Discussion: Patient–centered care planning.

Discussion: Patient–centered care planning.

Discussion: Patient–centered care planning.

In this simulation, you will be choosing a patient, conducting a short interview, and then assembling a concept map for use in that patient’s care plan.

Overview

You are a nurse at the Uptown Wellness Center. As you begin your shift, you get an email from the charge nurse. Click on the icon to read it.

Good morning,

We have two new patients coming in today.

First is Keith Rogers; he is a young man with a recent HIV diagnosis. He has described his living situation as unstable, and he has not begun treatment for HIV.

The other is Carole Lund. Carole is a new mother who had gestational diabetes during her pregnancy. She has continued to track her blood glucose postpartum, and is worried that it does not appear to be stabilizing.

Please review the attached patient profiles and decide which you’d like to take on today. When you’ve decided, talk to your patient and start planning his or her care. Thanks!

— Janie Poole

Keith Rogers Patient with HIV

Overview Reason for Referral: Keith is an 18–year–old African American man, and a recent high school graduate. He has HIV but has not been in treatment.

Situation: Although he has known his HIV status for some time, Keith is here today seeking treatment for the first time. He came alone on a city bus, and he doesn’t have a state–issued ID or insurance information, although he says he does have health insurance.

Interview:

7/16/19, 9(24 AMEvidence-Based Patient-Centered Care Transcript

Page 2 of 4https://media.capella.edu/CourseMedia/MSN6011/evidenceBasedPatientCenteredCare/transcript.html

How long have you known you were HIV–positive? Since this summer. They had one of those trucks outside GG’s where you can get tested for free. GG’s, that’s our club. So me and Nick, we go get the test and it was positive.

They gave us these pamphlets after, but I can’t leave stuff like that around the house. My folks didn’t know about me and Nick. So I trashed those pamphlets on the way home. That was…like six months back I guess.

Since you haven’t been in treatment, have you been doing other things to protect your health? Yeah. So here’s the thing about that. Nick says he read on the Internet that meth is supposed to help. Like methamphetamines. And you don’t have to do very much and it slows it down so you don’t get sick as fast, but doctors can’t prescribe it because it’s illegal. So we tried that. Nick thinks it’s working, but I don’t know, man. It makes my heart beat real fast and that freaks me out.

He’d be mad if he knew I told you that, like maybe someone’s gonna show up at the house and bust us. I guess I don’t care anymore. Discussion: Patient–centered care planning.

At intake you described your living situation as “unstable.” Can you tell me more about that? I’m at Nick’s right now. Mom threw me out of the house. I was…like, trying to find a way where I could get a test that wasn’t in front of a gay club, right, cuz…my folks just ain’t ready for that much truth, you know? So we’re at the clinic, and I get the test, and they call Moms in because technically I’m still a minor at that time, and we’re talking with the nurse or whoever and it just kinda comes out. How I got it. She hit the roof.

I don’t think that’s why she threw me out, though, even though at church they say it’s a sin. She’s scared. Everyone is scared. I got little sisters at home, Alexa and Marnie, and we only got one bathroom. It’s like…maybe I’m allowed to go ruin my life and they still love me and pray for me, but if I gave it to the girls…that they could never forgive.

So I’m sleeping on the couch at Nick’s place. His folks don’t want us sharing a bed, but they feed me and stuff. I don’t even know if Nick told them what’s up, so I just keep my mouth shut. If we break up over this, I’m in so much trouble.

What do you feel is the most important thing we can do to help you right now? Well. I have like five hundred dollars in the bank that I got for my birthday, but HIV drugs have gotta cost more than that. I’m under Dad’s insurance still, until I’m 25 I think. But I remember when my sisters were born it was so expensive anyway, and I’m scared that if the insurance company finds out, like…I have a terminal illness…that’ll just bankrupt the whole family. I can’t do that to them.

So I guess the first thing is, like, can you help me figure out how to do this without hurting anybody?

Carole Lund Patient with Diabetes

Overview Reason for Referral: Carole Lund is a 44–year–old woman of mixed Native American and European descent, and a new mother. She is concerned that she is not recovering from gestational diabetes.

Situation: Carole is here with her daughter, Kassandra, who is 10 weeks old. Carole was diagnosed with gestational diabetes at week 30 of her pregnancy. She has carefully logged her blood glucose since the diagnosis, and it shows 150–200 fasting, over 200 following meals.

Interview:

7/16/19, 9(24 AMEvidence-Based Patient-Centered Care Transcript

Page 3 of 4https://media.capella.edu/CourseMedia/MSN6011/evidenceBasedPatientCenteredCare/transcript.html

What diabetes treatments did you receive during your pregnancy? Well, they gave me a glucometer, so I started using that. I could see right away that the way I was eating was a problem; I would usually work straight through the day and then have one big meal in the evening, and that was making my numbers bounce all over. So I set alarms on my laptop, so three times a day I would get interrupted, have a small meal, take a short walk, and then test my blood sugar. That helped. And then I stopped drinking juice and soda, which I should have done years ago, and that helped too. But I don’t think my numbers improved as much as my OB/GYN wanted them to, but she said my blood sugar should return to normal after delivery.

Did your obstetrician advise you to take insulin during your pregnancy? She did, yeah, and we talked about it. I don’t like the idea of being dependent on a drug. I called my mother. She’s still on the reservation, so she called the elders, and we all agreed that injecting my body with an animal hormone was a bad idea. But then the doctor told me that they make synthetic insulin now, but that means it’s made in a laboratory somewhere, and I’m not sure that’s any better.

By then I was in my third trimester, and all the tests said Kassandra was big but healthy, so I thought we would just ride it out. It was supposed to clear up after she was born. But it hasn’t, and I know you have to be careful having a baby at my age. I want to do what’s best, but I don’t want to believe that insulin is my only option.

Are there any challenges in your life which you think may be interfering with your ability to follow a treatment plan? It’s harder now than it was before she was born. It’s just the two of us in the apartment, which is wonderful, but I don’t remember the last time I had a good night’s sleep. A lot of my work is freelance, so I make my own hours, but that also means if I’m not working I don’t get paid. I had family help while I was recovering from the C-section, and they helped cook healthy meals for me, and kept me on my schedule. Now it’s all on me — work, caring for my daughter, and managing my blood sugar. If I fall behind on anything, it will be looking after my health.

Do you have any other concerns you’d like to have addressed? I worry about Kassandra. She’s healthy and perfect, but I know that she’s at a greater risk for developing Type 2 Diabetes. I want to do whatever I can to reduce that risk, to care for her, and as she grows, to teach her how to care for herself. Discussion: Patient–centered care planning.