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.”

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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

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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.

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Category

Your

response Explanation

Risk Reduction Increased

acuity

Janeya is not engaging in risk behaviors.

Self-Management Increased

acuity

Janeya, her family, and the school nurse may enhance her selfmanagement.

Social Determinants of Normal Janeya may be vulnerable to social aspects of her environment,

Health acuity including access to care.

Surveillance Normal

acuity

Public health surveillance is not indicated.

Kenny Barrett Room

Kenny Barrett, Kenny Barrett is a 64-year-old male recently hospitalized for

management of undiagnosed hypertension. It was determined Kenny’s

hypertension and lower extremity pain was related to vasculitis. Kenny was

diagnosed with Buerger’s Disease. Medications: Atenolol 50 mg daily. Tylenol

325 mg prn pain. NKDA Surgical history: Kenny’s surgical history is positive

for a cholecystectomy and inguinal hernia repair. Social history: Kenny is

widowed. He lives alone in a two-bedroom home in a rural community. Kenny

recently retired and does not work outside of the home. He admits to

struggling financially and being dependent on his savings until he can

receive social security. He smokes one pack per day. The pain in his lower

extremities prohibits his engagement in exercise. Community Assessment:

Kenny lives in a rural community with limited resources. Kenny’s home is on

a dirt road, the nearest neighbor is “one country mile” away. Kenny lives

seven miles from the farm co-op where he can purchase fresh vegetables

and milk. To purchase items not available from the co-op, Kenny must go to

“town” nearly thirty miles from his home. There is a family physician in town,

however, the nearest hospital and specialty clinics are 80 miles. Kenny

receives his prescriptions via mail. Kenny travels via his car, which is

unreliable.

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