Case study – 9 questions, 3 sentences each

3 sentances for each question. APA format and each questions needs 1 citation.Case Study: Helen Wright In a small college town, Susan Cooper, the nurse coordinator for the medical home initiative in a local primary care provider’s office, assess a new client. The nurse introduces herself and goes over the intake form with Helen Wright to plan for her care management. Ms. Wright was referred by the local ED because of repeated visits and complains of “no one caring” for her or her well-being. The ED staff voiced concern for Ms. Wright, because she is estranged from her family, lives by herself, and has a long history of bipolar disorder. Ms. Wright’s recent visits to the ED center on vague somatic complaints, and she often leaves before being seen by the doctor, stating that they are wasting her time and what is the point?1. What is a key benefit of medical home models for care coordination? Use the following link for assistance: www.commonwealthfund.org/publications/from-the-pre… (Davis, Abrams, & Haran, 2009).2. Because of the referral information, what should the nurse assess in Ms. Wright’s initial appointment?Nurse Susan reviews Ms. Wright’s chart and finds she is a 72-year-old widow who has lived in the same house for the past 40 years. Her husband died 7 years ago. Ms. Wright states her health has been poor, especially since she was recently diagnosed with diabetes. The ED report indicates her type 2 diabetes is well managed, along with her hypertension. Her clinical notes indicate that she often displays attention-seeking behaviors with vague physical symptoms. She reports taking Ambien (zolpidem) 10mg as needed at bedtime, due to an inability to sleep; Remeron (mirtazapine) 15mg at bedtime; Prozac (fluoxetine hydrochloride) 20mg daily, admitting she sometimes forgets to take the morning dose, so sometimes she takes it in the afternoon or evening; Lithium 600mg three times a day; Xanax (alprazolam) 0.5mg as needed for anxiety; Glucophage (metformin) 500mg twice a day with meals; and Calan (verapamil) 240mg daily. Her hemoglobin A1C is 6.5, her morning fasting blood sugar was 112, her lithium level is 1.0, and her blood pressure is 118/74. Ms. Wright states her children are ungrateful and refuse to visit her. Notes on her chart indicate that family members have been present at ED visits in the past, but Ms. Wright is verbally abusive and her mood is labile at times.3. What are common symptoms that the nurse should screen for with depression in Ms. Wright?4. What additional information would the nurse assess to determine suicide risk?5. What protective factors could help reduce suicide risk?Ms. Wright has a flattened affect and makes poor eye contact; she is oriented to person, place, and time. She reports difficulty sleeping at times and anxiety when she is unable to fall asleep. The nurse notes Ms. Wright is well-groomed and has a body mass index (BMI) of 23 with appetite 5-foot 2-inch frame. Ms. Wright has no limitations with her range of motion and states that she goes to the grocery store weekly. She states she used to attend church, but no longer attends because “those old cronies are just busy bodies.”6. What areas should the nurse probe in more detail to assess suicide risk with Ms. Wright?7. How should the nurse approach asking whether Ms. Wright is having suicidal thoughts?Nurse Susan asks, “How do you feel about living by yourself?” Ms. Wright crosses her arms and says, “Well I am fine, what a silly question . . . my family says I am not easy to live with, because some days I am up, but most days I am down. They get tired of listening, so now I am just tired of living.” Ms. Wright reports to Susan that she feels passive about suicide and denies having a plan. She states she had attempted suicide about 20 years ago by overdosing on her medications; however, she denies a current suicide plan, stating she knows that would be wrong.8. What type of safety plan should the nurse establish with Ms. Wright?Ms. Wright agrees to enter into a verbal contract and see the social worker at the practice to establish a mental health care plan, along with managing her diabetes and high blood pressure with the primary care doctor. Nurse Susan gives her a hotline number that is available 24/7, should Ms. Wright feel alone and want someone to talk with: National Suicide Prevention Lifeline at www.suicidepreventionlifeline.org; 1-800-273-TALK (8255).The nurse takes this opportunity to review Ms. Wright’s medications and develop a medication therapy management (MTM) plan to improve her care outcomes (Cooper & Burfield, 2007). The nurse reminds Ms. Wright to take her lithium after meals with plenty of water to reduce stomach upset, and to have her lithium level checked monthly.9. Ms. Wright’s medication put her at the highest risk for which of the following? Select all that apply.a. Neurotoxicityb. Fallsc. Constipationd. bradycardiaNurse Susan recommends a medication review by the clinical pharmacist and with the care planning team at their clinic. Susan explains that she has concern about the combination of her medications and the risk of medication interactions and her risk of falling. The nurse explains that her Prozac should only be taken first thing in the morning, as this medication can cause excitability, making it difficult to go to sleep if taken too close to bedtime. Ms. Wright verbalizes an understanding of her medications and agrees to return for further coordination of services. Ms. Wright states she feels much better having someone to talk to and knowing she can come to this one location and access all her care.Suggested ResourcesCenters for Disease Control and Prevention. (2012). Web-based inquiry statistics query and reporting System (WISQARS). National Center for Injury Prevention and Control CDC Web site. Retrieved From http://www.cdc.gov/injury/wisqars/index.htmlCooper, J. W., & Burfield, A. H. (2007). Medication therapy management (MTM) strategies for geriatric patient interventions: Medicare part D implementation. Annals of Long-Term Care: Clinical and Aging, 15(7), 33-38.Davis, K., Abrams, M. K., & Haran, C. (2009). Can patient-centered medical homes transform health care Delivery? The Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/ publications/from-the-president/2009/can-patient-centered-medical-homes-transform-health- care-delivery
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Case Study: Helen Wright
In a small college town, Susan Cooper, the nurse coordinator for the medical home initiative in a
local primary care provider’s office, assess a new client. The nurse introduces herself and goes over the
intake form with Helen Wright to plan for her care management. Ms. Wright was referred by the local
ED because of repeated visits and complains of “no one caring” for her or her well-being. The ED staff
voiced concern for Ms. Wright, because she is estranged from her family, lives by herself, and has a long
history of bipolar disorder. Ms. Wright’s recent visits to the ED center on vague somatic complaints, and
she often leaves before being seen by the doctor, stating that they are wasting her time and what is the
point?
