NURS-FPX4050_HeckAshley_#4-1.docx - Final Care Coordination Plan Final Care Coordination Plan Ashley Heck August 2019 Capella University NURS-FPX4050

NURS-FPX4050_HeckAshley_#4-1.docx - Final Care Coordination...

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Final Care Coordination Plan Final Care Coordination Plan Ashley Heck August 2019 Capella University NURS-FPX4050 Coordinating Patient-Centered Care 1
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Care Coordination Plan Template Name: Josalynn Scott DOB: 09/19/1994 Address: Dexter, MN Payor Source: Medica (Mayo Clinic) 1. Current Problems With Status Summary: Patient presented to urgent care with complaints of neck pain and a swollen lymph node gland, also stating she had found a woodtick on her head earlier that evening. Tests were performed and Lyme’s Disease was the diagnosis. She was prescribed Doxycycline 100mg twice per day for ten days. The next week she had and EKG and an ultrasound of her left neck, which is where the swolled lymph node gland was located; both were negative for abnormal findings. Since her diagnosis, she has been fatigued and experiencing joint pain and weakness. This is her second time being diagnosed with the disease, so she does know what to expect. She has missed ten days of work in a four week span due to the fatigue and overall malaise from the disease. Some days she is perfectly fine, some days she can not get out of bed. She mentioned that one day her hand seemed to be effected; she could not use scissors or open anything with that hand. She took the following two days off from work and she felt better after that. 2. Routine Health Maintenance Physician: Mayo Family Clinic Southeast Physician’s Address: 4544 Canal Pl SE, Rochester, MN 55904 Physician’s Phone Number: (507) 293-8590 Preferred Hospital: Mayo Clinic Pharmacy: Mayo Clinic Mary Brigh Pharmacy’s Address: 1216 2nd St SW, Rochester, MN 55902 Pharmacy’ Phone Number: (507) 255-5123 3. Specialty Care Specialist One: N/A --- does not see a specialist, she refers back to her family practice physician if she needs to be seen 2
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4. Mental Health Provider Specialist One: N/A --- does not see a mental health provider 5. Hospital Care Date of Hospitalization: N/A --- no admits to a hospital 6. Patient Education – Josalynn was directed to lymediseaseassociation.org for education and resources. This site has lots of information on the disease itself, and where a patient can turn to if they need help. 7. Rehabilitation Services --- N/A 8. Medication List (List all medications, dosage, and purpose.) Medication: Doxycycline Dosage: 100mg twice per day by mouth Purpose: antibiotic to get rid of the bacteria Medication: Ibuprofen Dosage: 800mg as needed for pain every four to six hours Purpose: reduce swelling and pain 9. Signatures RN Care Coordinator Ashley Heck Patient Josalynn Scott Patient Contact Information (e-mail or phone) [email protected] 3
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Community Resources Template Mental Health Providers Mayo Clinic Psychiatry, Rochester, MN (507) 266-5100 Hospitals Mayo Clinic, Rochester, MN Education Services Rehabilitation Services N/A Pharmacies Mayo Clinic – Mary Brigh Building, St. Mary’s Campus DME Equipment Providers N/A Incontinence Service Providers N/A Parenteral Service Providers N/A Enteral Nutrition Providers N/A Social Services N/A Transition Services N/A Transportation Services N/A 4
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