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Hello guys! I need help filling out this Care Plan for a COPD Rehabilitation patient. These are all the information that was provided to me.  Thank you so much for your help! 

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Assessment Findings Diagnosis/Problem/Analysis
Plan Implementation Evaluation Alteration in
Respiration Status related to exacerb… Show more

Scenario Overview

Patient: Henry Williams

Diagnosis: COPD rehabilitation

This scenario is part of the Henry Williams Unfolding Case. The scenario can be used as a standalone scenario or as part 3 of the case.

The Unfolding Case

Henry Williams is a 69-year-old African American, a retired rail system engineer who lives in a small apartment with his wife, Ertha. Henry and Ertha had one son who was killed in the war 10 years ago. They have a daughter-in-law, Betty, who is a nurse, and one grandson, Ty. Henry is concerned about Ertha because she is experiencing frequent memory lapses.

The simulation scenarios focus on the physical and psychosocial changes that Henry encounters over the next few weeks. His failing health and his concern for his increasingly forgetful wife lead him through various transitions that affect his family and his living situation. The objectives focus on assessment and appropriate use of assessment tools such as SPICES: An Overall Assessment Tool for Older Adults, the Geriatric Depression Scale, the Pittsburgh Sleep Quality Index, the Katz Index of Independence in Activities of Daily Living (ADL), the Modified Caregiver Strain Index, and the Transitional Care Model : Hospital Discharge Screening Criteria for High Risk Older Adults. The objectives also focus on psychosocial issues with Henry’s wife and their daughter-in-law’s concern for their living arrangements, the proper use of the SBAR tool, and making appropriate community referrals.

Brief Summary of Present Scenario

This scenario takes place 10 days after Henry was transferred to the rehabilitation center. He is now awaiting discharge from the rehabilitation center. He received pulmonary rehabilitation, including education on how to pace himself, how to take his medications, when to do his breathing treatments, and when to contact the doctor. This scenario will include information about how Henry, Ertha, and the family have been dealing with the changes in their health and living situation. Betty reveals that she has had some difficulty dealing with Ertha during the time she stayed with her, but believes things will be fine once Henry and Ertha are together again. She will take them to their assisted living apartment.

The students should review discharge orders from the rehabilitation center, address safety concerns, assess the need for help with medications, and educate about available support resources. The assessment tools recommended for this scenario include the Transitional Care Model : Hospital Discharge Screening Criteria for High Risk Older Adults, and the Modified Caregiver Strain Index.

Learning Objectives

Upon completion of the scenario, the student should be able to:

· Assess the patient’s individual aging pattern and functional status using standardized assessment tools appropriate for this patient, to include:

o Katz Index of Independence in Activities of Daily Living (ADL)

· Assess the patient’s readiness for discharge

· Assess the implications of the transfer for the family

· Use communication techniques to recognize, respond to, and respect an older adult’s strengths, wishes, and expectations

· Identify community and support resources available to the geriatric client to assist with maintaining his independence and his ability to stay in the assisted living environment as long as possible

Patient Case Introduction to Students

Time: 1255

Report from the day-shift nurse:

Henry is a 69-year-old male who was admitted 15 days ago with an acute exacerbation of COPD. Five days after admission he transferred here to the rehab center for pulmonary rehabilitation. He is waiting in the conference room, dressed and ready to transfer to an assisted living apartment. Please complete the hospital discharge screening criteria to identify the transitional care needs.

Henry’s wife and daughter-in-law, Ertha and Betty, have just arrived to help facilitate the transfer to their new home. Henry has talked about his wife being “forgetful” and seems quite worried about her. Please make sure Henry is able to review his medications correctly and take them on his own. I have returned to him the home medications that he came in with. He is aware that a home care nurse can come and set up his pills, but he has not decided whether he wants that help. He also hasn’t decided whether any help is needed with activities of daily living, so please make sure to discuss the family’s needs.