1. What is a key benefit of medical home models for care coordination? Use the following
link for assistance: www.commonwealthfund.org/publications/from-thepresident/2009/can-patient-centered-medical-homes-transform-health-care-delivery
(Davis, Abrams, & Haran, 2009).
2. Because of the referral information, what should the nurse assess in Ms. Wright’s initial
appointment?
Nurse Susan reviews Ms. Wright’s chart and finds she is a 72-year-old widow who has lived in
the same house for the past 40 years. Her husband died 7 years ago. Ms. Wright states her health has
been poor, especially since she was recently diagnosed with diabetes. The ED report indicates her type 2
diabetes is well managed, along with her hypertension. Her clinical notes indicate that she often displays
attention-seeking behaviors with vague physical symptoms. She reports taking Ambien (zolpidem) 10mg
as needed at bedtime, due to an inability to sleep; Remeron (mirtazapine) 15mg at bedtime; Prozac
(fluoxetine hydrochloride) 20mg daily, admitting she sometimes forgets to take the morning dose, so
sometimes she takes it in the afternoon or evening; Lithium 600mg three times a day; Xanax
(alprazolam) 0.5mg as needed for anxiety; Glucophage (metformin) 500mg twice a day with meals; and
Calan (verapamil) 240mg daily. Her hemoglobin A1C is 6.5, her morning fasting blood sugar was 112, her
lithium level is 1.0, and her blood pressure is 118/74. Ms. Wright states her children are ungrateful and
refuse to visit her. Notes on her chart indicate that family members have been present at ED visits in the
past, but Ms. Wright is verbally abusive and her mood is labile at times.
3. What are common symptoms that the nurse should screen for with depression in Ms.
Wright?
4. What additional information would the nurse assess to determine suicide risk?
5. What protective factors could help reduce suicide risk?
Ms. Wright has a flattened affect and makes poor eye contact; she is oriented to person, place,
and time. She reports difficulty sleeping at times and anxiety when she is unable to fall asleep. The nurse
notes Ms. Wright is well-groomed and has a body mass index (BMI) of 23 with appetite 5-foot 2-inch
frame. Ms. Wright has no limitations with her range of motion and states that she goes to the grocery
store weekly. She states she used to attend church, but no longer attends because “those old cronies
are just busy bodies.”
6. What areas should the nurse probe in more detail to assess suicide risk with Ms. Wright?
7. How should the nurse approach asking whether Ms. Wright is having suicidal thoughts?
Nurse Susan asks, “How do you feel about living by yourself?” Ms. Wright crosses her arms and
says, “Well I am fine, what a silly question . . . my family says I am not easy to live with, because some
days I am up, but most days I am down. They get tired of listening, so now I am just tired of living.” Ms.
Wright reports to Susan that she feels passive about suicide and denies having a plan. She states she had
attempted suicide about 20 years ago by overdosing on her medications; however, she denies a current
suicide plan, stating she knows that would be wrong.
8. What type of safety plan should the nurse establish with Ms. Wright?
Ms. Wright agrees to enter into a verbal contract and see the social worker at the practice to
establish a mental health care plan, along with managing her diabetes and high blood pressure with the
primary care doctor. Nurse Susan gives her a hotline number that is available 24/7, should Ms. Wright
feel alone and want someone to talk with: National Suicide Prevention Lifeline at
www.suicidepreventionlifeline.org; 1-800-273-TALK (8255).
The nurse takes this opportunity to review Ms. Wright’s medications and develop a medication
therapy management (MTM) plan to improve her care outcomes (Cooper & Burfield, 2007). The nurse
reminds Ms. Wright to take her lithium after meals with plenty of water to reduce stomach upset, and
to have her lithium level checked monthly.
9. Ms. Wright’s medication put her at the highest risk for which of the following? Select all
that apply.
a. Neurotoxicity
b. Falls
c. Constipation
d. bradycardia
Nurse Susan recommends a medication review by the clinical pharmacist and with the care
planning team at their clinic. Susan explains that she has concern about the combination of her
medications and the risk of medication interactions and her risk of falling. The nurse explains that her
Prozac should only be taken first thing in the morning, as this medication can cause excitability, making
it difficult to go to sleep if taken too close to bedtime. Ms. Wright verbalizes an understanding of her
medications and agrees to return for further coordination of services. Ms. Wright states she feels much
better having someone to talk to and knowing she can come to this one location and access all her care.
Suggested Resources
Centers for Disease Control and Prevention. (2012). Web-based inquiry statistics query and reporting
System (WISQARS). National Center for Injury Prevention and Control CDC Web site. Retrieved
From http://www.cdc.gov/injury/wisqars/index.html
Cooper, J. W., & Burfield, A. H. (2007). Medication therapy management (MTM) strategies for geriatric
patient interventions: Medicare part D implementation. Annals of Long-Term Care: Clinical and
Aging, 15(7), 33-38.
Davis, K., Abrams, M. K., & Haran, C. (2009). Can patient-centered medical homes transform health care
Delivery? The Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/
publications/from-the-president/2009/can-patient-centered-medical-homes-transform-healthcare-delivery

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