Important to look for ADLS, look for adequate resources for Mrs. H Attached Files: HEA 3301 Case Study #2 Rubric template.docx HEA 3301 Case Study #2 Rubric template.docx - Alternative Formats (13.733 KB) HEA 3301 Universal Transfer Form.docx HEA 3301 Universal Transfer Form.docx - Alternative Formats (15.896 KB) might help Case Study Assignment #2:  Transition of Care Due Wednesday, August 11th, by midnight Read the case study, and then answer the questions that follow.  Answer each question individually; this should not be one long essay.  Be complete and comprehensive in your answers.  There is no maximum or minimum number of pages—you will be graded on the accuracy, quality, and comprehensiveness of your answers.  Your writing must also be college-level. If you don’t know what something means in the case study, look it up.  In the words of your book, case managers are able to access information to address the needs of their clients.  In other words, it is up to you to seek the knowledge about medical terms, procedures, equipment, or diagnoses that you need to effectively plan for the patient. Plagiarism and Quotes: Writing for this class must be yours and only yours—completely original and written for the first time by you.  Any words (including direct quotes and paraphrasing) that are not fully and completely the result of your own individual thought process must be cited using APA format.  If plagiarism is found in your paper, you will receive zero points for your paper, and possibly a failing grade in the class and/or an Academic Honesty report.      Please note that ALL text references and your reference page should be in APA style (papers not in APA style will have a point reduction).      For those of you not familiar with APA style, you should either consult an APA style manual in the library, or the following site can give you useful guidance: http://owl.english.purdue.edu/owl/resource/560/01 You may not include ANY direct quotes in this paper; they are not necessary to accomplish the goals of this paper. ALL work should be in your own words; this is how I will know that YOU fully understand the materials.  ANY paper that has direct quotes (whether they are properly cited or not) will have deductions. ANY paper that features more than 10% of its body as direct quotes (whether properly cited or not) may receive a zero for the assignment. Transitional Care Case Study Mrs. Helen Stanley is an 84-year-old woman with current osteoporosis, lumbar compression fractures, and chronic pain.  She also has Giant Cell Arteritis (GCA)/Polymayalgia rheumatica (PMR)—treated with steroids since 2001—and a colo-vesticular fistula since 2002.  She also has diabetes, COPD and hypothyroidism, all controlled with multiple medications.  She also suffers from notable depression since the death of her spouse 5 years ago. Her medications are: Metoprolol   SR 25 mg qd          • Furosemide 80 mg qd   KCl 80 mEq qd                           • Prednisone 10 mg qd   Alendronate 70 mg qweek         • Calcitonin NS 200 IU qd   Ca/D 500/200 TID                      • Morphine SR 30 mg BID   Morphine IR 5 mg q4h prn         • NPH   insulin18   Mirtazapine 15 mg qhs               • Warfarin 2mg qhs   Senna 2 tabs qhs                       • Colace 100 mg BID   L-thyroxine 50 mcg qd                • Ranitidine 150 mg qd   Albuterol nebs                             • Ipratropium MDIqAM/12 qPM Mrs. Stanley lives in a second-floor apartment by herself, and all three of her children have passed on.  She does not drive and is socially isolated.  Her primary insurance is Medicare. Mrs. Stanley has an extensive history of hospitalization.  In the past five years, she has been hospitalized for hypotension, congestive heart failure, severe UTI, pain management due to compression fractures in her lower back, symptomatic uterine prolapse (spontaneously resolved), and COPD exacerbation.  Two months ago, Mrs. Stanley had minor trauma caused by sitting down abruptly on the commode.  This resulted in excruciating low back pain the following day.  She was hospitalized for pain control, and no new fractures were found.  She was discharged to home. Unfortunately, her functional status steadily worsened along with her back pain, and she was readmitted to the hospital for pain management and consideration of minimally invasive spinal surgery  (vertebroplasty).  She experienced delirium and respiratory depression on morphine. A fentanyl PCA/patch was tried with some relief. After extensive discussion with the radiologist, it was decided that the risk of sedation outweighed the potential benefit of the procedure, and she received an epidural steroid injection instead. While her pain improved, no functional benefits were noted (for example, she is unable to sit on the toilet for a BM without severe pain).  