Choose one case study for your assessment task.
Case Study 1- Candice Hadden
As a RN you have been employed as a case manager for a local NDIS provider. Candice is a 21-year female with Rheumatoid Arthritis. Candice weighs 40 kg and has short stature at 123cm tall. Candice has significant issues of pain and joint inflammation in her extremities and her back. She has had surgery three times to fix foot deformities and hand deformities from the arthritis. Candice has acute episodes of pain as part of her chronic illness life experiences. These acute episodes of pain can be idiopathic, or diet related (she is gluten intolerant). When Candice has acute episodic pain and inflammation related to her condition, her mobility is severely impacted to the point of not being able to independently mobilise or care for herself and hygiene needs. She needs personal assistance with all ADLs and a support person for social access all the time (i.e. she needs someone with her in case she suddenly deteriorates while out in public).
When at her optimal health, Candice works part -time as a support office worker at her local NDIS provider (5 hours per day three times per week). She has a certificate 4 in Business Administration with a disability elective from TAFE. Candice’s mother is her primary carer and her father helps with care as he is working full time. Candice has a NDIS package of care with a carer supporting her for three hours, three times a week for social community access or personal care. Candice has a sister and two brothers (they are quadruplets). Candice is actively involved in a youth group at her church with other young adults when she is well. She enjoys reading, going to the movies and some swimming with support at hydrotherapy.
Candice’s medication prescriptions are as follows:
Oral prednisolone 5mg daily mane, Oral paracetamol 500mg qid, Oral methotrexate 10mg weekly, Subcutaneous Humira 40 mg second weekly, Peppermint capsules (mintec 0.2ml per tablet) before meals.
When she has acute episodic pain her GP reviews and adjust prednisolone to increase her dose for a short period of time (dependant on severity of exacerbation).
Case Study- 2 John Blackwell
You have been employed as Community Case Manager RN for a local community health service.
John is a 65-year-old Italian man with type 2 diabetes with who presented to his GP with difficulties voiding (a slow stream and dribbles) and pain in his lower back. After some medical investigations he was diagnosed with prostate cancer and underwent an urgent radical prostatectomy (with a suprapubic incision to remove some lymph nodes (for cancer screening as well) one week ago. The lymph nodes appeared to have cancer so they were sent for histopathology and testing. The CT scan and MRIs prior to discharge showed the cancer has possibly spread to his sacrum (as there was a suspicious lesion) and he has some suspicious shadowing in the brain. He was commenced on dexamethasone 5mg daily to slow down the spread of the cancer and to help with lower back pain in conjunction with other analgesia. The dexamethasone has impacted his ability to control his blood glucose levels and it has recently risen in the last few days. His BGLs are ranging from 8-14mmol/L but have been as high as 16 mmol/L post operatively in the ward since starting dexamethasone.
He was discharge home this morning from hospital and has received a CHSP (Commonwealth Home Care Support Program) home care package of care which the discharge facilitator from the hospital instigated from the local home care service provider (you are employed by this service). John has temporary IDC, with an out-patients appointment and trial of void (TOV) in 6 weeks. His PICC line is insitu for possible use for chemotherapy and it was dressed yesterday in the ward.
He is scheduled for an oncologist consultation and planning with the oncology nurse early next week after his surgical wound has had a chance to heal. His prognosis is 2-10year life expectancy depending on chemotherapy outcomes, but the doctors are not entirely sure until the frozen sections and histopathology resections (from surgery) results are returned. This usually takes 10-14 days. The doctors have indicated that the chemotherapy is more likely to be used for life prolonging measures rather than seeking a cure.
The family are looking into non-conventional treatment options. John recently retired from the building industry, he lives with his wife and has a large supportive family who live close by. He has four adult sons who are all married with small children. The diagnosis of a life limiting illness has impacted his mental health. He is currently shocked by the diagnosis and has been talking like he is in the denial phase of grief with the pending diagnosis. He stated the tests will come back clear and he will be alright and is looking forward to getting into his garden greenhouse again and getting the lettuce, tomatoes and basil planted as spring is approaching.
He is a current smoker, drinks frequently 8-10 standard drinks a week (mostly red wine and Grappa) and eats a Mediterranean diet. He is 171cm tall and weighs 105kg.
Past Medial History
Type 2 diabetes
Hypertension
Peripheral neuropathy, numbness in feet
Sciatica
Medications
Metformin 1g BD,
Dexamethasone 5mg daily mane
Panadol Osteo 1200mg TDS
Endone 5mg QID PRN as needed for pain for one more week.
Frusemide 40mg BD
Potassium Chlorvescent 1 tablet diluted daily in 150mls of water.
Atacand 16mg Mane
