The patient suffered from an exacerbation of her once stable illness. Her husband was accurate in his description of the proper care. The clinic staff is surprised that this exacerbation occurred. This scenario repeats: The patient returns again after discharge with the area slightly larger but healing well. She is again on oral antibiotics, and care is reviewed with her husband. They are educated on the need to contact the office for any increase in redness, warmth, or drainage. They express understanding. To be certain there are no further issues with caring for the wound, home health nursing is scheduled to follow up in 48 hours. The home health nurse calls after the visit to update the provider on findings. She arrived at the home, which is a small wooden house heated by a wood stove. The air is blowing through the single pane glass, and the curtains are moving in the draft. There is no running water in the winter because there is minimal insulation and the pipes freeze. There is a creek/pond that is used to bring water up to the house for dishes, bathing, and toileting. This is the water that has been used to clean the wound. The patient has only the amount of antibiotics she was discharged with—three tablets—and they are unable to afford the medication to complete the course. The only beverage is coffee, which they make with boiled water, and other than some eggs and a few canned goods, the only food is instant noodles and oatmeal. Case Study Question #3 What systemic intervention could be implemented by the hospital system to prevent similar readmissions from occurring? a. Discharging patients to a nursing home instead of home. b. Completing an evaluation of social determinants of health in the hospital. c. Completing a home visit before discharging patients home. d. Purchasing antibiotics for patients. Answer : b Rationale : Although all the interventions would have helped to prevent Marlene’s readmission, these patient- specific interventions would assist only in this particular situation without addressing underlying issues. Evaluating social determinants of health in the hospital prior to discharge would help bring light to underlying issues that may prevent optimal healing when the patient is discharged. Once the lack of running water was discovered, the primary care provider held a family conference to discuss options. In this particular situation, the best option was admission to a nursing home because of the inability to provide safe care in the home environment and the inability to perform self-care related to decreased mobility. health outcomes are less favorable for individuals of lower socioeconomic status; racial and ethnic minorities; and those residing in areas with inadequate infrastructure, limited access to healthcare, education, and employment opportunities, as well as higher rates of crime or environmental hazards, whether urban or rural.
reactions. The area is measured and redressed. Her husband is able to appropriately review the application of the topical ointment and dressing. She is scheduled to return to the clinic in 1 week. Based on this brief summary, we know that the patient has multiple risk factors that can influence her health. She is morbidly obese with a chronic disease (hypertension) and is prediabetic, lives in a rural area, has decreased mobility with intermittent edema, and has already had a hospital admission for cellulitis. She has less than a high school education and lives with her husband, who collects disability, and with their daughter. The good news is that she has family support. Her husband is involved in her care, her wound is healing nicely, she is having no reaction to the medication, and she is able to return in a week for follow- up. Instructions have been reinforced, and both Marlene and her husband appear to understand them. Case Study Question #1 Individuals with less education are more likely to report all the following EXCEPT: a. Poor health. b. Chronic disease. c. ADL or IADL limitations. d. Higher income. Answer : d Rationale : Individuals with low education are more likely to obtain low-paying jobs and report poor health, chronic disease, or ADL or IADL limitations. Case Study Question #2 Social support is important in the lives of the aging population. For the aging population, quality social networks with social support help to: a. Keep them safe. b. Delay the onset of dementia. c. Positively predict physical and mental health. d. Decrease the risk of chronic disease. Answer : c Rationale : Quality networks of social support are believed to increase a sense of physical and mental well-being. One week later, Marlene returns to the clinic for additional care. She has a low-grade fever of 100.2 degrees F and appears flushed. Her heart rate is elevated at 105 beats/min. She describes some chills, and her husband says that “the leg was feeling a little hot.” The wound is undressed and has extended in size from the last visit. It is red and warm, and the erythema is now extending away from the wound margins and spreading up her calf. The wound specialist is called and agrees to see her later that day in his clinic. The clinic receives a call that Marlene has been admitted and cultures are pending. Conclusion Research has shown that socioeconomic factors, environmental conditions, and health-related behaviors determine up to 80% of a person’s health (Tiase et al., 2022). The five social determinants of health have been increasingly recognized as important contributors to health, chronic disease, and patient outcomes. Currently,
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Book Code: MTX1326
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