client care plans
38477Review the three clinical vignettes found in Chapters 12-14 of our textbook and distinguish which service package you would recommend given the clinical presentation of each client.
In 250 words, discuss the treatment goals and objectives you would propose to help with each client’s distress level, including details about motivation.
In an additional 250 words, discuss how you would create a plan to keep these clients safe.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
This assignment assesses the following programmatic competency:
Paul is a 13-year-old male with truncus arteriosis, a congenital heart condition, for which he is currently receiving symptomatic care. The reason for the cardiology clinic visit was to evaluate high levels of fatigue, which signiicantly afect his ability to atend school. Con-sistently for the past 9 months, Paul’s oxygen saturation levels have been running between 85% and 89% (pO2 50–55), a dangerously low range, and are slowly becoming progres-sively worse. His extremities have a blue/purple tint, and there is signiicant clubbing of his ingers.Paul has very limited daily activities. He becomes easily fatigued when he goes out, and he has not atended middle school since the beginning of the academic year (nearly 6 months). Despite nonatendance at his school, he receives no tutoring or home schooling and is far behind in the special program provided by his middle school teachers.Medical management consists of water pills and heart strengthening medications. His cardiologist also recommends the use of oxygen while sleeping. However, Paul is very anxious about wearing an oxygen mask or even nasal prongs. His parents have not fol-lowed through to arrange for this and are not pushing him. As a result, Paul has been to the emergency room six times in the last 2 months for water pill adjustments and oxygen supplementation. He has never been admited to the hospital, though it was encouraged on three occasions.Paul’s cardiologist recommends cardiac catheterization to determine the status of his heart condition. Paul and his parents, however, are very fearful about his undergoing this procedure. Paul underwent several surgeries during his irst few years of life to correct his cardiac defect. Paul’s doctors feel that given the physical deterioration observed in him, he will likely require further corrective surgery. Both parents are fearful that surgery will kill Paul or that it would provide litle beneit to their son’s quality of life.
Robert is a 49-year-old electrician for a large manufacturer who has been identiied through the employer’s disability management report. The disability management company at Rob-ert’s worksite notes that he has been on short-term disability for 4 months and would be a candidate for long-term disability soon. Robert’s disability manager, Charlene, is con-cerned that if Robert is placed on long-term disability, which has more rigorous deinitions of what constitutes disability, he will not remain qualiied for disability support. Robert would then ind it di□cult to obtain alternative employment because of his health history. Charlene indicates to her supervisor that Robert has been seen in the emergency room ive times in the last 2 months and has been in contact with his personal doctor twice monthly. He is on ive medications, all prescribed by his general practitioner, Dr. Couch, who, as a retired surgeon, is supplementing his income doing general practice during a challenging economy.In addition to chronic lung disease, Robert has a long history of anxiety with panic atacks. There is, however, no mental health professional involved in his care. Since the company’s contracting health plan changed 3 years earlier, Robert has been forced to see Dr. Couch because his old primary care doctor was not in the new health plan network. Dr. Couch is. For three years, Robert’s work performance record has deteriorated. Dis-ability and family leave time tracking indicate that he has taken time of for breathing problems, chest pain, back pain, headaches, anxiety, and lu-like episodes. This is, however, the irst extended leave that he has taken. Dr. Couch, who signs Robert’s disability forms, projects that he will be permanently disabled according to a discussion he has had with the disability plan’s medical director.Since his early 20s, Robert has been treated for anxiety disorder with panic atacks, a condition that runs in his family, but has stopped going to a therapist or psychiatrist be-cause he can save out-of-pocket expenses by geting all of his care from Dr. Couch. Robert’s last admission of 2 days was 6 months earlier for chest pain. At that time, oxygen satura-tion was 91% and FEV1 was 58% of predicted. Despite a normal heart tracing and litle other evidence of a cardiac origin for his chest pain, Robert refused to leave the emergency room because he thought he was going to die. He smokes two packs of cigaretes per day. Chapter 13 Assisting Robert: Disabled Employee With Chronic Lung Disease, Panic Atacks, and Alcohol Abuse 197A