Develop a plan of care for Frank, which include these four medical conditions

Introduction:Clients in rural areas tend to have an overall poorer health status than their urban counterparts and are more likely to have one or more of the following chronic conditions: heart disease, chronic obstructive pulmonary disease, hypertension, arthritis and rheumatism, diabetes, cardiovascular disease, and cancer. Despite the high prevalence of chronic health conditions, rural adults are less likely to seek medical care than urban adults, and older rural adults have more difficulty maintaining independence due to lack of services and staff (Bushy & Napolitano, 2018)Scenario:As a new public health nurse, you are requested to conduct a routine home visit to see Frank, a 76-year-old Hispanic man, who has been a client of the Public Health Service for three years. He lives in a 950 sq. ft. one-bedroom, one-bath house in a small, coastal town in Texas (population = 3,000). Since Frank has Veterans Administration (VA) health care benefits, he sees a doctor when he needs to, but not on a regular basis. He says his only complaint is being tired all of the time, which he says is because he doesn’t sleep well at night. Frank adds that he takes frequent naps during the day as he just cannot stay awake. He has a history of poorly managed diabetes mellitus, which resulted in a below-knee amputation of his left leg six years ago. Frank is 5’9″ tall and weighs 297 pounds. He used to smoke two packs of cigarettes per day, but now only smokes half a pack because it is too difficult to turn off the oxygen. His lifetime pack year history is almost 100 pack years (40 cigarettes per day divided by 20 cigarettes × years smoked). He says that he drinks a six-pack beer every day, but only after 5:00 p.m. For his family history, his father died from a heart attack at age 67 and his mother died when she was 89. He does not have any siblings. Frank is divorced and has two children who are married—his son lives in Dallas and daughter lives in Houston. He talks to them about once a month on the telephone. He adds that they want him to move to Houston to be close to his daughter, but he doesn’t want to leave the small community where he knows everyone and can get around. He is in a wheelchair and has oxygen delivered via nasal cannula at 2 L/minuteInitial physical examination reveals blood pressure to be 168/92, pulse 102, and respiratory rate 26. HEENT—head, eyes, ears, nose, and throat—examination is unremarkable, and lungs reveal decreased breath sounds. Cardiac examination is normal, and abdominal examination reveals the presence of an obese abdomen without any other gross abnormalities. The patient has 2+ pitting edema on the right lower extremity to mid shin. His skin is intact without any signs of breakdown or rash. His stump is pink and blanches easily. He has diminished sensation in the right foot, with complaints of numbness. Pedal pulse is faint but palpated.A review of his medical records shows that he has been diagnosed with diabetes mellitus type 2, alcohol-related cirrhosis, chronic bronchitis, and hepatitis C.You talk to Frank about his options for transportation, noting one of the local churches has a volunteer program that offers free rides for elders to get to health care appointments. Frank states that he would be interested in exploring that option for future appointments.You recognize that outcomes will be greatly improved while working with Frank if you can form a partnership with him, based on mutual respect and involvement in his plan of care. You know you need to develop a plan of care and recognize that Frank is the determining factor in whether the plan will succeed or fail as he is in control. You want to partner with Frank to provide compassionate and coordinated care and interventions based on respect for Frank’s preferences, values, and beliefs. You review his medical records again, remembering he has four medical conditions: diabetes mellitus type 2, alcohol-related cirrhosis, chronic bronchitis, and hepatitis C. As you develop a plan of care for Frank, you include these conditions in his plan of care.After assessing the client, his home, and his community, and speaking with Frank’s children, it is determined that with proper resources and assistance, Frank can stay in his home.Base one the case study:1. Develop a plan of care for Frank, which include these four medical conditions: diabetes mellitus type 2, alcohol-related cirrhosis, chronic bronchitis, and hepatitis C.
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