2 questions about management of care

caliotter3 · Aug 10, 2011

On the second one, referrals may not be necessary. On the first one, I don't agree. Think the answer should be c, but can see how it is d. Newly diagnosed = doesn't know the basics, so the nurse is taking care of basic instruction on behalf of the client, who may be embarassed to admit he doesn't know this yet.

Rach10388 · Aug 10, 2011

1. when prepare a client newly diagnosed with diabetes for discharge, which activity describes the nurse's role as a client advocate?
a. arranging for a visit with a home health nurse
b. providing medication instructions to the client's parents
c. instructing the client to follow up in few weeks
d. teaching the client how to admin insulin
why the correct answer is d?
As an advocate, the nurse needs to act on the behalf of the client. How d represents the definition?
Why not c?
2. the goals of case management are? more than one answer
a. improving the coordination of care
b. increasing referrals to local organizations
c. reducing the fragmentation of care
d. discharging clients quickly
why not b? On Saunders, case management includes coordination of all services, referral, and follow-up.
Any thought will be greatly appreciated.

for 1, you are an advocate so you want to make sure they can manage their disease, they have to be able to car for them selves before they can follow up with the nurse. you should NEVER SEND SOMEONE HOME WITHOUT MAKING SURE THEY CAN CARE FOR THEMSELVES. Make sense?

as for 2, yes referrals are important but thats passing the buck, you want to make sure they are at their best with the least amount of referrals needed. increasing these referrals is $$$ and also meaning their may be a knowledge defibcit or even a self care deficit, you want to minimize referrals I would think if anything, but referrals should still be implemented if the client only needs LITTLE guidance

make sense?

hope that helps

HappyMeNow · Aug 10, 2011

For question number 1, you have to think: if there is only ONE thing you can do for the patient, which would it be? Would you let the patient go home not knowing how to administer insulin but knowing when to do follow up? I think in this case being able to self administer insulin is a LOT more important.

shescoolie · Aug 10, 2011

In question #1 you can see that the first three actions, the NURSE is doing the action, in the last one the nurse is teaching the CLIENT to do the action and in turn placing the client in a role of self-care. All of the answers are good, but this is the BEST answer, because it gives us the best outcome...the patient is able to be independent in providing his own care if we choose D.

In #2, I think the key work is INCREASING. How is increasing referrals reeeeallly managing care? It is not. I think if it just said making appropriate referrals, then that would have made the answer right. Think about it, how would a nurse INTENTIONALLY increase referrals? You would always have to be deliberately looking a service that MAYBE the patient needs just to keep your referral numbers up. Just doesn't make sense.

vpoonia · Aug 10, 2011

As for the answer to your questions....Here is my rationale:

Answer 1 - D - (why??) - because, if you DON'T teach the client correct use of insulin, they may take too much - and then bottom out - and run into a coma...which negates ALL other interventions given, because now the client is dead - or severely disabled.

Answer 2 - A & C - (why??) - Because case management helps manage the condition of the client by bringing together all aspects of care needed to successfully attain the results (my own understanding of the definition -please dont chew me on that). Based on this analogy, A seems like a correct choice. Now, C pretty much states the same thing as A when rephrased, so I would pick that too.

Please let me know if these rationales helped. email is [email protected]

I would appreciate your input.

Also, please please remember -- that NCLEX is about application of knowledge, and not just what the book says in concrete words. There are thousands of books out there, with thousands of different opinions. Attain the base knowledge, and THINK about what is being asked. Reason with yourself if what you are answering makes sense....(just the way i tried to explain for ques 1), and you will find your efforts being much better guided.

Once again, if any of you out here need a perspective, feel free to ask away, and i will do my best to give you the rationale in understandable terms. You have the email listed above (but no spamming, or 100 question lists - THOSE will go straight to the iggy list-only human myself.

euphoria02 · Aug 10, 2011

My answer for number 1 would be D

As I have understood, being a patient advocate also means fostering patient wellness by promoting independence. By educating the client how to administer his/her medication, you are making him/her in charge of his/her health. He/She has the right to be knowledgeable on how the disease should be managed.

As for number 2, the choice B sounds like 'passing the buck' to me. I haven't read Saunders 4th ed but as I can see it, 'increasing referrals' is not necessarily 'collaboration' but much more of like getting rid of the patient. Before making referrals, we must have utilized all possible resources so that it will be cost effective for the management and the patient.