Vulnerabilities And Strengths In The Family
Identify the vulnerabilities and strengths in the family when considering your discharge plan.
• Vulnerabilities o Caregiver stress and fatigue
• The daughters of Mrs. Davis may already be stressed out from their full time jobs and taking care of their teenage children. The daughters may feel additional stress associated with caring for their mother. o Economic and financial matters
• Even though Mrs. Davis has a pension from her husband and social security, additional expenses related to the most recent hospitalization could add financial burden to her and her daughters. o Living space
• Mrs. Davis’ room is on the second floor. It would be safer for her if her room would be on the first floor so that she does not have to take the stairs, which could potentially cause her to fall again.
• Strengths o Support system
• Her family would serve as her support system, which helps her in coping with her condition. o Diversionary activities
• If Mrs. Davis has healthy interactions with her family, instead of focusing on the recent hospitalization and the adjustments associated with it, she would concentrate on getting better faster rather than get depressed or feel powerless. o Socialization
• Perhaps, having her friends die or moved away may cause her to feel lonely or alone so having her family around would help her with …show more content…
her social interactions, which would help improve her mood and aid her motivation to recuperate from her illness.
What are the diagnoses that need to be managed in the discharge plan?
• Diabetes o Mrs.
Davis needs to be educated on how to manage her disease appropriately and on how to take her medications properly. She also needs to know the side effects that the medications and what to do the manage it. Healthy diabetic diet, daily exercise as tolerated, and promotion of good sleep should be considered. If she has a type 1 diabetes, teaching on how to take the blood glucose levels and how to properly administer the insulin are very crucial for her disease management. It is also essential to ensure that she understands what she needs to do, so a return demonstration should be done by Mrs. Davis. This concept can also be used to teach her
family.
• Anxiety o Mrs. Davis does not want to burden her daughters so it is possible that she would feel anxious when she goes home. She may feel worried because she may feel that she is being a source of stress to her children.
• Decreased independence o The broken wrist may limit her ability to do the ADLs and she may depend more on her family to help her with her ADLs.
• Infection o The wound on her right shin might be infected if proper wound care and treatment is not in placed.
• Pain o The broken wrist and the wound on the right shin could possibly cause her pain. Aside from the prescribed medications, non-pharmacological intervention such as cool/warm applications and calming techniques might be helpful.
What are the resources within the family for caregiving?
• Emotional support
• Provide a list of Medicare-certified skilled nursing facility (SNF) via http://www.medicare.gov/nursinghomecompare or home health agencies (HHA) via http://www.medicare.gov/nursinghomecompare and respect the patient’s and family’s preferences (CMS, 2014).
• Make appropriate referrals such as medical equipment suppliers and community resources (CMS, 2014).
Include anticipatory guidance in your patient education section for both Mrs. Davis and her family.
• Teaching on how to cope with the changes of Mrs. Davis’ condition should be approached in a holistic manner. When you tell the patient and the family of what to expect before the patient returns home, everyone would be more prepared and would better accept the situation. Better preparation could lead to better acceptance, which may yield better coping mechanisms, thereby producing better health care outcomes.
Identify interprofessional resources that you would use for this patient.
• PCPs such as NPs – point of contact in terms of the patient’s diagnosis, treatment, and plan of care
• SNF or HHA nurses – provides skilled nursing services
• Pharmacist – to review medications and medication compliance
• Social worker – to help the patient and family in terms of community support resources, living space modifications, and provision of mobility assistive devices if necessary
• Physical Therapy – to teach and guide the patient with the the appropriate exercises to aid in the healing of the broken wrist
• Spiritual support – Mrs. Davis was an active participant in her church so it is important that there is a spiritual support for the her, which can boost her morale and encourage a positive outlook in life
It is important to include an ongoing reassessment (Quality Assessment and Performance Improvement Program, for example) of Mrs. Davis’ situation to ensure that post-acute and post-transitional care discharge needs are met (CMS, 2014).
