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Case Management.docx - Case Management Case Management...

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Case Management 1 Case Management Melissa Thomas NUR 370: Gerontology Facilitator: Carolyn Hamilton September 6, 2008
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Case Management 2 Plagiarism Statement I have read and understand the plagiarism policy as outlined in the University Bulletin and this module as it related to the IWU Honesty/Cheating Policy. By affixing this statement, I certify that I have not cheated or plagiarized in the process of completing this assignment. If it is found that cheating and/or plagiarism have taken place, I understand that the consequences of this action may include expulsion from Indiana Wesleyan University. ________________________________ _______________________ Name Date
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Case Management 3 Case Management H. A. is a ninety year old, divorced male who was brought into the emergency room by an ambulance service because he had called 911 for increase shortness of breath and increase in lower extremity edema. He was admitted to the Intensive Care Unit (ICU) with the diagnosis of “Respiratory distress, congestive heart failure and pulmonary edema.” Initial assessment found him to be in respiratory distress with cyanosis present, pulse oximetry at 71 percent on 100% non re-breather (NRB) mask, pink frothy sputum was present. He had an elevated WBC, Pro BNP, low sodium and potassium levels with a temperature of 101.5f., blood pressure 196/101, heart rate 134 and heart rhythm was sinus tachycardia. H.A. was placed on BIPAP upon arrival to the emergency room. H. A. has pertinent medical history of having congestive heart failure, coronary artery bypass graft, insulin dependent diabetic, permanent pacemaker, pulmonary edema requiring a BIPAP and hypertension. H.A also has a scarred left ear with half of it missing due to being burned in a house fire as a child. H. A. is a WWII Veteran that has not smoked for twenty plus years and has been divorced for thirty plus years. He is five feet and ten inches tall and weighs 69 kilograms. H.A. was an orphan who later in life found out that his siblings were able to live with their parents. He lives alone and has been independent so far to this point. H.A has several hobbies including collecting angels, porcelain dolls, lighthouses and clocks, feeding squirrels and reading. H.A does have a strong family support system. According to Reed (1993), the basic structure known as the core, is “a circle surrounded by a series of concentric rings” that represent the “basis of resource protection for the core of the system”. These rings are known as the lines of defense. H. A has core elements of
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Case Management 4 being a 90 year old male with unstable vital signs, respiratory distress with pink frothy sputum, cyanosis, normal functioning integumentary system and normal functioning immune system. According to Neuman’s model, the first line of defense is the flexible line of defense. The flexible line of defense as described by (Reed, 1993), is “accordion like in nature expanding or contracting, depending on the needs of the client.” The flexible line of defense also acts to keep
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