prepare portfolio as well as infographic portfolio

prepare portfolio as well as infographic portfolio you will be providing information on service networks of health and community support services like a holistic support service (ie, Alzheimer’s Society) that are applicable to your case study. You will compile the information in a concise infographic. 1. You will utilize the case scenario already provided for your previous case scenario assignment. Your case scenario should be on the first page of your portfolio. 2. Select 1-3 holistic community supports (depending on which agency you choose) that are applicable to your patient. 3. Gather information on the service. Patients must receive the necessary details, how to access the service, what is covered, cost, location etc. 4. Present the information about this service in a portfolio style. Pretend you are handing this over to the client. You may provide supporting materials from agencies/services. 5. Complete a 250 word “Dear Patient” letter (to be included in your portfolio) to discuss the benefits that will emerge from utilizing the services outlined collaboratively. this is a case study Case Study: Jean’s Story Jean is a 62-year-old woman with renal failure that requires her to undergo frequent dialysis. Jean is also a person living with dementia, recently diagnosed. For several years, she has lived in a suburb of a medium-sized city in Southwestern Ontario. Jean is single and lives on her own. It isn’t easy for Jean to get to her dialysis appointments three times a week. She recently had her driver’s license removed, so she now relies on buses and cabs to get to the dialysis center. Jean’s daughter lives nearby and is a major source of emotional support; she gives Jean rides if she’s able to get time off work, but that is rarely possible. Jean has a few close friends who can help at times, but because Jean’s appointments take so long and happen during business hours on weekdays, she usually has to go by herself. Jean has no other family involved in her life. She has a neighbour whom she has become good friends with often checks in on her and whom Jean shares many of her concerns with. They have become friends who watch out for one another. Frequently, it seems to Jean that there are so many rules in place about how her care will be handled that her providers and the system feel like obstacles she must overcome, rather than allies. Further, it seems that the rules are set up for the system and the providers, not for Jean. A few months ago, Jean was living alone and independently in her one-bedroom apartment. She enjoyed knitting and playing the piano. She was very handy with a sewing machine and loved doing crafts. Today she’s at risk of being admitted to a long-term care home, due to significant complications of her disease and its treatments but also, related to her lack of community supports. Here’s her story: Day One, Monday Jean is at the dialysis clinic and it’s noted that she is experiencing poor blood flow. With poor flow, it is difficult, if not impossible, to complete an effective dialysis session. Because of the poor flow, it takes five hours to complete the dialysis that day, instead of the usual three. The nephrologist, Jesse, orders an ultrasound of Jean’s upper arm, to be done at the local hospital about eight miles away. The nurse, Mercedes, gives Jean a handwritten order form for the ultrasound and calls the radiology department, scheduling the test for 9 AM the next morning. Jean does not tell Mercedes that she can no longer drive and may not be able to get to the test on time. Day Two, Tuesday Jean takes the bus in the morning, but makes a transfer onto the wrong bus along the way, only to arrive at the hospital at 10:00am. When she checks in at the desk, the clerk, Jonas, tells her they cannot perform the test. He says the department has a policy that anyone who is more than 15 minutes late must be rescheduled. The department has a high percentage of patients who show up late or not at all, he says, and they want to be fair to those who arrive on time. Jean asks if there is any way to get the test done today, but Jonas, who got yelled at last week for sneaking in a late patient, tells her this is simply not possible. He reschedules the test for Thursday at 10 AM. Upset, frustrated, and exhausted by the fact that she just wasted several hours, Jean hands Jonas a paper with her daughter’s phone number on it and asks him to call her. Her daughter takes the day off of work to give her mom a ride home and provide support, not before explaining to Jonas about her mom’s dementia diagnosis, of which he was unaware. Day Three, Wednesday Wednesday morning Jean goes to dialysis as usual. This time, there is almost no blood flow