References
Centers for Medicare & Medicaid Services. (2014). Discharge planning [PDF file]. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Discharge-Planning-Booklet-ICN908184.pdf
• Vulnerabilities o Caregiver stress and fatigue
• The daughters of Mrs. Davis may already be stressed out from their full time jobs and taking care of their teenage children. The daughters may feel additional stress associated with caring for their mother. o Economic and financial matters
• Even though Mrs. Davis has a pension from her husband and social security, additional expenses related to the most recent hospitalization could add financial burden to her and her daughters. o Living space
• Mrs. Davis’ room is on the second floor. It would be safer for her if her room would be on the first floor so that she does not have to take the stairs, which could potentially cause her to fall again.
• Strengths o Support system
• Her family would serve as her support system, which helps her in coping with her condition. o Diversionary activities
• If Mrs. Davis has healthy interactions with her family, instead of focusing on the recent hospitalization and the adjustments associated with it, she would concentrate on getting better faster rather than get depressed or feel powerless. o Socialization
• Perhaps, having her friends die or moved away may cause her to feel lonely or alone so having her family around would help her with …show more content…
her social interactions, which would help improve her mood and aid her motivation to recuperate from her illness.
What are the diagnoses that need to be managed in the discharge plan?
• Diabetes o Mrs.
Davis needs to be educated on how to manage her disease appropriately and on how to take her medications properly. She also needs to know the side effects that the medications and what to do the manage it. Healthy diabetic diet, daily exercise as tolerated, and promotion of good sleep should be considered. If she has a type 1 diabetes, teaching on how to take the blood glucose levels and how to properly administer the insulin are very crucial for her disease management. It is also essential to ensure that she understands what she needs to do, so a return demonstration should be done by Mrs. Davis. This concept can also be used to teach her
family.
• Anxiety o Mrs. Davis does not want to burden her daughters so it is possible that she would feel anxious when she goes home. She may feel worried because she may feel that she is being a source of stress to her children.
• Decreased independence o The broken wrist may limit her ability to do the ADLs and she may depend more on her family to help her with her ADLs.
• Infection o The wound on her right shin might be infected if proper wound care and treatment is not in placed.
• Pain o The broken wrist and the wound on the right shin could possibly cause her pain. Aside from the prescribed medications, non-pharmacological intervention such as cool/warm applications and calming techniques might be helpful.
What are the resources within the family for caregiving?
• Emotional support
• Provide a list of Medicare-certified skilled nursing facility (SNF) via http://www.medicare.gov/nursinghomecompare or home health agencies (HHA) via http://www.medicare.gov/nursinghomecompare and respect the patient’s and family’s preferences (CMS, 2014).
• Make appropriate referrals such as medical equipment suppliers and community resources (CMS, 2014).
Include anticipatory guidance in your patient education section for both Mrs. Davis and her family.
• Teaching on how to cope with the changes of Mrs. Davis’ condition should be approached in a holistic manner. When you tell the patient and the family of what to expect before the patient returns home, everyone would be more prepared and would better accept the situation. Better preparation could lead to better acceptance, which may yield better coping mechanisms, thereby producing better health care outcomes.
Identify interprofessional resources that you would use for this patient.
• PCPs such as NPs – point of contact in terms of the patient’s diagnosis, treatment, and plan of care
• SNF or HHA nurses – provides skilled nursing services
• Pharmacist – to review medications and medication compliance
• Social worker – to help the patient and family in terms of community support resources, living space modifications, and provision of mobility assistive devices if necessary
• Physical Therapy – to teach and guide the patient with the the appropriate exercises to aid in the healing of the broken wrist
• Spiritual support – Mrs. Davis was an active participant in her church so it is important that there is a spiritual support for the her, which can boost her morale and encourage a positive outlook in life
It is important to include an ongoing reassessment (Quality Assessment and Performance Improvement Program, for example) of Mrs. Davis’ situation to ensure that post-acute and post-transitional care discharge needs are met (CMS, 2014).
References
Centers for Medicare & Medicaid Services. (2014). Discharge planning [PDF file]. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Discharge-Planning-Booklet-ICN908184.pdf