Betty seemed a bit upset today. She mentioned it had been difficult for her to take care of Ertha and she’s worried about how everything is going to work out for Henry and Ertha. She wants to help them as much as she can but I think she has been stretching herself in trying to help, so I recommend you try doing an assessment for caregiver strain.

Patient Details

Patient Data: Male- Age: 69 years. Weight: 88 kg (194 lbs). Height: 183 cm (72 in).

Allergies: Penicillin

Past Medical History: Chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), asthma, hearing loss (wears hearing aids).

History of Present Illness: COPD. Henry has spent 15 days in the rehabilitation facility having therapy and education for managing his COPD and increasing his activity tolerance. He has improved greatly and uses his oxygen at night and only as needed. He has shown that he knows how to do his breathing treatments and manage his medications. Now he and his wife Ertha are going to an assisted living apartment for the first time.

Social History: Retired.

Primary Medical Diagnosis: COPD, cardiovascular disease.

Surgeries/Procedures & Dates: Appendectomy at age 15.

Provider’s Orders

Discharge orders:

· Fluticasone proprionate 250 every 12 hours

· Albuterol 2 puffs as needed for acute onset of shortness of breath

· Respiratory treatment: Albuterol 2.5 mg & Ipratropium bromide 0.5 mg in 3 mL normal saline every night and PRN as needed for breathing changes/shortness of breath

· Rosuvastatin calcium 20 mg PO every evening

· Lisinopril 12.5 mg PO daily

· Metoprolol tartrate 50 mg PO daily

· Acetylsalicylic acid 81 mg PO daily

· Montelukast 10 mg PO every evening

· Prednisone 10 mg PO daily

· Schedule clinic appointment for evaluation in 10 days

Nursing Diagnoses

· Alteration in Respiration Status related to exacerbation of COPD

· Risk for Powerlessness related to chronic condition and lack of control over living arrangements

Overview of Proposed Correct Treatment

· Introduce self

· Identify patient

· Perform focused assessment for transfer to assisted living

· Perform medication reconciliation

· Assess and evaluate need for help with medications

· Assess need for help with meals, bathing, and other activities of daily living, using the Katz Index of Independence in Activities of Daily Living (ADL)

· Ask questions related to Ertha’s condition

· Consider whether Ertha needs a referral to her PCP for diagnostic evaluation

· Ask questions to determine appropriateness of discharge

· Assess readiness for discharge using Transitional Care Model

· Assess patient and family’s understanding of life in assisted living facility

· Educate about available support resources

· Educate about activities

· Educate about medication

· Explore resources, including adult day care centers and respite care for Henry

Case Considerations

The focus in this scenario is the transition from the rehabilitation center to an apartment in an assisted living facility. Understanding that older adults are vulnerable during such transitions is fundamental to ensuring competent, individualized care for older adults and their caregivers.

As part of the transition, it is important to assess Henry’s functional status and desire for care after transition. Using standardized assessment tools, in this case the Katz Index of Independence in Activities of Daily Living (ADL) and the Transitional Care Model (TCM), will help to ensure a systematic approach to the assessments.

In this case there are also indications that Betty has been stretching herself in taking care of Ertha. Since Ertha and Henry are likely to still need help with many things after they transfer to the assisted living facility, it is appropriate to also assess how Betty is managing the caregiver role. The Modified Caregiver Strain Index can be used to identify families in need of additional assessment and interventions to help with managing the caregiver role.

The family needs to make important decisions about appropriate life changes, and the nurse can assist the family by providing information about available support resources and help them access and evaluate resources. Analyzing risks and benefits of care decisions in collaboration with the interdisciplinary team, the patient, and the family is an important aspect of care because it aids Henry and his family in making these life transitions.

Assessing the family’s understanding of life in an assisted living facility, educating about medication and activities of daily living, and providing advice about Ertha’s condition are other important elements in ensuring continuity of care during the transition.

SCIENCE
HEALTH SCIENCE
NURSING
NURS 625

 

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