Nursing care management plan Ben
Nursing care management plan Ben
Assessment HSNS363 Assessment 1
PREPARATION OF GP/NURSING CARE MANAGEMENT PLAN
Patients diagnosis / health needs
Management goals with which the patient agrees
Treatment and services required, including actions to be taken by the patient Arrangements for providing treatment/services
Post-traumatic stress disorder (PTSD)
Continue to engage in regular psychotherapy sessions IAW DVA plan
Engagement with DVA case manager
Attend regular psychotherapy sessions Ensure next visiting psychologist appointment booked (practice staff/practice nurse liaise with community mental health who arrange visits)
Depression
Reduce/remove requirement for medication to manage symptoms
Increase productivity and engagement in enjoyable activities (particularly social activities)
Attend regular psychotherapy sessions
Discuss changes care requirements with psychologist
Increase exercise/physical activity Monthly visiting psychiatrist however access local psychologist in interim due to acute onset of depression (GP referral required)
Chronic lower back pain Complete manual work (or farm) related activities unimpeded
Improve sleep quality (currently woken frequently by discomfort)
Increase ability to exercise to assist with depression/PTSD symptoms Attend Physiotherapy and Orthopaedic (spinal) RV GP and Ben to liaise with DVA case manager. Arrange referral to physio and orthopaedic specialist (Sydney)
Changes to/additional medication requirements:
Recently commenced Sertraline, Ibuprofen, Panadeine Forte and Oxycodone (pain medication PRN).
Adapted from: DoH, Chronic Disease Management (formerly Enhanced Primary Care or EPC) GP services. Resources for providers. Printable version of CDM GPMP sample form for MBS item 721. https://www1.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-chronicdiseasemanagement
Case Study Assessment HSNS363 Assessment 1
BEN
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Ben is a 28-year-old male who has recently returned to Westtown after serving 10 years in the Australia Defence Force. Ben grew up on a farm in the Westtown area and returned to the region to be close to family and to seek employment in the mining sector.
Prior to returning home Bens tasks in the Defence Force were primarily office-based following a training accident 3 years ago which resulted in an L4-L5 spinal fusion and associated medical restrictions resulting from chronic lower back pain. Ben was forced to leave the ADF on medical grounds 9 months ago.
Ben does receive assistance with medical costs from The Department of Veterans Affairs (DVA) in relation to both his PTSD and back injury. Prior to his accident Ben had a very active role in the ADF as an infantry soldier and felt frustrated by the restricted duties due to his injuries. He says he would rather work with his hands than drive a desk.
Ben returned to the care of his childhood GP when he returned to Westtown with whom he has a good rapport. Ben visits the clinic monthly for psychological consultation for PTSD associated with is military service which is paid for by the Department of Veterans Affairs (DVA).
Ben was successful in gaining a job working at the local mine where his role involved driving heavy machinery. Ben enjoyed the role however the long hours of sitting plus the vibration of the heavy earthmoving equipment aggravated his lower back. The mine is above ground and explosives are occasionally used on site. Ben tries to avoid being at work these days as he finds these activities sometimes act as a trigger for his PTSD.
Ben is reluctant to say anything as he was afraid that his medical issues might interfere with his employment. Ben tries to ensure he has a rostered day off when he needs to attend medical appointments so he doesnt draw attention to the same.
For the last 3-4 months Bens lower back pain has been increasing to the extent that the discomfort was affecting his ability to operate at work and also his ability to get adequate sleep at night. Ben is increasingly relying on pain medications to get through the day and get to sleep at night. Ben has been attending the Youbeaut clinic on a regular basis since he commenced work for pain relief. He is currently prescribed Ibuprofen, Panadeine Forte, and if required Oxycodone, all PRN. Bens GP has referred him to the local Physiotherapist which is covered by DVA.
Six weeks ago, Ben was forced to take sick leave due to his discomfort. He was unable to operate heavy machinery due to the lower back discomfort and the requirement to take Endone for pain relief. During this time Ben was notified that after being employed at the mine for only 6 months Ben has been laid off due to downsizing associated with lower commodity prices.
Ben has been unable to find employment in town as a result of the economic downturn associated with the ongoing drought in the area. As a result, Ben has had to move back to the family farm with his parents. The farm is located 25km from Westtown and the nearest neighbours are 5km away.
Ben is used to having a close network of friends and has enjoyed living in town particularly socialising with old friends and with the younger members of the mining workforce. Ben likes to unwind with a few beers at the end of the week which he used to relieve the stress and help him forget about his problems. Ben is finding that the amount of alcohol he is consuming during these sessions and the frequency with which he is drinking alcohol is increasing since he was laid off at the mine.
He is reluctant to move back to the farm as all of his siblings have moved away and he has a tenuous relationship with his father (Doug) who is himself struggling with the psychological impacts of the drought. Doug has low health literacy in relation to the benefits of psychological therapy (or a willingness to engage the same). His attitude has always been to toughen up and get on with it. Ben has a good relationship with his mother (Mary) although she is a reserved character who doesnt like conflict and tends to not discuss these issues for fear of Ben or Doug getting upset.
