CASE ANALYSIS 1
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ASSESSMENT
Mr. And Mrs.
Boxwell are in their 70s and have lived modestly on a fixed income since Mr.
Boxwell’s retirement .However, their budget has been strained this year because
they must pay $300 to $400 each month in out-of-pocket expenses for
prescription medications .Mrs. Boxwell confessed to you, the community health
nurse visiting them after receiving a referral from the coordinator of the
senior center they attend, that in some months they skip medication doses to
make “ends meet.” They both take drugs for high blood pressure; Mrs. Boxwell is
diabetes, and Mr. Boxwell has congestive heart failure .They live in a small,
older home .their 8-year-old car is seldom driven, because they report that
“the traffic is getting worse” and they have come close to having an automobile
crash twice while they were driving in the past 3months.they are receptive to
you suggestions and are trying to stay healthy and independent.
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NURSING DIAGNOSES
1. The clients are
at risk for an alteration in their health status due to insufficient finances
to purchase needed medications for chronic disease.
2. The clients are
at risk for altered safety when driving related to chronic health problems,
diminished driving skills, and a history of narrowly avoided automobile
crashes.
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PLAN/IMPLEMENTATION
Diagnosis1:
The community
health nurse will explore the clients’ eligibility for Medicaid. It is possible
that these clients are eligible yet unaware of this program.
The community
health nurses consult with the clients’ primary health care provider and
suggest that their prescriptions be changed to generic from brand names and to
have some medications ordered in larger doses. They are less expensive and the
client can break them in half safely. For example, atenolol, the generic for
Tenormin, is prescribed 25mg qd –it come to 50-mg scored tablets and costs just
20% more than the 25mg tablets.
Mrs. Boxwell will
check with her present distributor of diabetic supplies for larger quantities
and generic brands of syringes, alcohol pads, and so on.
Diagnosis2:
Mr. Bowell will
look into selling their car, exploring the bus schedule, and cost of taking a
taxi to the doctor and the grocery store. Mr. and Mrs. Boxwell daughter spends
a day each month with them and takes them wherever they want to go, as long as
it is “a fun outing”.
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EVALUATION
The couple is
eligible for Medicaid, which will help defray the out-of-pocket costs for
medications. They have reduced medication costs as much as possible and report
not missing any prescribed medications.
They sold their
car and are negotiating the bus in good weather .They use a taxi in the winter
or when it is raining. They figured that they save $1000 per year in auto
insurance, auto maintain, and gasoline, whereas the bus and taxi cost them
about $22 per month.
Because the couple
is receptive to the help you have provided, you initiate a discussion regarding
their long-term plans for housing needs as they get older. Not opposed to a
senior housing option and have been talking about it with their daughter. They
are going to talk with a realtor about selling their home, explore some senior
apartments with their daughter on her monthly visits, and review their budget.