Ethical/legal/social/political isssues
What are some barriers you can foresee for Dolly's care and treatment?
Transportation, living alone, financial coverage, lack of support, caregiver burnout (from mother), adherence to medication regimen, intellectual disability, comorbidities.
This nurse is responsible to make sure Dolly understands her medications and their timing and that she has a med card to reference at the time of discharge.
Bedside RN.
When Caring for Dolly after her transplant what intervention can help reduce anxiety and improve Dolly’s outcome for success?
Schedule a plan to meet with mental health physician frequently now post-transplant. Dolly’s anxiety is increasing and we need to assess Dolly for Depression. Some side effects of anti-rejection medications may also cause depression/anxiety. Anxiety and depression are common following kidney-transplant ("Care after transplant," n.d).
According to the Ramsey County Community Health Assessment (Ramsey County, 2018a), Ramsey County has the average expense of healthcare for someone with chronic kidney disease (CKD) in the metro region. HealthyPeople 2020 benchmark indicator is to reduce the proportion of population with CKD. As nurses, what can we do at a community or systems level to promote improvement in this area?
Come together and meet with community partners, policy makers, and Ramsey County Leadership to advocate
Join support groups or create our own support groups
Educate community by decreasing and/or managing modifiable risk factors such as DM, HTN, smoking, diet.
Inform of resources available
Encourage healthy socialization
Dolly wants her boyfriend to assist her with her cares post-transplant. Considering he just relapsed, how might this elicit different responses among nursing caregivers?
Nursing staff want to encourage family and spouse support and may not want to alienate Dolly from Willie
Nursing caregivers may be concerned about Dolly’s safety with Willie drinking again
Dolly has complex needs and Willie may be unable to meet those needs while drinking
May be difficult to educate Willie while he is under the influence
Worry about Dolly’s mental health as it relates to Willie’s choices
True or False:
Dolly having Down Syndrome can affect her survival rate post-kidney transplant
False
A study by Marten, Jones, and Reiss (2006) showed that the survival rate of people with an intellectual disability (ID) post-kidney transplant was the same as the overall national survival rate, 90%. People with ID may require more assistance managing their healthcare, but they does not correlate with a decreased success rate following transplants.
Nurse who could assist with concern about medication administration complexity.
Homecare nurse.
What interventions will we consider in infection control plan to address Dolly’s risk for infection in discussion with transplant team?
Educating on washing hands frequently (convenient hand sanitizer on hand)
Food safety
Wearing a mask while in public (prevention of respiratory infection)
Monitoring/wound education for Dolly along with wound care nurse
Prophylactic antibiotic therapy (pros vs. cons)
In home nurse
After, transplant, patients take immunosuppressive medications to prevent graft vs host disease. The suppression of the immune system makes it difficult to fight infection your risk is highest one to six months after transplant. Food safety is a major concern for those post-transplant on immunosuppression ("infection control post-transplant," 2019, p. 1).
True or False. Adults caring for adult children with disabilities and further health conditions are more likely to have increased rates of depression, divorce, socialization, functional status, and financial security.
What is False. Increased rates of depression and divorce. Decreased socialization, functional status, and employment.
Dolly’s family suggested home care to help Dolly manage her increased medical needs. How might this option stimulate different responses from nursing caregivers?
Nurses will want to support Dolly’s autonomy and ability to care for herself
Assess Dolly’s needs and determine if it is appropriate for her to continue her medical cares independently
Home care might allow Dolly assistance with would care and difficult medication regimen
Might eliminate some appointments and allow Dolly to receive care from home vs. travelling
Offers additional education opportunities and a new support system post-transplant
How can we, as Dolly's consulting nurse, help Dolly over come these barriers?
Connect her with transportation (i.e., metro mobility), home health aid to help with wound care and medication regimen, therapy to help manage stress and anxiety, provide emotional support for Dolly, connect Dolly with social services to help financially (i.e., medical assistance).
Best referral if Dolly's incision became infected and needed additional care.
Wound care nurse.
What interventions can be implemented to help family’s ability to help succeed with successful transplantation?
Assess mom, sister and neighbors ability to participate in care plan
Develop a communication plan amongst caregivers and Dolly
Assess families coping strategies and ability to get home health aid for Dolly’s mother to help alleviate stress of caring for her husband
Assessing community support system to aid in grocery shopping and other errands for family and Dolly/help Dolly with Daily checklist and staying organized (church) in home.
Support Dolly’s relationship with her father
Measures of parent and family functioning were associated with several important health-related factors, such as medication adherence, readiness for discharge, and number of hospitalizations (Cousino, 2017).
Per Schoon, Porta, & Schaffer (2019), working with Dolly and her family to identify services in their community that they can use to help them be successful in coping with their adjustment is an example of this type of intervention.
What is case management?
List three different ways technology be used to assist with nursing cares and Dolly’s health status?
Online education resources (National Kidney Foundation, transplant living)
Online support groups
Alarms and phone reminders to help Dolly to remember to take her medications at the appropriate time
Imaging
Laboratory blood testing
Electronic Health Record (EHR)
Telehealth
This prohibits disability-based discrimination by doctor's offices, state-run hospitals, and organizations that receive federal funding.
What is The Americans with Disabilities Act
Who could be called if there appears to be continuous outbreak of communicable diseases in Dolly's high-rise apartment.
Public health nurse.
What community resources can we utilize to ease the burden on Dolly and her family?
What community resources can we utilize to ease the burden on Dolly and her family?
Online grocery delivery services
Meals on wheels to help Dolly and mother/father with at least one meal per day
Utilizing delivery EBT grocery service with small delivery fee
Church resources near Dolly’s place ( free nightly meals on certain days at Creekside community center)
VEAP has plenty of community resource referrals for those with DDs in every situation and it is all for Minneapolis
Salvation Army for help with utilities
To help ensure that patients have successful transplant surgery outcomes, it's important ... online support services, educational resources, and community-based interventions increase overall success ("Caring for transplant patients," 2019).
Using the Web of Causation, report two nursing interventions that can assist Dolly in gaining long-term successful treatment.
Educate on and Implement self-care activities
Hold family care conference and discover current family roles
Collaborate with wound nurse visit
Collaborate with transplant coordinator
Assign designated transporter and backup.
Assist patient in filling out metro mobility form
Refer to supportive community resources
Name 4 appropriate referrals that can be made for Dolly post-transplant.
Support groups for transplant patients
Transplant physician
Clinical transplant coordinator
Transplant pharmacist (Help Dolly navigate new medication regimen)
Transplant social worker (assess Dolly’s new needs post-transplant)
Transplant dietician
Financial counselor (help with insurance benefits and billing)
Mental health (assess increased anxiety)
Home health care
Wound care
Infectious disease (assess wound for possible infection)
Considering that Dolly has down syndrome, what are some diseases that she is at an increased risk of having?
Respiratory failure, dementia, epilepsy, heart failure, and pneumonia
Best contact for Dolly if she is confused about the timing and frequency of her meds.
Transplant coordinator.
What will be the most important component in coordinating plan of care and scheduling for Dolly to be successful?
Communication with team and Dolly’s ability to stay in communication and communicate using electronic methods should be evaluated thoroughly.
Communication in a healthcare setting is one of the most important tools we have for providing great patient care and improving patient satisfaction. ... They are expected to speak with the patient, determine his or her needs, and solve problems, all in a proactive manner ("Communication," 2018).
Chocolate.
Pick another
A new technology that promotes adherence to medication regimen in kidney transplant patients by monitoring medication ingestion.
Ingestible Sensor System (ISS) for kidney transplant patients