You are the nurse making a home visit to provide care for an 82-year-old woman who has returned home after abdominal surgery to repair an inguinal hernia. She is needing dressing changes and IV antibiotic therapy. Upon your arrival, her daughter meets you at the door and requests a private conversation after her mother’s care is complete. While your patient is sleeping, her daughter relates her numerous concerns about her mother’s safety if she remains living at home alone. She indicates that her mother loses her keys on a weekly basis, forgets to pay her utility bills, and continues to hoard the food her daughter delivers weekly, eating very little.
- As the nurse and case manager in the community setting, what are your priorities regarding case and care management for this patient? How should the daughter’s safety concerns be addressed?
SOLUTION – Abdominal Surgery: Priorities regarding case and care management
As the nurse and case manager in the community setting, my priorities regarding case and care management for this patient would include:
- Assessment:
- Conduct a comprehensive assessment of the patient’s physical and cognitive function, including her ability to perform activities of daily living (ADLs) independently and any signs of cognitive impairment or dementia.
- Evaluate the patient’s wound healing progress and response to IV antibiotic therapy.
- Assess the patient’s home environment for safety hazards and barriers to independent living.
- Care Planning:
- Develop a personalized care plan that addresses the patient’s post-surgical recovery needs, including dressing changes, medication management, and nutritional support.
- Collaborate with the patient’s healthcare team to ensure continuity of care and optimize outcomes.
- Educate the patient and her daughter on wound care techniques, medication administration, and strategies to promote recovery and prevent complications.
- Support Services:
- Coordinate with community resources and support services, such as home health aides, meal delivery programs, and transportation services, to assist the patient with ADLs and ensure her safety at home.
- Provide referrals to social services or caregiver support groups for additional assistance and resources.
- Communication and Collaboration:
- Maintain open communication with the patient, her daughter, and other healthcare providers involved in her care to address concerns and coordinate services effectively.
- Involve the patient and her daughter in the care planning process and encourage active participation in decision-making regarding the patient’s safety and well-being.
Regarding the daughter’s safety concerns, they should be addressed through:
- Assessment of Cognitive Function:
- Conduct a thorough assessment of the patient’s cognitive function to determine the extent of any memory loss or cognitive impairment that may be contributing to her safety concerns.
- Safety Interventions:
- Implement safety measures within the home environment to address specific concerns, such as installing key racks near the door, setting up automatic bill payments, and organizing food deliveries to ensure proper nutrition.
- Provide education to the patient and her daughter on strategies to enhance safety and prevent accidents, such as using memory aids, organizing belongings, and implementing fall prevention measures.
- Supportive Services:
- Explore the option of home health aides or companions to provide supervision and assistance with ADLs, medication reminders, and household tasks to ensure the patient’s safety and well-being.
- Offer referrals to community resources and support services, such as memory care programs or respite care, to provide additional assistance and relief for the daughter as a caregiver.
- Regular Follow-up:
- Schedule regular follow-up visits to reassess the patient’s needs, monitor her progress, and address any new concerns or challenges that may arise.
- Maintain ongoing communication with the patient and her daughter to provide support and guidance as needed, and to ensure that the patient’s safety needs are being met effectively.