Ben has been receiving psychological treatment focused on cognitive behavioural therapy for several years with good effect. He has a high level of health literacy in relation to these practices and to date he has been happy to engage as he has found it very beneficial.
That said, events over the last 6 months have led to him feeling increasingly depressed. Ben has commenced treatment with a local psychologist in addition to the regular monthly psychiatrist appointments. Despite this, his depression has continued to escalate over the last few months and at his most recent psychiatrist appointment his specialist suggested he commence medication to help control his depression.
Apart from the psychological strategies Ben uses to deal with his PTSD and depression he finds exercise very useful in managing his symptoms. Ben has a membership to one of the Gyms in town however has not been attending regularly lately due to his back discomfort. Now that he is back living with his parents the distance makes it difficult to attend regular.
Discuss the elements of Bens medical history that contribute in him being classified as medically complex.
Ben had spent the last ten years serving in the Australian Defence Force (ADF), he was forced to leave after he had suffered a workplace injury resulting in a L4-L5 spinal fusion causing lower back pain and many medical restrictions.
Ben is suffering with post traumatic stress disorder (PTSD) as a result of his time in the ADF, he is seeing a psychologist currently.
Ben used to be extremely active but is now limited because of his injury; he has a referral to a physiotherapist and used to go to the gym, which helped with his discomfort, but now finds the distance too much since moving back in with his parents. He's been referred to a physiotherapist and an orthopaedic specialist in Sydney, which is a long way from Westtown.
Bens back pain has been increasing lately, he is requiring the use of extra pain relief to get him through the day. He prescribed Ibuprofen, Panadeine Forte, and if required Oxycodone, all PRN. Due to his increased pain when operating machinery in the mines and taking oxycodone, Ben was fired from his job and has been unsuccessful in gaining another job.
Ben finds himself drinking more alcohol now that he is unemployed.
Post-traumatic stress disorder (PTSD) is the most common psychiatric disorder that develops after witnessing a traumatic event (National Institute of Mental Health, 2019). Although Ben is currently seeking psychiatric help, it is clear that PTSD has a significant impact on Ben's daily life, as he attempts to avoid certain days of work that trigger him. As a result of this Ben has been prescribed an anti-depressant medication sertraline.
In addition to PTSD, Ben is also suffering with chronic pain which has been known to contribute to a persons wellbeing, mental health and day to day life. Chronic pain can have an effect on someone's ability to work, which then affects their ability to earn an income and leaves many homeless, just like Ben, who was forced to move back home with his parents when he lost his job after ten years away, which would also have an effect on his mental health.
Medical complexity is defined as the presence of multiple organ systems affected by chronic health conditions, functional restrictions, ongoing reliance on medical technology, and high resource requirements (Kuo & Houtrow, 2016). Other elements that can complicate someones physical state include life stressors, social setting, and behavioural problems, all of which can have an impact on health and class someone as medically complex (Kuo & Houtrow, 2016).
In Bens case, he is taking multiple pain medications and antidepressants due to his back injury, chronic pain, and PTSD, all of which contribute to variables in his life; he also has a lack of services in his remote town, which impacts his chronic conditions, therefore Ben is deemed to be medically complex based on each of these factors (Cohen et al., 2021).
Consider Bens situational complexity. Identify and discuss how these factors may create barriers to Nursing management.
Ben is currently 25km from Westtown, a rural town where his closest neighbour is 5km away. Prior to returning to Westtown to be with his family, he was going to the local gym, which he believed was helping his lower back pain.
He no longer has access to a gym as he now lives in a rural town, and he is experiencing increased pain, so he is relying on opioid medications to relieve it; continued opioid use has been linked to opioid dependence and other medication addictions, which could make Ben's nursing management of his pain and other conditions difficult (Sadiq et al., 2020). One of Bens pain medications; oxycodone, is an opioid that is typically only used for short-term pain relief; a medication fact page warns users not to drink alcohol or operate heavy machinery while taking oxycodone, both of which Ben has been doing (South Australia Health, 2021).
Ben's PTSD is still relatively new, he only receives monthly psychological consultations. Ben might benefit from more frequent psychological consultations or another method of dealing with his PTSD. Ben should be entitled to additional mental health consultations as the ADF has provided approximately $146 million to improve the mental health care programme and services over the last few years (Binskin, 2015). The lack of mental health appointments may be due to Ben living in a rural area with a limited number of psychologists and a high demand for patients needing to be seen; this may have an impact on Ben's nursing management of PTSD.
Provide a brief discussion relating to how multimorbidity impact diagnosis and treatment for complex patients.
According to Navickas et al (2016) the definition of multimorbidity is the co-existence of two or more chronic illnesses.
The implications of multimorbidity have been found to be extensive and detrimental as people with many morbidities often experience early death, frequent hospitalisations, extensive hospital stays, and numerous medical visits each year (Navickas et al., 2016).
