Nurse case managers control health care

Define case management and create a case management plan for a patient with
COPD. Give an introductory paragraph discussing COPD and then discuss how a
case management worker can implement a program to assist this patient.
*Constructs an implementation plan.
*Proposes approach to gain buy-in from key stakeholders.
*Examines key outcomes of the case management plan.
Here is a website that will show you a sample case management plan for a patient with
COP
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tient
****Use this as a guideline and please adhere to the three guidelines I provided for
you. I have had this paper written before and got a terrible grade on it. Once again,
this is from a case management point of view. A case manager is assigned to a patient
with a chronic illness to make sure they have everything they need.
Nurse case managers are supposed to act as liaisons between patients, their families
and health care personnel to ensure efficient and prompt health care service. They
devise care plans, which include patient referral or admission, medication doses,
administering therapies and treatments, evaluation of results and a summation of the
plan’s effectiveness. In some instances, nurse case managers control health care
resources and purchase services for patients, and they may also provide emotional
support and provide medical advice. Overall, nurse care managers are responsible for
the prompt and effective provision of health care services.

Case Management

Case management denotes cases where medical case managers create liaison between
patients having a long-term health condition, with their medical practitioners and the patient’s
friends and family. Case managers do not offer treatment or diagnosis. Instead, they only
monitor the patient’s treatment plan so as to make sure that all people responsible for
implementing the plan are doing their respective duties as required. As such, the case
manager works for the interests of the patient (William, 2003).

Case Management 2
Case management highlighted below is a management plan to oversee the treatment
of an elderly patient with chronic obstructive pulmonary disease (COPD). COPD is a
condition that makes breathing difficult, and progressively worsens breathing as the condition
progresses. The condition is characterized by chest tightness, shortness of breath, wheezing,
production of mucus as well as other symptoms (Juvelekian & James, 2013). The condition is
caused by prolonged smoking and/or exposure to lung irritants such as dust, chemical fumes
and other irritants commonly designated as air pollutants (Young et al. 2009).

Case

A 50 year old industrial worker that smokes at least a pack of cigarettes in day has
been smoking for over 30 years, and now he has been diagnosed with COPD. The patient is
released after prolonged treatment that was necessitated by an exacerbation of the condition
while at work. The exacerbation was a result of continued exposure to environmental
pollutants at the patient’s workplace. After successful control of the exacerbation the patient
has been released to outpatient care, where he will be receiving care from his primary care
physician. The discharge plan offered upon release recommends that the patient should stop
working at the factory because it exposes him to chemical irritants and pollutants that
possibly trigger exacerbations and worsening of the condition. In the discharge plan the
practitioner in charge of the patient recommends a lung transplant as a long-term solution
based on the worsening condition of the patient’s status. This is due to the poor prognosis as
determined by the worsening condition of the patient.

The lung transplant may offer better results, but it carries with it a greater risk for
COPD patients, and may result in high risks of morbidity and mortality. However, the plan is
promising because lung transplantation may improve exercise capacity and pulmonary
function (Juvelekian & James, 2013). The patient is worried about leaving his job so as to

Case Management 3
avoid exposure of pollutants that could exacerbate the condition. Additionally, he is worried
about receiving a lung transplant because of the risks associated with transplant of key organs
such as lungs. Additionally, the patient is faced with challenge of stopping cigarette smoking
because he is already addicted. The patient spends his few weeks after discharge adapting to
the home care situation where he uses portable oxygen equipment. The patient has problems
coming to terms with the fact that he may have to drop from his work at the local factory
where he works as a way to minimize the risk of exacerbating the condition. He frequently
receives visits from the primary care physician that closely monitors his drug regimen and
daily exercise.

As a case manager assigned to the patient, I collect all information pertaining to the
drugs that the patient is using as well as any other health related engagements that he is
undertaking. I establish that the patient is adhering to the drug regime prescribed before his
discharge. However, I note that he has relapsed into his smoking habits because of the urge to
smoke, which bears negatively on the improvement of his health (Young et al. 2009). The
patient reports that he cannot overcome the urge to smoke because he was deeply addicted to
cigarette smoking.

A review of the current situation shows that cessation of smoking and quitting his job
at the factory are the most important things necessary to avert any further exacerbation of the
condition. In relation to this fact, I develop short-term goals to first tackle the addiction
problem and the reduction of occupational exposure. In order to handle the smoking issue
counseling sessions and hypnosis is scheduled so as to help the patient overcome the urge to
smoke. The counseling sessions are designated to take a group form where the patient would
meet other people with smoking problems so as to learn from their experiences (Juvelekian &
James, 2013).

Case Management 4
In addition to this, family counseling sessions at home are organized for both the
patient and his family. The family sessions are geared towards garnering support or buy in
from the family, which plays a significant role in overseeing the recovery of the patient
(Ferguson & Cherniack, 1993). It is anticipated that the family’s engagement will be
important in convincing the patient to abandon his job. If family members can understand the
risk of occupational exposure, then it will be easier for the patient too because he is the
breadwinner (Hurst et al. 2010). The family has therefore to be convinced about the need to
stop the patient from working so as to avert the worsening of the condition. A contingent plan
is also in order just in case the hypnosis and counseling fail in relation to combating the
smoking problem. This plan may include the use of nicotine replacement to help cut back on
smoking.

Apart from these short-term plans, the implementation plan shall also entail creating
an exercise regime to which the patient shall abide to as a daily routine. This is aimed at
helping improve lung exchange capacity and prevent possible disease progression in the
patient (Juvelekian & James, 2013). The patient shall also be expected to stay away from any
sources of environmental pollutants, lest they worsen the condition again.

Finally, the ultimate goal will also include training the family members and friends on
how to detect possible exacerbation of the condition so as to always monitor the patient
(Ferguson & Cherniack, 1993). Inclusion of the family in such training is an important
component because they will learn what to do or how to assist the patient whenever
symptoms worsen or health seems to deteriorate. Therefore, the family will be educated to
look out for general signs of worsening such as insomnia, malaise, breathlessness, chest
tightness, wheezing, depression, fatigue and confusion. As the case manager it will also be
appropriate to link the patient and family to a health outreach programs concerned with

Case Management 5
COPD information dissemination so as to keep them always informed about new
developments in relation to the condition. This will be significant because it will help in
keeping both the patient and the family updated about any care information that may help
improve the status of the patient. The finally expected outcomes should include adherence to
the set up exercise regime, strict adherence to medical regime and overall quitting of the
smoking habit.

Reference

Ferguson, G. T. & Cherniack, R. M 91993). Management of chronic obstructive pulmonary
disease. New England Journal of Medicine; 328 (1), pp. 1017-1022.
Hurst JR, Vestbo J, Anzueto A, et al. (2010). Susceptibility to exacerbation in chronic
obstructive pulmonary disease. New England Journal of Medicine, 363 (1), pp. 1128-
38.

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