Assignment: Case Management Models Essay
Assignment Case Management Models Essay
On this day, I was assigned to work in the patient admission unit in the department. The day was relatively busy and a patient was brought to the department by community social worker. The patient was 32 year-old female. She was brought to the department with history of chest pains, general body weakness, productive cough and loss of body weight. The patient reported that the symptoms started about one month ago and worsened over the last two weeks. The patient also reported that she has 16 weeks pregnancy. According to her, she had history of two previous admissions due to tuberculosis and pneumonia. She had no history of surgeries. The patient is divorced and living alone. However, she has a boyfriend who she believes to get married to in the future. She is not employed. She works as a casual laborer in her community. The patient reported that she is a heavy drinker as well as smoker. According to her, she smokes about five packs of cigarettes in a day. She also takes alcohol on almost daily basis. When asked whether she has started antenatal clinics, the patient reported that she believes that her baby is well since she has not experienced any health problems with the pregnancy. The vital signs were; temperature 38.3 degree Celsius, blood pressure of 142/87, pulse of 86, respiratory rate of 26 breaths per minute, and SP02 of 90.
A review of systems was done at the point of contact with the patient. Generally, the patient appeared wasted, poorly groomed and tired. Her mental assessment showed absence of any abnormalities. There was low capillary refill, tough skin, and discolored nail beds on the assessment of the integumentary system. The respiratory system showed rapid, labored respirations, chest in drawing, and presence of wheezes on inspiration. The patient coughed spitting blood stained sputum. The cardiovascular system showed normal heart sounds. There was normal production of urine. The musculoskeletal system did not show any signs of disorder. Abdominal palpation revealed an abdominal mass at the level of the umbilicus. A probable diagnosis of pregnancy was made. Sputum test and tuberculin sensitivity tests turned positive. Therefore, a provision diagnosis of tuberculosis in pregnancy was made (Nguyen et al., 2014). Therefore, this formed the basis of plans for further management of the patient in the hospital and at the community level.
Acute Management
Tuberculosis in pregnancy is among the health problems that face a significant proportion of pregnant women globally. According to statistics, approximately 60 in every 100, 000 people are pregnant women with tuberculosis in high burden nations and 20 in every 100, 000 in low burden countries (Saramba & Zhao, 2016). The incidence rate of tuberculosis in pregnancy is significantly high in countries with strained socioeconomic resources. Unlike tuberculosis in non-pregnant persons, tuberculosis in pregnancy is a challenge since it lowers the outcomes of the unborn baby. It also increases the risk of vertical transmission from the mother to the child within the first three weeks after birth. Vertically acquired tuberculosis is associated with high mortality rate if left untreated (Saramba & Zhao, 2016). Therefore, early identification and management is of great importance in tuberculosis in pregnancy.
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The acute management of the patient’s condition comprises of a wide range of interventions. According to the CDC, the preferred treatment of tuberculosis in pregnancy includes the use of isoniazid, rifampin, and ethambutol of a daily basis for a period of two
months. It is the followed by isoniazid with rifampin daily for seven months (CDC, n.d.). Besides the pharmacological management, it is important that the patient be kept in isolation from others until the sputum test is negative. The isolation room should have negative pressure where air is exhausted outside to prevent transmission to the other patients and healthcare providers. There is also the need for supportive therapy. The patient needs oxygen and fluid support to balance body tissue perfusion and fluid and electrolyte levels in the body. The patient should also be fed on high protein diet. This is important to replace the lost body weight and facilitate recovery. Health education is also important during the patient’s stay in the hospital. The patient should be educated on the need for beginning antenatal visits. She should also be educated on the importance of lifestyle and behavioral change. This includes educating her on the adverse effects of smoking and alcohol abuse on the fetus (Bekker et al., 2016; Sulis & Pai, 2018). The patient should also be educated on the risk of vertical transmission of the disease to the unborn baby. Through it, the possibility of adherence to treatment regime will be high. The patient will also be booked for smoke caseation clinic where she will receive the support she needs to stop smoking.
Community Management
The care of this patient extends beyond that provided in the hospital. She must receive the support she needs in the community for her to achieve optimum health and wellbeing. The community healthcare workers, community based organizations, and religious institution should be involved in promoting the health of the patient and other suffering from similar conditions. These stakeholders should engage in activities that would optimize the patient’s health outcomes by promoting treatment adherences and improvement of the treatment outcomes. The activities include mobilization of the community to develop environments that promote effective communication as well increase the demand for enhanced services that improve the treatment outcomes for tuberculosis patients (Holmes et al., 2017). The stakeholders are also needed to implement the initiatives that prevent further spread of the disease in the community. This includes encouraging the utilization of preventive methods such as covering mouth during sneezing and coughing to prevent the spread of the disease.
Moreover, the community can initiate and involve the patient in activities or programs that raise the awareness of the vulnerable populations about tuberculosis, risk factors, symptoms, and importance of early diagnosis and treatment. Lastly, the community members support the recovery of the patient by providing her with the nutritional and psychosocial support that she needs. This includes increasing the availability of balanced diets that would improve the recovery process. They also create safe environment for the patient where stigmatization of the patient due to her health status is discouraged (World Health Organization, 2018).
Continuum/Collaborative
Continuum of care is important for full recovery of the patient from the condition and improved outcomes for the baby. This implies that there should active collaboration between different stakeholders to achieve these outcomes. The different levels of healthcare providers must work together to optimize the outcomes of care. Nurses, physicians, counselors, and community based health workers must collaborate in the assessment, planning, implementation, monitoring, and evaluation of the healthcare needs of the patient (Holmes et al., 2017). The community members are also critical in promoting the creation of home environment that safeguards the social, physiological, physical, and psychological needs of the patient. They are also needed to provide the patient with the nutritional support she needs alongside the adoption of interventions that will enhance her adherence with the treatment (World Health Organization, 2016). Based on this, it is evident that the patient’s recovery is highly dependent on multidisciplinary interventions that would enhance her health and outcomes.
Case Management Concepts – Week 1 Assignment Case Management Models
Create a case management plan following the steps below: In your area of clinical specialty, think of a complex acute patient that you have taken care of. If a patient doesn’t come to mind, be creative: choose a complex and/or chronic disorder such as an uncontrolled diabetic who lives alone and has a very small pension; a vehicular accident victim who has multiple systems involved; a patient with bipolar disorder who is homeless, won’t take meds, and now has pneumonia. Develop your scenario about the patient in the first paragraph. Create a case management plan for each of the categories of models: Within the walls (acute); Beyond the walls (community) and Continuum/collaborative. Conclude each plan with a brief description of the model with which you have chosen to develop the plan, and support each plan with at least one reference.////////
Please follow the instructors\’ APA instructions which include, no opinions should be give unless the are in the final paragraph and are listed as authors\’ reflections ( this paragraph is not required). All statements should be cited unless they are considered common knowledge. /////////
The book we are using is, Introduction to Care Coordination and Nursing Management, By Laura J. Fero , Charlotte Harrick , and Jie Hu . ISBN 978-0-7637-7160-7. It is not necessary for you to have this book as I will be uploading the class lectures but if you do have access to it might be helpful.