COMMUNITY HEALTH

Case scenario:
You are the nurse assigned to do skilled nursing visits (SNV) twice a week for Mr. L. he is a 48 y/o male. Mr. L was recently discharged from the hospital with weakness of all extremity due morbid obesity. Mr. L current weight is 320 pounds his height is 5’8 inches. Mr. L diagnosis includes asthma, a history of pancreatitis and newly diagnosed with Insipidus Diabetes. Mr. L needs medication teaching and more information about his diagnoses. His income is limited. He will not be able to return to work in the near future because of the weakness and his inability to stand for long periods of time. While in the hospital Mr. L used a wheelchair or walker for mobility. Mr. L experiences severe SOB on exertion. Mr. L health insurance will cover the cost of his medication, a walker and wheelchair.
Mr. L has orders from his health care provider to monitor and record his blood sugar two times a day for the next month. Mr. L blood sugar range s 190mg/dl-240mg/dl. He does not own a glucose monitor, nor can he afford to purchase one. Mr. L has medication to pick up at his local pharmacy. Mr. L is a single parent of 3 teenagers. He is recently divorced from his wife. He does not receive child support. Mr. L wants to continue “family time” with his children. “Family time includes a once a week “fun “activity for Mr. L and the 3 children. The children are doing well in school, but Mr. L cannot afford the cost of buying the children bus cards therefore the children must transfer to the local in district high school. The children are adjusting to the divorce but upset and angry about having to leave their old school and friends.
Mr. L eldest child has been complaining of a tooth ache. The children have an active medical card which covers dental care.
Mr. L is very depressed and has a stressful life raising three children on a fixed income and as a single male parent. Mr. L wants family counseling to help with his depression. Mr. L and his children just moved to a ground level apartment in this community because he can not walk up to the second floor of his old building. Mr. L cannot drive his car anymore, but his eldest child is a licensed driver and Mr. L sister will be assisting him with transportation. Mr. L also wants to find a new place for his family to worship. Mr. is also very concern about the number of vacant buildings and liquor stores in the area.
Your assignment will be to assess the community and find resources for Mr. L
 Where can Mr. L go to purchase an inexpensive blood glucose monitor?
 Find the local library so Mr. L can have computer access to do research and find reading materials about his diagnosis’s.
 Mr. L is interested in an exercise program for himself & family. Where can Mr. L and his children exercise for free or at a reduced cost?
 Where can Mr. L and his family go for an inexpensive family activity? Mr. L wants to take his children out for dinner, because they are doing well in school. Locate a restaurant this community. Look at the menu. Keep in mind that Mr. L is diabetic and obese. Can he make healthy food choices for him and his children? What are the healthy foods on the menu?
 Locate and identify the chain grocery stores in this community. Go into one of store’s meat department. Is the meat fresh? Is there a large selection of lean meats to choose from? Go to the fresh fruit & veggie department? Is there a large selection to choose from? Are the fruits & veggies fresh? Are the stores accessible by public transportation?
 Find the local grocery (non-chain, usually a corner store) store. Go into the meat department. Is the meat fresh? Is there a large selection of lean meats to choose from? Go to the fresh fruit & veggie department? Is there a large selection to choose from? Are the fruits & veggies fresh?
 Remember he has medication to pick up at the pharmacy. What pharmacies are in the community? Are the accessible by public transportation? Does the pharmacy offer delivery service?
 Did you see any dental offices in this community? If so, how many? What is the address?
 Did you see any churches? If so, what are the denomination? What is the address?
 How many liquor stores did you count in this community? Name at least 3 of the stores.
 What is the name of the fresh fruit & veggie market?
 Is free or low-cost mental health/counseling service available in this community? What is the name of the providing organization?
 What is the ethnicity of the people in this community? What type of community is this? (i.e. working class, poor, low income)?
 Locate the police department for the community. What street is it on?
 Locate the local post office. What street is it on?
 What is the name of the local High School?
Assignment # 2
You have to teach Mr. L about healthy eating to assist with weight loss. Prepare a 3-day menu that includes breakfast, lunch, dinner and 2 snacks. Remember Mr. L has Insipidus Diabetes, and he must monitor his blood sugar.
Assignment # 3
 Develop a teaching plan that includes the following:
 potential causes of pancreatitis
 classifications of pancreatitis
 signs & symptoms of pancreatitis
 complications of pancreatitis