Question

Transitions in Care Case Study

Rochelle is a 15-year-old girl who had been admitted from the ER for an emergent laparoscopic appendectomy one week ago just after Christmas break. She returned two days’ post discharge with abdominal pain, nausea, vomiting, abdominal bloating and fever. She went under an exploratory abdominal surgery to determine what the issue was. It was found that during the laparoscopic appendectomy the surgeon clipped her bowel and she now had peritonitis with multiple abscesses. She had an abdominal debridement and wash out to address the abscess and the surgeon used a pilonidal or open surgical wound, requiring the wound to heal from the bottom up. She has a wound vac over the wound and the foam needs changed daily. She has continued to have nausea and vomiting and abdominal distention and the Dr. has ordered an NG tube to address these issues. Rochelle has become very uncooperative and verbally aggressive with all the hospital staff. She lives with her mother who works a full-time job and a part time job on the weekend and is unable to be at the hospital with Rochelle. Her friends from school had come to visit initially but as her stay in the hospital has lengthened the visits have become less. Rochelle does not have any siblings and her father lives out of state. She is due to be discharged home within 48 hours, the NG tube to be d/c’d prior to discharge. She will go home with a wound vac and does continue to need some assistance with her ADL’s due to the wound vac placement and pain issues.

Consider the following questions:

a. Which providers would you need to collaborate with for her care transitions and follow up?

b. Who would you identify as a needed team members in her transition planning?

c. Who/what are Rochelle’s natural and informal support systems. Would you need more information to discover this? If so, what would you need to know?

d. What sort of individualized goals would you make in collaboration with Rochelle and her mother that are strength based and need based?

e. How would you incorporate or link with mental health promotion, prevention, and early identification and intervention to improve long-term outcomes?

Answer 1

a) We will have to collaborate with her mother for care transition and follow up as she is the who cam remain with her always.

b)The transition team members include the surgeon, the nursing staff, other health care providers, her mother and friends.

c) Rochelle's support system will surely be her parents and her friends. Its very important to know that whom she is close to among her parents and friends as they can provide her with the much needed strength and support.

d) At first we should ask rochelle not to take stress and to be positive. She should be made to believe that she will be just like before very soon. Her mother should also be told to give her time and attention and not to let her feel that she is alone in all this

e) Early identification and intervention lead to

• Improved diagnosis and treatment.
• More timely and targeted refferals to specialist.
• Improve confidence and engagement of primary care providers.