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Community Population Health Discharge Plan Individual Assignment

Case Study Instructions:

Scenarios: Bent, 29, with unexplained weight-loss, treated for Anorexia Nervosa.  Recently married. Lives with extended family in a 6th floor apartment. Employed as a night security guard. Pays out of pocket for health services.  Resides in zip code 11203 

 

Individual Discharge Plan for Community Health Nurse (Individual)  

This assignment is based on the client scenario you have been assigned.

The aim of this assignment is to:

  • Enhance the students' understanding of the requirements and resources needed to care for a client in their respective zip code community setting. 
  • Improve the students' skills in identifying priority diagnosis for care of the client while in the community setting.
  • Strengthen students' knowledge and skills of identifying collaborative groups and institutions at the community level that will facilitate optimal care of the client while in the community.
  • Strengthen the students' ability to identify and apply primary, secondary and tertiary prevention methods associated with the care of the holistic person, which includes their medical, social and physical and spiritual being. 

All scenarios are as follows: Each student is assigned a client scheduled for discharge back to their community (zip-code area) from the acute care setting.  As the Community Health Nurse assigned to care for this client, the student will be required to prepare a discharge plan of care (template provided) for the client (template provided).  The plan of care must begin with the priority teaching focus and 3 priority nursing diagnosis (actual/problem-focused, risk, health promotion or syndrome).  The care will then focus on Primary, Secondary and Tertiary levels of prevention for management of the client while in the community, not only specific to the health condition; resources and knowledge of the resources available within the community.  

**Students are provided with a discharge plan template.  

Points allotted as follows:

  • Identification of 3 Priority Nursing Diagnoses for care in the community (must be complete nursing diagnoses.  A complete Nursing Diagnosis includes the Nursing Diagnosis-Related to/etiology-symptomology or exhibition if not a risk diagnosis)– 6% 
  • Identification of Primary, Secondary and Tertiary levels of prevention appropriate for age, gender and diagnosis (for the holistic client not only for health condition or medical diagnosis)– 3%
  • Setting S.M.A.R.T objectives for continuity of care in the community setting (must show all components of the objectives for each diagnosis) – 2.0% 
  • Using the Functional Health Status Approach to Community Health Assessment (Chapters 11 and 13): identify the health care agencies within the community (Zip code area) you would most likely collaborate with to ensure your client receives optimal care in the community setting.(Must give details of how each identified community resources fits into the care of the client, the type of insurance accepted, if the client qualifies to receive care/service from the resource, and how would the client begin to get services)– 4.0%

 


 

 Community Population Health Discharge Plan Individual Assignment

Student Name:  ____________________ Date:  ______________

Patient Name:  _____________________

Medical Diagnosis:  ____________________________________________________________

Priority Teaching Topic: _______________________________________________________________

Priority Nursing Diagnoses

Primary Prevention needs

Secondary Prevention needs

Tertiary Prevention needs

S.M.A.R.T Objectives for each Diagnosis

Based on the diagnoses, list the resources needed to care for this client in their Community (Zip Code Area)

Nursing Diagnosis 1

 

 

 

 

 

Nursing Diagnosis 2

 

 

 

 

 

Nursing Diagnosis 3

 

 

 

 

 

As the Community Health Nurse for this client, use the Functional Health Status Approach method for Community Assessment list the agencies available in the zip-code area to facilitate partnering for care of the individual in their community.  (For full points: Include how these resources will be integrated into the care of your client and what is the process regarding insurance, accepting the patient): ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

Case Study Sample Content Preview:

Community Health Plan: Brooklyn, New York
Your Name
Subject and Section
Professor’s name
Date
Community Population Health Discharge Plan Individual Assignment
Student Name: ____________________Date: March 21, 2021
Patient Name: Bent
Medical Diagnosis: Anorexia Nervosa
Priority Teaching Topic: Dietary and Fluid Volume Control
Priority Nursing Diagnoses

Primary Prevention needs

Secondary Prevention needs

Tertiary Prevention needs

S.M.A.R.T Objectives for each Diagnosis

Based on the diagnoses, list the resources needed to care for this client in their Community (Zip Code Area)

Imbalanced nutrition

According to the N.E.D.C. (n.d.)., the nurse practitioner shall help the patient to do the following:
1 Recognize that the Western body type, where the patient must maintain a lean or muscular body, has many consequences, such as poor nutrition that may lead to other diseases;
2 Teach the patient the significance of a positive outlook on body image, eating, and proper weight management;
3 Help the patient diminish the magnitude of importance that he places on his body;
4 Deliver quality education on the adverse outcomes of extreme dietary restriction CITATION NEDnd \l 13321 (NEDC, n.d.).

To detect nutritional balance, the nurse practitioner must do regular physical and laboratory examination, which include the following:
1 Anthropometric measurements, including the height and weight for the computation of body mass index, limb-girth measurement, and waist and hip measurements for the waist-hip ratio;
2 Laboratory analysis of serum protein and electrolytes, and micronutrients;
3 X-ray to check for bone density;
4 Using a diary to monitory dietary intake;
5 Teach the patient to use a diary to jot down psychological issues encountered (Knox et al., 2003; Mayo Clinic, n.d.).

1 Refer the patient to psychiatry for proper psychotherapy and psychoeducation for eating problems in anorexia (Zeeck et al., 2018);
2 Refer the patient to a dietitian (Mayo Clinic, n.d.).;
3 Prescribe antidepressants and anti-anxiety medications when necessary (Mayo Clinic, n.d.);
4 Prescribe vitamins and minerals to prevent micronutrient deficiencies (Mayo Clinic, n.d.).

1 To promote balanced nutrition by the proper patient and caregiver education and track the progress using a food diary filled out separately by the patient and the caregivers every day. The diary shall be reported to the community nurse every week;
2 To prevent extreme body changes secondary to dietary restriction and monitor the changes by doing a general physical examination and laboratory testing once every two to three months, the patient has good progress or monthly if the patient has a poor prognosis.

1 Food rich in micronutrients, carbohydrates, protein, and less fat content
2 A pharmacy near the patient’s home or place of work to easily access medications such as antidepressants, anti-anxiety medications, and appetite stimulants
3 A medical laboratory where the patient can request the examinations necessary to track his nutrient problems
4 Access to clinics where the patient can seek help for his psychol...
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