Judith Hanks Room

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, vis ...

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.” You responded correctly to 9 out of 10 evaluations: Category Your response Explanation Community Assessment Increased acuity Resources in the community will need to be assessed, including internet resources and community resources after telehealth program is completed Culture/Belief's/Spiritualit y Normal acuity There is no indication of concerns in this care. Resource Identification Increased acuity Judith requires assistance in identifying local and web-based resources about her health and means to enhance her health Self-management Increased acuity Judith needs to manage her own illnesses and goals will be established for Judith to prevent exacerbations Social Determinants of Health Increased acuity The Hanks live in a rural area and are isolated due to their lack of transportation and Judith’s illness Surveillance Normal acuity There is no indication of concerns in this care. Education/Counseling Increased acuity Judith will need to be educated on the elements of the telehealth program, the program goals and strategies, the equipment and peripheral devices, and means to meet goals through behavior change Disease/Illness Prevention Increased acuity Judith needs to manage the cirrhosis, heart failure, and alcoholism Health Promotion Increased acuity Judith requires resources and education to enhance her health including diet, activity, and lifestyle changes Risk Reduction Normal acuity Judith will need ongoing support to reduce risks such as alcohol intake, inactivity, and potential injuries that could occur due to her 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