through her fistula. Jesse, the nephrologist, orders a blood test of, among other things, her potassium level, to make sure dialysis is still regulating Jean’s electrolytes. She is sent to the emergency department (ED) after the potassium check comes back dangerously high at 6.3 mmol/L. The care team in the ED treats Jean’s potassium level with a combination of medications. An ultrasound, the same type of procedure that Jesse ordered on Monday, shows a significant blood clot within Jean’s fistula that extends into her vein. Jean is admitted to the hospital and given tPA (tissue plasminogen activator) to break up the clot — an effort that is successful. Afterward, Rachel, the internal medicine resident caring for Jean, starts her on intravenous heparin and oral warfarin (both blood thinners) to prevent the clot from recurring. A temporary dialysis catheter is placed in Jean’s neck, and that night she has dialysis that corrects her high potassium level. Although this is all explained to Jean, no one has checked to ensure she understands the situation, nor is anyone aware that she is a person living with dementia. Due to this, there is no attempt to seek consent to speak with her daughter, or find additional supports for her. Day Seven, Sunday On Sunday, Jean is ready for discharge. Lydia, the nurse caring for her that day, goes over the written discharge instructions with her. Lydia tells Jean to see her primary care physician by Tuesday to have her International Normalized Ratio (INR) checked, since she is taking warfarin. Fortunately, Jean has notified her daughter of her situation and her daughter is there when Lydia comes in. Lydia says that after this initial check on Tuesday, Jean’s primary care physician will need to check her INR on a weekly basis. Jean’s daughter shakes her head and tells Lydia that it’ll be hard to get to her primary care doctor so her INR levels can be checked — it’s just too much for her to do on top of dialysis. Quickly, Lydia finds Ana, the social worker on the unit, and asks about an alternate plan for Jean. The two of them decide that the dialysis unit might be the best place to check her INR in the future, since she goes there anyway three times a week. Ana also suggests that Jean meet with a nutritionist before she leaves. The reason is that there are many foods that contain vitamin K, which counteracts the effects of warfarin. It would be a good idea for Jean to learn which foods she should avoid after her discharge. Lydia thinks this is a good idea and decides to contact a nutritionist. However, it’s Sunday, and no nutritionist is available. Lydia asks the physician filling out Jean’s discharge orders to request an outpatient nutrition appointment instead. All these instructions are written on Jean’s discharge orders. Tired from poor sleep over the past few days in the hospital, and due to her cognitive impairment, Jean barely remembers hearing the instructions and leaves the written discharge instructions in her daughter’s car when she goes home. A discharge summary is mailed to her primary care doctor. Jean’s daughter makes an assumption that someone on Jean’s care team will follow up with her with further instructions. She doesn’t hear anything, so assumes that everything is taken care of. The hospital’s appointments desk (open Monday through Friday) makes a nutrition appointment for Jean the day after her discharge, but when the case worker calls Jean, her phone is disconnected. The case worker mails her an appointment slip instead, but it is unclear whether or not she receives it. She does not come to the appointment. Day 25, Thursday Two and a half weeks later, her daughter brings Jean to the emergency department. Jean has right arm pain and swelling. Studies show she has a new deep venous thrombosis (a blood clot in a vein deep in the body), and her INR is 1.1. When asked about her warfarin dosage, Jean’s daughter says nobody has been checking it, and that Jean has been taking the 2.5 mg per day warfarin dose she was discharged on two weeks ago. She says she was aware that her INR was supposed to be checked at the dialysis unit, but after some investigation it appears that when Jean went for dialysis, this didn’t happen. Jean’s daughter says at one appointment she brought it up with the medical assistant who took her weight and blood pressure at the start of her visit to the dialysis unit. The assistant told her that he didn’t know about the INR issue but would check on it. Jean’s daughter says she never heard anything more about it. Once again, Jean is admitted to the general medicine unit and placed on an intravenous heparin drip and oral warfarin. It takes 10 days for her INR to creep up to therapeutic range. She has significant pain in her