Case Scenario_ Mr. L

Purpose and Background:

The World Health Organization defines public health “as the organized measures to prevent disease, promote health and prolong life of the population as a whole.” Public health (PH) nurses provide essential services such as monitoring the health of individuals. They also diagnose, inform, educate, and develop policies for us as a community to lead healthier lives. Other interventions are featured in the PH Intervention Wheel:

There are interrelationships between individuals, families, and communities and their health systems. Therefore, PH nurses consider the multiple factors that will determine the health of their clients. PH nurses also look at stages of health, levels of prevention and are able to intervene at those primary, secondary, and tertiary levels. PH nurses are collaborators; they build on relationships with social organizations. All aspects of the client’s life are evaluated as the nurse works through the nursing process.

PH nurses sometimes function as home healthcare nurses or case managers. In addition to performing thorough assessments, these nurses readily engage in health education/teaching.

Activity Objectives:

Following an assessment of a client/patient who has several chronic illnesses described below in a case scenario, the student will:

1. determine community resources that are relevant to assisting the client;

2. write a teaching plan pertaining to two of the patient’s primary diagnoses;

3. appreciate the importance of health education as a significant public health intervention.

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Course Outcomes:

This activity aligns with several of the course outcomes as stated below:

a. To be able to examine health care delivery systems and resources.

b. To understand health promotion priorities for all individuals, families, communities.

c. To be able to examine the environmental, biologic, psychosocial risk factors for a particular disease and disability.

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Case

You are the home health nurse assigned to do skilled nursing visits twice a week for Mr. L. During your initial assessment, you learned the following:

Medical History

Mr. L is a 48-year-old male. He was recently discharged from the hospital with weakness of all extremities due to morbid obesity. Mr. L ‘s current weight is 320 lbs., ht.5 ft. 8 inches. Mr. L’s diagnoses include T2DM and asthma. Mr. L needs medication teaching and more information regarding his diagnoses.

Mr. L is wheel chair mobile and can use a walker.

Mr. L experiences severe shortness of breath on exertion.

His blood sugar levels range between 190 mg/dl-240 mg/dl. He does not currently have a blood glucose monitor at home: he cannot afford to buy one at this time. He has medication to pick up from the pharmacy.

Psychosocial History

His income is limited. He will not be returning to work because of his inability to stand for long periods of time and also the weakness that he has sustained after hospitalization.

The health insurance coverage that Mr. L has will cover the cost of medications, the walker, and the wheel chair. Mr. L is Medicaid pending.

Mr. L is a single parent with three teenagers (ages 13,14,17). He was recently divorced from his wife of 17 years. Family time includes a “fun activity with his 3 children once a week. The children are doing well in school at this time. Mr. L cannot afford bus cards for his children; therefore, the children must transfer to a local in-district high school. The children are adjusting to the divorce but are upset and angry about having to leave their old school and their friends. The eldest child has been complaining of a tooth ache. The children do have medical cards which covers dental care.

Mr. L has been depressed and is stressed due to raising the three children on a fixed income and being a single, male parent. Mr. L would like to participate in some type of family counseling to help with the depression.

The children and Mr. L have just moved to a ground level apartment because it was too difficult for Mr. L to walk up to the second floor. Mr. L cannot drive any longer due to health reasons. His eldest child does have a license. His sister can also help with transportation. Mr. L has concerns regarding his place of worship and would like to find a new church. Mr. L has some concerns about the neighborhood—specifically, the vacant buildings and many liquor stores.

Orders from his health care provider include:

· recording his blood sugars two times a day for the next month

· 2 x w visits to improve blood sugar levels and provide necessary health teaching r/t weight loss and asthma control.

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You will construct an APA-formatted word doc divided into the three parts noted below:

· In Part A, answer the questions in complete sentences like: “Mr. L can buy an inexpensive glucometer at the Walgreens on….”

· For Parts A and B, create a teaching plan, as if you were actually teaching Mr. L during one of your home visits as his case manager. Be as creative as you can. Visuals are important. Append supplemental materials as appropriate. For example, if you were going to give Mr. L a handout, include it as an appended doc.

Part A. Assessment of Community Resources (25 %/Points)

The following questions pertain to Mr. L and his family. For this assignment, answer the questions as if Mr. L and his family live in YOUR community.

· Where can Mr. L buy an inexpensive glucometer? (1)

· Where is a local library? An agency provides commuter access for Mr. L to do research needed for his present diagnosis. (1)

· Mr. L would like to participate in an exercise program for himself and the family. Where can Mr. L and his children exercise for free or at a reduced cost? (2)

· Where can Mr. L and the family go for an inexpensive family activity? (1)

· Mr. L wants to take his children out for dinner to reward them for doing so well in school. Locate a restaurant in the neighborhood. Look at the menu. Keep in mind that Mr. L has diabetes and is obese. Can you make healthy food choices for him? And the children? What are the healthy food choices on the menu? (2)

· Locate the chain grocery stores in this neighborhood. Go to the store and visit the meat market/department. Is the meat fresh? Is there a large section of lean meats to choose from? Go to the produce section of the store. Is there a large selection to choose from? Do the fruits and veggies look appealing and fresh? Is there public transportation nearby to get to this store? (10)

· What are the pharmacies in the neighborhood? Are the pharmacies available by public transportation? Is there delivery service available? (1)

· What are the dental services in this neighborhood? How many dental offices are there in this neighborhood? (1)

· What are the churches in this neighborhood? What denominations? (1)

· What is the racial makeup or ethnicity of this neighborhood? (1)

· Where is the local police department? (1)

· Where is the local post office? (1)

· What is the name of the local high school? (1)

· Where is an agency that Mr. L can receive counseling for himself and the children? (1)

Part B: Health Education about Weight Loss (25%/points)

Develop a healthy eating plan for Mr. L to assist with weight loss (10)

· Prepare a 3-day menu to include breakfast, lunch, dinner and 2 snacks (15)

Part C: Health Education about Asthma (25%/points)

· Develop a teaching plan for Mr. L about his asthma. Include the following information:

· What is asthma? How is it impacted by overweight? (5)

· Create a printed “Asthma Action Plan” for him, noting how he should manage his asthma both routinely and during an attack. (15)

· Include daily and rescue meds. Consider the 10 rights of medication administration.

· Include information about/list of possible asthma triggers and ways to avoid them. (5)

Grading Rubric

ContentPoints PossiblePoints EarnedComments*
Assessment of Community ResourcesSee directions for details about points distribution. All questions should be answered. Provide details.25
Teaching Plan: Weight LossSee directions for details about points distribution. Create a teaching plan, as if you were actually teaching Mr. L during one of your home visits as his case manager. Be as creative as you can. Visuals are important. Append supplemental materials as appropriate. For example, if you were going to give Mr. L a handout, include it as an appended doc.25
Teaching Plan: AsthmaSee directions for details about points distribution. Create a teaching plan, as if you were actually teaching Mr. L during one of your home visits as his case manager. Be as creative as you can. Visuals are important. Append supplemental materials as appropriate. For example, if you were going to give Mr. L a handout, include it as an appended doc.25
ReferencesEvidence can include your course text, web sites, etc.Use APA format (7th edition)5
ReflectionIn a paragraph of at least 3 sentences, what are your thoughts about this activity? (3) Did it take you about 8 hours to complete? (1) Imagine that you would really do this w/ a client. Name at least 3 the barriers & facilitators associated w/ this experience? (6)10
Writing MechanicsUse correct spelling (1) grammar (1) and punctuation (1). Make sure your prose is clear (3). Organize the paper into the three Parts (1). Structure the doc into APA format (3)10
100