CASE
ANALYSIS 2
;
ASSESSMENT
Lopez is a mother of three children aged 2 to 9 years old. The
eldest, Ernesto, was diagnosed with severe Down syndrome at birth. He is
confined to a wheelchair, require total care, and remains at home with his
mother and younger siblings, who are not yet in school. Anna’s husband works
long hours as a computer repairman for a large company. They have health
insurance, but it does not cover additional expenses, such as day care for. The
family has done very well in providing for Ernesto’s needs, and they receive
periodic visits from you, the community health nurse, to evaluate his condition
and check on the feeding tube used for his nourishment. Physically, Ernesto was
stable, but notice that Anna has been increasingly withdraw at the visits,
rarely offering information, but responding to questions appropriately. She
seems less engaged with her other children as well, only occasionally smiling
at them.
;
NURSING DIAGNOSIS
1. At risk for depression related to ongoing caregiver demands and
of respite care
2. At risk for altered health status due to limited focus on
self-care needs
;
PLAN/IMPLEMENTAYION
Diagnosis1:
The community health nurse will discuss with the client the need
for a thorough physically assessment, including an evaluation for depression.
The community health nurse will contact the insurance provider to
discuss day care option for Ernesto. If unavailable, local community
organizations will be contacted for appropriate referrals. In addition, the
need for more frequent visits to the family will be discussed with the
insurance carrier to address the needs of the mother as caregiver.
Diagnosis 2:
The community health nurse will discuss with the client her
concerns about her overall physical and mental health and discuss some
self-care option that may improve her well-being: improved nutrition, physical
activity, leisure time options, and adjustment of family. Schedule to
accommodate more free time for self-care.
;
EVALUATION
The client was at first very reticent to make an appointment for
an evaluation, but after thinking it over for a week and discussing it with her
husband, she did so. Her husband was relieved that she had suggested the
appointment, because he was growing increasingly concerned over her husband
withdrawal but did not know how to bring up the subject. The family physician
referred Anna to a psychologist for evaluation of the depression. The insurance
carrier agreed to increase home visit on a short-term basis but did not have a
respite care option available for Ernesto. Fortunately, a local faith-based
community group was able to provide limited assistance to the family. They
identified several members who had raised children with similar disabilities
and were willing to stay with Ernesto and the other children once a week for 24
hours. This allowed Anne some free time to make appointments with her
psychologist, shop, or visit friends. After several months, Anna has begun to
smile more and seems much more relaxed at the home visits.
The children are all doing fine, and the respite care is expected
to continue for at least the next 6 month .The need for ongoing attention to
her own self-care need is emphasized with Anne by the community health nurse.