goals
  1. Discuss and Critically Analyse Consumer Directed Care/Self-Management
  1. Design a Self-Management Care Plan

Choose one case study for your assessment task.

Case Study 1- Candice Hadden

As a RN you have been employed as a case manager for a local NDIS provider. Candice is a 21-year female with Rheumatoid Arthritis. Candice weighs 40 kg and has short stature at 123cm tall. Candice has significant issues of pain and joint inflammation in her extremities and her back. She has had surgery three times to fix foot deformities and hand deformities from the arthritis. Candice has acute episodes of pain as part of her chronic illness life experiences. These acute episodes of pain can be idiopathic, or diet related (she is gluten intolerant). When Candice has acute episodic pain and inflammation related to her condition, her mobility is severely impacted to the point of not being able to independently mobilise or care for herself and hygiene needs. She needs personal assistance with all ADLs and a support person for social access all the time (i.e. she needs someone with her in case she suddenly deteriorates while out in public).

When at her optimal health, Candice works part -time as a support office worker at her local NDIS provider (5 hours per day three times per week). She has a certificate 4 in Business Administration with a disability elective from TAFE. Candice’s mother is her primary carer and her father helps with care as he is working full time. Candice has a NDIS package of care with a carer supporting her for three hours, three times a week for social community access or personal care. Candice has a sister and two brothers (they are quadruplets). Candice is actively involved in a youth group at her church with other young adults when she is well. She enjoys reading, going to the movies and some swimming with support at hydrotherapy.

Candice’s medication prescriptions are as follows:

Oral prednisolone 5mg daily mane, Oral paracetamol 500mg qid, Oral methotrexate 10mg weekly, Subcutaneous Humira 40 mg second weekly, Peppermint capsules (mintec 0.2ml per tablet) before meals.

When she has acute episodic pain her GP reviews and adjust prednisolone to increase her dose for a short period of time (dependant on severity of exacerbation).

Case Study- 2 John Blackwell

You have been employed as Community Case Manager RN for a local community health service.

John is a 65-year-old Italian man with type 2 diabetes with who presented to his GP with difficulties voiding (a slow stream and dribbles) and pain in his lower back. After some medical investigations he was diagnosed with prostate cancer and underwent an urgent radical prostatectomy (with a suprapubic incision to remove some lymph nodes (for cancer screening as well) one week ago. The lymph nodes appeared to have cancer so they were sent for histopathology and testing. The CT scan and MRIs prior to discharge showed the cancer has possibly spread to his sacrum (as there was a suspicious lesion) and he has some suspicious shadowing in the brain. He was commenced on dexamethasone 5mg daily to slow down the spread of the cancer and to help with lower back pain in conjunction with other analgesia. The dexamethasone has impacted his ability to control his blood glucose levels and it has recently risen in the last few days. His BGLs are ranging from 8-14mmol/L but have been as high as 16 mmol/L post operatively in the ward since starting dexamethasone.

He was discharge home this morning from hospital and has received a CHSP (Commonwealth Home Care Support Program) home care package of care which the discharge facilitator from the hospital instigated from the local home care service provider (you are employed by this service). John has temporary IDC, with an out-patients appointment and trial of void (TOV) in 6 weeks. His PICC line is insitu for possible use for chemotherapy and it was dressed yesterday in the ward.

He is scheduled for an oncologist consultation and planning with the oncology nurse early next week after his surgical wound has had a chance to heal. His prognosis is 2-10year life expectancy depending on chemotherapy outcomes, but the doctors are not entirely sure until the frozen sections and histopathology resections (from surgery) results are returned. This usually takes 10-14 days. The doctors have indicated that the chemotherapy is more likely to be used for life prolonging measures rather than seeking a cure.

The family are looking into non-conventional treatment options. John recently retired from the building industry, he lives with his wife and has a large supportive family who live close by. He has four adult sons who are all married with small children. The diagnosis of a life limiting illness has impacted his mental health. He is currently shocked by the diagnosis and has been talking like he is in the denial phase of grief with the pending diagnosis. He stated the tests will come back clear and he will be alright and is looking forward to getting into his garden greenhouse again and getting the lettuce, tomatoes and basil planted as spring is approaching.

He is a current smoker, drinks frequently 8-10 standard drinks a week (mostly red wine and Grappa) and eats a Mediterranean diet. He is 171cm tall and weighs 105kg.

Past Medial History

Type 2 diabetes

Hypertension

Peripheral neuropathy, numbness in feet

Sciatica

Medications

Metformin 1g BD,

Dexamethasone 5mg daily mane

Panadol Osteo 1200mg TDS

Endone 5mg QID PRN as needed for pain for one more week.

Frusemide 40mg BD

Potassium Chlorvescent 1 tablet diluted daily in 150mls of water.

Atacand 16mg Mane

Student to fill out Goals and corresponding intervention under each goal

 

 

 

 

SMART GOAL 1:

 

 

 

 

SMART GOAL 2:

SMART GOAL 3:

Self-Management

Intervention 1 and Rationales

 

 

 

 

 

 

 

 

 

Self-Management

Intervention 2 and Rationales

 

 

 

 

 

 

 

 

 

 

 

 

 

Self-Management

Intervention 3 and Rationales

 

 

 

 

 

 

 

 

 

 

 

 

Self-Management

Intervention 4 and Rationales

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Self-Management

Intervention 5 and Rationales

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Self-Management

Intervention 6 and Rationales

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Self-Management

Intervention 7 and Rationales

 

(delete or add rows as required)

 

 

 

 

 

 

 

 

 

  1. Reference List
 

NURBN 3033 Primary Health 4: Nursing People Living with Chronic Conditions

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Tellus molestie nunc non blandit massa enim nec dui. Tellus molestie nunc non blandit massa enim nec dui. Ac tortor vitae purus faucibus ornare suspendisse sed nisi. Pharetra et ultrices neque ornare aenean euismod. Pretium viverra suspendisse potenti nullam ac tortor vitae. Morbi quis commodo odio aenean sed. At consectetur lorem donec massa sapien faucibus et. Nisi quis eleifend quam adipiscing vitae proin sagittis nisl rhoncus. Duis at tellus at urna condimentum mattis pellentesque. Vivamus at augue eget arcu dictum varius duis at. Justo donec enim diam vulputate ut. Blandit libero volutpat sed cras ornare arcu. Ac felis donec et odio pellentesque diam volutpat commodo. Convallis a cras semper auctor neque. Tempus iaculis urna id volutpat lacus. Tortor consequat id porta nibh.

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Hac habitasse platea dictumst vestibulum rhoncus est pellentesque. Amet dictum sit amet justo donec enim diam vulputate ut. Neque convallis a cras semper auctor neque vitae. Elit at imperdiet dui accumsan. Nisl condimentum id venenatis a condimentum vitae sapien pellentesque. Imperdiet massa tincidunt nunc pulvinar sapien et ligula. Malesuada fames ac turpis egestas maecenas pharetra convallis posuere. Et ultrices neque ornare aenean euismod. Suscipit tellus mauris a diam maecenas sed enim. Potenti nullam ac tortor vitae purus faucibus ornare. Morbi tristique senectus et netus et malesuada. Morbi tristique senectus et netus et malesuada. Tellus pellentesque eu tincidunt tortor aliquam. Sit amet purus gravida quis blandit. Nec feugiat in fermentum posuere urna. Vel orci porta non pulvinar neque laoreet suspendisse interdum. Ultricies tristique nulla aliquet enim tortor at auctor urna. Orci sagittis eu volutpat odio facilisis mauris sit amet.

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