right arm, and she now requires intermittent oral narcotics to function. Ana, the same social worker from the last hospitalization, calls Jean’s dialysis unit and speaks to the nurse manager about following the INR. Ana feels horrible about the communication lapse at the end of Jean’s last hospitalization. The resident calls Jesse, Jean’s nephrologist, to make sure he too is aware he needs to follow her INR levels closely, and that they will be drawn during dialysis each week. During this hospitalization, Jean is finally able to meet with Jane, the nutritionist. It turns out that Jean has been intermittently eating spinach salads as part of a weight loss diet she is on. Spinach has large amounts of vitamin K and counteracts warfarin. These salads may well have been making her anticoagulation levels unstable. Jane gives Jean some written information about which foods she can eat as well as the importance of eating approximately the same amounts every day. Jean is on a very tight food budget and also has a difficult time remembering what she has eaten at each meal. Day 36, Monday Jean goes home late on Monday, after dialysis in the hospital. She spent her 62nd birthday in the hospital. Because of visiting restrictions, her daughter and friends had to leave at 8 PM rather than staying a few more hours to spend time with her. At home Jean feels nauseated and ends up vomiting. She skips her dialysis on Wednesday, feeling too worn out and sick to go. Mercedes, the nurse at the dialysis center, is surprised when Jean doesn’t show up. She calls Jean’s cell phone, but she only gets a message that the number has been disconnected. Mercedes considers calling the police to have them check on Jean. One of her patients has a sudden drop in blood pressure during dialysis, however, and in her rush to help, she forgets to make the call. Later that day Jean realizes that her face is tingling. Her friend urges her to call someone, but Jean just wants to try and get some sleep. She feels exhausted and sick. Day 39, Thursday Jean’s friend has contacted Jean’s daughter who arrives at Jean’s house and takes her to the ED. She arrives at the ED at 1 pm, but she has to wait two hours before labs are drawn. The physician sees her and provides a cursory exam. Jean’s daughter has had to take time off of work and must get back, so she has no choice but to leave Jean at the ED until the end of the day. Jean’s potassium levels are high and at a “critical level”. The lab technician calls the ED and promptly relates this potentially life-threatening result to the ED nurse, who tells the ED physician. The physician pages the nephrology fellow, who gets Jean sent over to dialysis immediately. Jean’s other lab results, including her INR levels, show up about 30 minutes later. Her INR is 5.3. A lab technician enters the result into the computer. At about 6 PM, Jean arrives on the medical surgical unit in the hospital. Fatigued, she again complains of face tingling and nausea. She is given some compazine for the nausea (there is a standing order for compazine as needed) and falls asleep. Day 40, Friday Early the next morning, Grant, a medical student, sees Jean. He thinks she seems overly tired but does not really know her baseline mental status. Grant decides to wait until formal patient care rounds to voice his concerns. During rounds at 9 AM, he speaks to Valerie, the attending physician. Valerie looks up Jean’s lab results on the computer and notes the extremely high INR. She orders an emergency CT scan of Jean’s head. Ninety minutes later the radiologist pages Valerie. Jean has an acute subdural hematoma (a bleed on the brain). She is transferred to the intensive care unit, neurosurgery is called, and the care team gives Jean fresh frozen plasma to replace the clotting factors she no longer has in her blood. The surgeons take her to the operating room, remove the bulk of the hematoma and stop the bleeding. Jean has a very slow recovery and is left with increased cognitive decline. Jean is no longer able to live on her own and after much effort by Ana, the social worker, Jean may be able to stay at home with 24-hour paid caregiving support. About Jean’s health care system: Jean receives her care from several systems. Some use an EMR system and others use paper charts. The EMR system used by the hospital is different than that used by Jean’s primary care provider, and different still from the one used by the dialysis centre. None are linked. This case has been adapted from: Baum, Karyn. (June 8, 2017). Advanced Case Study Retrieved from http://www.ihi.org/education/IHIOpenSchool/resources/Pages/Activities/AdvancedCaseStudy2010.aspx SCIENCE HEALTH SCIENCE NURSING LHC 2104

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