WEEK 11 Case Studies

CASE STUDY # 1
Complex Urban Home Care
Stephanie is a HHN working with Darlene. A 56-year-old client who lives independently but
who requires assessment, postoperative wound care, support, and teaching following cardiac
bypass surgery. Darlene lives in an urban high-rise apartment in downtown Vancouver with an
excellent adapted train system, but her mobility challenges due to chronic muscular dystrophy
coupled with fatigue and restrictions related to postoperative protocols necessitate home nursing
care. Stephanie collaborates with Darlene to understand her needs beyond just the postoperative
protocols from the surgical team. She assists Darlene in interpreting and understanding the
protocols, but also in adapting the restrictions and progressive activities to her own abilities.
Darlene has a weekly home support worker who provides basic home-making services (including
some assistance with meal preparation) as well as bathing assistance. Otherwise, Darlene
manages independently at home with some adapted equipment such as a walker, and other aids
in her kitchen and bathroom. Stephanie is proposing that Darlene consider an additional day or
two per week of home support. However, Darlene refuses claiming that the cost will strain her
already limited budget. She adds, “I can manage for the short term. Maybe I will call my sister
who lives in the suburbs and ask her to come stay with me for a week or two”.

THINK ABOUT IT
Stephanie assesses that Darlene’s recover may already be prolonged due to her mobility
challenges. Stephanie clarifies Darlene’s home support needs and discusses options and ideas
including social services aid to crisis/temporary home support.

1. How can Stephanie conduct her assessment and planning in ways that are respectful and
supportive of Darlene’s choices in relation to her own nursing goals, plans, and realities?

2. Stephanie assesses that Darlene’s recovery may already be prolonged due to her mobility
challenges. How can Stephanie ensure that best practices and referral for support information is
thoroughly discussed to aid decision making with the client?
CASE STUDY # 2

Case Study: Home Health Care for Patient with Infected Leg Ulcer

Patient Profile: Melody Tennant, 43 years old, has been referred to home care of her leg wound
and intravenous antibiotics. She lives alone in an apartment with her cat in an area of town
identified as having a high number of calls to the police. Melody worked as a food server but is
currently out of work. She is candid with the nurse completing her admission and she shares the
fact that she has been trying to stop her intravenous drug use for years. Her right lower leg ulcer
is the result of injection drugs six months ago. The injection site became a “sore” and “just never
healed.” Melody went to the walk-in clinic when she could no longer stand the pain and her
boyfriend noticed her leg was pink and warm to touch. The walk-in clinic physician sent her to
the emergency department, where the methicillin-resistant Staphylococcus aureus (MRSA)-
infected leg wound was diagnosed.

Subjective Data

• Has history of being hepatitis B positive (3 years)

• Has varicose veins in both legs; worries that the home care nurses will want her to wear
support stockings for her varicose veins, and she finds them “ugly.”
• Complains of pain in her right lower leg and asks for “something to take the edge off.”

Objective Data
Physical Examination

• Peripheral intravenous site (saline lock) in left hand

• Dressing to right lower leg; 10- x 10-cm foam dressing with adhesive edges
• Right lower leg ulcer; 10% pionk base, 90% yellow base, irregular flat edges. Wound
size is 0.5cm deep, 7cm long, 4.4 cim wide. Periwound skin is deep pink, and the
diameter of the right lower leg calf is greater than that of the left.

Collaborative Care

• Methadone, 50mg PO once daily

• Vancomycin, 500m intravenously BID
• Multivitamin, 1 tablet PO daily
• High-protein diet

Discussion Questions
1. Priority decision: What are the initial priorities for the home health nurse?
2. What other members of the team should be involved in the care of Melody? What are their
roles and responsibilities?
3. Priority decision: What type of patient education program should be implemented? What are
the priority teaching goals to promote self-management.?
4. What should the nurse consider in the nutrition assessment? How will the nurse address the
economic considerations related to Melody’s diet?
5. How can the nurse address Melody’s coping skills and use community resources to intervenen
with her substance use?
6. What types of supplies will Melody need? What diagnostics, teaching, and community
resources should accompany the use of these supplies?
7. What types of patient-centred strategies can the nurse use to promote safety for both Melody
and the nurse?
8. What are the expected long-term outcomes for Melody?