Life care planning – Case management in Nursing

Life care planning – Case management in Nursing
Q. Summarize your life care plans and post in this week’s discussion area. Discuss whether or not you feel comfortable doing life care planning. Why or why not? What
areas might you need to improve or develop further to feel more comfortable and be more competent as a nurse life care planner?
Peer T – A life care plan for Tammy, 47 year old female diagnosed with schizophrenia. The client has financial difficulties, noncompliant with her medical regimen.
She has been neglecting to take her medication because of the side effects. She has been having tactile, auditory, and visual hallucinations. Tammy has been a client
of the local mental health center since 1989 and have not taken any medication for two months.
Schizophrenia is a convoluted mental disease that requires durable management with antipsychotic medications and holistic care. Schizophrenia discloses societal and
mental deficiency, expansively affecting memory, attention motor skills, decision-making ability, and intelligence (Goolsby & Grubbs, 2011). Symptoms of Schizophrenia
falls into two categories “positive” symptoms which are usual by their presence (hearing voices); and “negative” symptoms which are unusual by their absence
(restricted range and intensity of emotional expression) One percent of the population is affected by schizophrenia, a serious illness that is irrespective of culture,
class, or race (Jones, Hacker, Cormac, Meaden,& Irving, 2014). One percent of the population is affected by schizophrenia, a serious illness that is irrespective of
culture, class, or race.
The life plan for Tammy supports the need for assistance with finances and medication compliance. Due to the severity of Tammy’s illness a plan has been put into
place to assist with supervised living arrangements. Therefore before she is in full blown crisis someone can identify she needs help and refer her before things get
out of hand. Someone can also help her manage finances, and medications. Stress triggers psychosis and makes schizophrenia worse, keeping the stress level under
control is very important. Someone will help her with her coping skills dealing with her schizophrenia to help minimize exacerbations.
Although writing this life plan was challenging, it was very beneficial to and for me. I feel that I need much more practice writing a variety of life
care plans with a life care planner them before I will feel comfortable enough to complete one alone. Life care planning is a consistent process for evaluating the
patient and disability in order to establish all of the needs dictated by the onset of that disability.

Goolsby, M., & Grubbs, L. (2011). Interpreting Findings and Formulating Differential Diagnoses. Advanced Assessment, 2(17), 522-523.
Jones, C., Hacker, D., Cormac, I., Meaden, A., & Irving, C. B. (2012). Cognitive behavioral therapy versus other psychosocial treatments for schizophrenia. The
Cochrane Database of Systematic Reviews, 4, CD008712. http://doi.org/10.1002/14651858.CD008712.pub2

Peer A – This student created a life care plan for Annette, a sixty-eight-year-old female diagnosed with amyotrophic lateral sclerosis (ALS). The plan was developed
surrounding her desire to remain in her own home; therefore multiple in home support services were necessary as was coordination of care and services in order for her
desires and wishes to be met.
ALS is a progressive neuromuscular disease that results in degeneration of nerve cells of the brain and spinal cord (Yaskowiak, 2012). ALS is also known as Lou
Gehrig’s disease. Each year in the United States, approximately 30,000 people are diagnosed with ALS, with the average age at onset of fifty-eight (Gentry & Casey,
2011). The average age at onset of symptoms ranges between forty and sixty years of age, and regardless of rapid or slow progression of the disease, respiratory
failure from progressive paralysis is the most common cause of death making ALS a fatal diagnosis (Davis & Lou, 2011). The average life expectancy for a patient
diagnosed with ALS is three years after symptom onset, and it is uniformly fatal (Paganoni et al., 2015). This makes management of the newly diagnosed ALS patient
complex, requiring detailed follow up and collaboration with multiple providers is essential to ensure comprehensive care that is both supportive and palliative (Davis
& Lou, 2011).
The life care plan reflected the need for coordinated medical services by including routine appointments with her primary care physician, neurologist, pulmonologist,
and mental health provider. In home care included visits by a skilled nurse, occupational therapist, physical therapist, palliative care nurse, dietician, speech and
language pathologist, as well as paid caregivers twelve hours per day. Riluzole was prescribed, as it is the only medication approved by the FDA for treatment of
ALS, and this cost was included as one of the plan components’ (Davis & Lou, 2011).
Safety precautions, communication interventions, assistive devices, and dietary interventions are all required during the course of ALS in order for appropriate
management of symptoms (Davis & Lou, 2011). ALS eventually impacts all areas of activity of daily living function and requires the use of adaptive equipment to meet
dressing, ambulation, feeding, bathing, toileting, grooming, mobility, and sleeping requirements (Bedlack & Mitsumoto, 2013). Costs related to durable medical
equipment and home renovations were also incorporated to provide a holistic picture of cost required to meet all areas of care in the home. Overall, the total cost
came to $328,072.36 for Annette’s three year life expectancy. As of 2012, those Veterans service connected for ALS were elevated to 100% service connected status,
with claims treated as priority with expeditious processing (Yaskowiak, 2012). This essentially equates to all care needs, equipment needs, and possible housing
renovation requirements would be covered under Annette’s VA benefits utilizing various programs and grants as needed, it also increases her monthly compensation rate
to assist with financial strain (Yaskowiak, 2012).
This project was challenging and educational. Overall, I feel as though I now have a broad grasp on the goal of and process involved in developing a life care plan.
It would take much more practice and experience in order to be able to feel comfortable or confident in the role of completing life care plans more frequently and
comprehensively.
Apuna-Grummer, D., & Howland, W. A. (2013). A Core Curriculum for Nurse Life Care Planning. Bloomington, IN: iUniverse, LLC.
Brewah, H. (2013). Integrated health care for patients with motor neuron disease. British Journal of Nursing. 22(20) 1182-1188.
Bedlack, R., & Mitsumoto, H. (2013). Amyotrophic Lateral Sclerosis A Patient Care Guide for Clinicians. New York, NY: DemosMedical.
Davis, M., & Lou, J. (2011). Management of amyotrophic lateral sclerosis (ALS) by the family nurse practitioner: a timeline for anticipated referrals. Journal of the
American Academy of Nurse Practitioners. 23(9), 464-472.
Gentry, T., & Casey, K. (2011). Creating an assistive technology clinic: the experience of the Johns Hopkins AT clinic for patients with ALS. Neurorehabilitation. 28
(3), 281-293.
Paganoni, S., Karam, C., Joyce, N., Bedlack, R., & Carter, G. (2015). Comprehensive rehabilitative care across the spectrum of amyotrophic lateral sclerosis.
Neurorehabilitation. 37(1), 53-68.
Powell, S., & Tahan, H. (2011). CMSA Core Curriculum for Case Management. (2nd ed). Philadelphia, PA: Lippincott Williams & Wilkins.
Yaskowiak, M. (2012). Veteran advisor: ALS benefits. PN. 66(12), 65-66.
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