While in the hospital, she reported pain in her vulvar/labial region and experienced vaginal bleeding. She is currently incontinent. She also experienced a notable exacerbation in her CHF and COPD symptoms, including such severe dizziness, weakness, and shortness of breath that she cannot walk independently. She is also unable to stand long enough (or safely enough) to prepare food.  Mrs. Stanley’s depression has also steadily increased.  She frequently and tearfully expresses her strong desire to return home.  She misses her own bed, her cat, and her own things around her.  She desires her plan to be discharge to home. Currently, Mrs. Stanley is as medically stable as the medical staff can make her in the hospital.  She will be discharged from the hospital tomorrow. Case study adapted from:  http://www.hopkinsmedicine.org/gec/studies/osteopo... What Level of Care does Mrs. S require upon discharge, and what care setting is appropriate?  In other words, what is the appropriate setting for Mrs. S to be in following her discharge from the hospital and why?  Specifically discuss whether Mrs. S is a good candidate for discharge directly to home and why or why not? What resources are needed to move Mrs. S to her next level of care?  What care coordination will the case manager have to do to ensure her success at transitioning to the next level? Discuss at least three functional issues (including ADL issues) that must be resolved before Mrs. S can go home. Discuss at least three psychosocial issues that must be addressed before Mrs. S can go home. Discuss at least three actions that the case manager can take to increase the chance that Mrs. S can go home AND that she does not wind up back in the hospital. The following form is an example of the type of transfer form you will have to complete as a case manager.  Fill out the following form as completely as you can based on the information that you have—leave blank what you don’t know.  [Again, if you don’t know what a term means, look it up.  Finding information is a key competency for a case manager.] Universal Transfer Form DNR: ?Yes ?No  Reason for Transfer: _____________________________________________________________________________________  Clinical Summary: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________  Mental Status at Discharge:    ?Alert, oriented, follows instructions    ?Alert, disoriented, but can follow simple instructions  ?Alert, disoriented, but cannot follow simple instructions  ?Not alert      ? Numeric Pain Score: ?1? 2 ?3 ?4 ?5 ?6 ?7 ?8 ?9 ?10 Location______________________ Functional Status at Discharge: ?Ambulates independently ?Ambulates with assistance ?Ambulates with assistive device ?Non-Ambulatory Medications administered today with time: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________  Isolation/ Precaution:  ?N/A ?MRS ?VRE ?C-Diff ?Other____________________________________________________  Communication Interpreter Required  ?Yes ?No Primary Language: _________________________ Able to: ?Understand ?Speak ?Read ?Write  Secondary Language: ________________________Able to: ?Understand ?Speak ?Read ?Write? N/A Aphasia: ?Expressive ?Receptive. Sign language use: ?Yes ?No  Devices/ Special Treatments:   ?N/A ?V/PICC line/Portacath     ?Pacemaker      ?Foley Catheter      ?Internal Defibrillator     ?TPN       Other:___________________    At Risk Alerts: ?N/A                                                                                ?Pain  ?Seizure ?Falls  ?Pressure Ulcer ?Bleeding ?Aspiration ?Wanderer             ?Elopement Limited/non-weight bearing ?Left ?Right        ?Other: ______________________ Equipment Needed: ?Walker Cane ?W/C ?Brace ?Specialty Mattress ?Wound VAC ?N/A  Weight Bearing Status: ?Non-weight ? L ?R ?Partial weight ?L ?R ?Full weight    ?L ?R ?Amputee   ?Prosthesis use ?N/A                                                                      Mobility: Upper extremities ?Normal ?Impaired:___________________________________________ Lower extremities ?Normal  ?Impaired:_ _________________________________________  Activities of Daily Living:  (mark I=independent; D=dependent; A=needs assistance)  _____ Bathing   _____ Toileting/Transfers  _____ Dressing   _____ Ambulation  _____ Eating  Continence:             Continent            Bowel ? Bladder ? Occasionally Incontinent    Bowel ? Bladder ? Incontinent   Bowel ? Bladder ? Vision:     ?Sees Adequately          ?Impaired – sees large print but not regular print.        ?Moderately impaired – limited vision cannot see headlines.                                                                                                                  ? Severely impaired – no vision or only sees light, color shapes ? Uses Visual Aid Type:______________________________ Last bowel movement: Date: / /   Catheter last changed:?N/A        Date: / /               Auditory:  ?Hears adequately ?Minimal Difficulty  ?Intermittently Impaired  ?Highly Impaired  ?Uses Auditory Aid  Type: _______________________ Needs assistance with feeding:  ?Yes ?No      Trouble swallowing:   ?Yes ?No   Form adapted from:  http://www.nursingworld.org/MainMenuCategories/ANA... Value Points Value Points 1) Level of Care and care setting AND WHY 10 4) 3 Psychosocial Issues  12 2) Resources 12 5) 3 Preventative CM Actions 12 2) Care Coordination 12 6) Transfer form matches Case 20 3) 3 Functional Issues, must include ADLs

Identify one of the resources at the CDC Wonder site above and describe how a nurse might use this information in practice.One resource on the CDC Wonder site is the Heart Disease and Stroke Atlas. This link provides information on the number of heart disease patients as well as stroke patients from any given geographical regions. It details the risk factors, number of deaths, average cost of each hospitalizations that are specific to each regional area. This information is very useful in our practice to help us educate our patients and their families along with educating the general public to help reduce the number of hospitalizations in our particular regions. Providing specialized care to patients using a team approach we are able to have greater reach and influence on the education the patients and their families receive. "Inter professional teams, coordination of care across the illness trajectory, and technological advances will be key components in the new system—arenas in which nurses are familiar and have demonstrated their value." (ANA, 2015, p.46)How might nurses utilizing tele-health benefit from these resources?Tele-health benefit from these resources can provide the caregiver as well as the patient with access to critical information and resources. According to Fronczek, Rouhana, & Kitchin, (2017) as a growing technology tele-health is still changing and can be accessed from several mediums. Apps on smart phones, computer access, and even video conferencing can be used to talk with healthcare providers, assess non emergent patients, and even refer consultations and provide information. Using tele-health may benefit nurses because it allows them to have access to the information they need as well as make referrals as needed. This use of this technology is fairly new and still evolving and I sure the advancements made in the future could advance healthcare by leap years. "Tele-health extends access, and it has the potential of making healthcare services more convenient for patients."(Kruse, Krowski, Rodriquez, Tran, Vela, & Brooks, (2017)Address what you find innovative about the link.I found the CDC WONDER site very helpful. It provides an amazing amount of data and links to sub-topics and information that can be accessed to provide improved quality healthcare. The information can be accessed not only by healthcare providers but also patients. Education is key to prevention and treatment. The more information that we can provide for our patients either via written literature or web based applications the better. This site provides all encompassing diagnosis with treatment options, mortality rates, contributing factors, and average estimated costs of treatment. Feel free to share some of your nursing innovation ideas!I have a few nursing innovation ideas. One being cordless telemetry, BP, O2 SAT, and temperature monitoring through a wrist bracelet that is water proof and relatively inexpensive. I have seen some prototypes that are being developed but I would like to see them in the acute care settings. I think this would be beneficial to the nurses as well as the patients. ReferencesAmerican Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.Fronczek, A. E., Rouhana, N. A., & Kitchin, J. M. (2017). Enhancing Telehealth Education in Nursing: Applying King’s Conceptual Framework and Theory of Goal Attainment. Nursing Science Quarterly, 30(3), 209–213. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1177/0894318417708418 (Links to an external site.)Kruse, C. , Krowski, N., Rodriguez, B., Tran, L., Vela, J., & Brooks, M. (2017). Tele-health and patient satisfaction: a systematic review and narrative analysis. BMJ open, 7(8), e016242. Retrieved from doi:10.1136/bmjopen-2017-016242