TRIGGERED CASERobert has been identiied as a candidate for case man-agement since he triggered numerous items on the disability company’s red lag system. He has concur-rent physical and mental health di□culties for which he receives no mental health services. Robert is, how-ever, consuming many medical services. He has been hospitalized in the last 6 months and has been seen in the emergency room at least two or more times each month for the past several months. Though his treatment is with a single physician, he is on numer-ous and changing medications. None are being taken regularly for anxiety despite notation of symptoms in emergency room discharge reports. Charlene, Robert’s disability manager, asks if Robert would be willing to work with a health specialist associated with his insur-ance company who could, perhaps, help him get bet-ter control of his health and hopefully back to work. Robert agrees.TRIAGE: ENROLLMENT SPECIALIST INTERACTIONRobert does not answer the phone to talk with the case management enrollment specialist two times be-fore she inally connects. He states that he was afraid it was his boss wanting him to return to work. Rob-ert likes his job and wants to work, but he says, “I just couldn’t.” When he went to work before, he was afraid he would have a “breathing spell,” make a mistake, and possibly hurt himself or someone else. Since he is an electrician, this is a real possibility. He has been on short-term disability for the past 4 months. Robert will go on long-term disability in a couple of months. His income would drop in half when this occurs and his job with his current employer will no longer be guaranteed should he improve and wish to return. At age 49, he does not want to stop working. Robert was good at what he did. The workplace was also his social outlet and the area of his life that made him feel good about himself.Robert notes that his breathing and anxiety symp-toms had been in good control before he started care with Dr. Couch. According to Dr. Couch, Robert does not need mental health services. Dr. Couch considers chronic bronchitis the main reason for Robert’s being unable to work.Robert had a good work history up to 3 years ago and wants to change his current condition (Appendix B, “Readiness for Change Scale,” 11 on a scale of 10, see www.springerpub.com/kathol) but has litle conidence in being able to do so (Appendix B, “Readiness for Change Scale,” 3 on a scale of 10). He also does not know where to start. Robert has never been in case management before; has a telephone, which he indicates he would answer if someone can really help him; and has health conditions that are reversible and have been controlled in the past. This identiied him as a high-priority candidate for case management.During the past several years, Robert has noted a dramatic increase in his out-of-pocket expenses for health services, including emergency room visits, med-ications, tests, and short hospitalizations. Last year, he breezed through his $4,000 high deductibles by mid-March. Luckily, the company’s insurance covered most expensive health events, such as emergency room visits, ambulance costs, and inpatient stays, ater he reached his deduction limits. This year Robert reached his $4,500 deduction limits in February and has used over $55,000 in health beneits. Not only are his health problems high cost because of medical expenses, he has also been absent from work at least a third of the year. Lost productivity and disability costs are also adding up. His composite picture stratiies him into Level IV for consideration of case management. He is a highly complex patient.The enrollment specialist obtains the necessary permissions and then transfers Robert to a case man-ager, Martin, who is free to add a case. She wants to make sure that the connection with Martin is made im-mediately because Robert has been di□cult to get a hold of during the triage process.INITIAL CONTACT WITH THE CASE MANAGERThe enrollment specialist ills in Martin briely about the issues that Robert is having and his current health challenges. In addition to connecting Robert to Martin, the enrollment specialist forwards claims data, to which she has access, for Martin to review. She also sends the disability notes from Charlene. While Martin glances at the claims material and notes during the initial discus-sion, he does not spend much time on them because he wants to make sure that he connects with Robert.Martin starts his interview by summarizing the case management program and answering Robert’s questions. He gives a bit about his background and tells Robert how the program works. In short, Martin helps patients who have complicated problems, not just with their medical treatment but also with any-thing that makes it di□cult for them to regain health, including insurance, inances, transportation, and doc-tor issues. Robert conirms that he understands and is willing to proceed. He says that he has a litle time but has already been on the phone for 15 minutes.
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