Keith is an 18–year–old African American man, and a recent high school graduate. He has HIV but has not been in treatment. Situation: Although he has known his HIV status for some time, Keith is here today seeking treatment for the first time. He came alo
Reason for Referral: Keith is an 18–year–old African American man, and a recent high school graduate. He has HIV but has not been in treatment.
Situation: Although he has known his HIV status for some time, Keith is here today seeking treatment for the first time. He came alone on a city bus, and he doesn’t have a state–issued ID or insurance information, although he says he does have health insurance.
How long have you known you were HIV–positive?
Since this summer. They had one of those trucks outside GG’s where you can get tested for free. GG’s, that’s our club. So me and Nick, we go get the test and it was positive.
They gave us these pamphlets after, but I can’t leave stuff like that around the house. My folks didn’t know about me and Nick. So I trashed those pamphlets on the way home. That was…like six months back I guess.
Since you haven’t been in treatment, have you been doing other things to protect your health?
Yeah. So here’s the thing about that. Nick says he read on the Internet that meth is supposed to help. Like methamphetamines. And you don’t have to do very much and it slows it down so you don’t get sick as fast, but doctors can’t prescribe it because it’s illegal. So we tried that. Nick thinks it’s working, but I don’t know, man. It makes my heart beat real fast and that freaks me out.
He’d be mad if he knew I told you that, like maybe someone’s gonna show up at the house and bust us. I guess I don’t care anymore.
At intake you described your living situation as “unstable.” Can you tell me more about that?
I’m at Nick’s right now. Mom threw me out of the house. I was…like, trying to find a way where I could get a test that wasn’t in front of a gay club, right, cuz…my folks just ain’t ready for that much truth, you know? So we’re at the clinic, and I get the test, and they call Moms in because technically I’m still a minor at that time, and we’re talking with the nurse or whoever and it just kinda comes out. How I got it. She hit the roof.
I don’t think that’s why she threw me out, though, even though at church they say it’s a sin. She’s scared. Everyone is scared. I got little sisters at home, Alexa and Marnie, and we only got one bathroom. It’s like…maybe I’m allowed to go ruin my life and they still love me and pray for me, but if I gave it to the girls…that they could never forgive.
So I’m sleeping on the couch at Nick’s place. His folks don’t want us sharing a bed, but they feed me and stuff. I don’t even know if Nick told them what’s up, so I just keep my mouth shut. If we break up over this, I’m in so much trouble.
What do you feel is the most important thing we can do to help you right now?
Well. I have like five hundred dollars in the bank that I got for my birthday, but HIV drugs have gotta cost more than that. I’m under Dad’s insurance still, until I’m 25 I think. But I remember when my sisters were born it was so expensive anyway, and I’m scared that if the insurance company finds out, like…I have a terminal illness…that’ll just bankrupt the whole family. I can’t do that to them.
So I guess the first thing is, like, can you help me figure out how to do this without hurting anybody?
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Patient with Diabetes
Reason for Referral: Carole Lund is a 44–year–old woman of mixed Native American and European descent, and a new mother. She is concerned that she is not recovering from gestational diabetes.
Situation: Carole is here with her daughter, Kassandra, who is 10 weeks old. Carole was diagnosed with gestational diabetes at week 30 of her pregnancy. She has carefully logged her blood glucose since the diagnosis, and it shows 150–200 fasting, over 200 following meals.
What diabetes treatments did you receive during your pregnancy?
Well, they gave me a glucometer, so I started using that. I could see right away that the way I was eating was a problem; I would usually work straight through the day and then have one big meal in the evening, and that was making my numbers bounce all over. So I set alarms on my laptop, so three times a day I would get interrupted, have a small meal, take a short walk, and then test my blood sugar. That helped. And then I stopped drinking juice and soda, which I should have done years ago, and that helped too. But I don’t think my numbers improved as much as my OB/GYN wanted them to, but she said my blood sugar should return to normal after delivery.
Did your obstetrician advise you to take insulin during your pregnancy?
She did, yeah, and we talked about it. I don’t like the idea of being dependent on a drug. I called my mother. She’s still on the reservation, so she called the elders, and we all agreed that injecting my body with an animal hormone was a bad idea. But then the doctor told me that they make synthetic insulin now, but that means it’s made in a laboratory somewhere, and I’m not sure that’s any better.
By then I was in my third trimester, and all the tests said Kassandra was big but healthy, so I thought we would just ride it out. It was supposed to clear up after she was born. But it hasn’t, and I know you have to be careful having a baby at my age. I want to do what’s best, but I don’t want to believe that insulin is my only option.
Are there any challenges in your life which you think may be interfering with your ability to follow a treatment plan?
It’s harder now than it was before she was born. It’s just the two of us in the apartment, which is wonderful, but I don’t remember the last time I had a good night’s sleep. A lot of my work is freelance, so I make my own hours, but that also means if I’m not working I don’t get paid. I had family help while I was recovering from the C-section, and they helped cook healthy meals for me, and kept me on my schedule. Now it’s all on me — work, caring for my daughter, and managing my blood sugar. If I fall behind on anything, it will be looking after my health.
Do you have any other concerns you’d like to have addressed?
I worry about Kassandra. She’s healthy and perfect, but I know that she’s at a greater risk for developing Type 2 Diabetes. I want to do whatever I can to reduce that risk, to care for her, and as she grows, to teach her how to care for herself.
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Well, it sounds like this is a more complex case than we thought at first. I’m going to need you to put together a concept map for your patient’s care plan.
I need a brief description of your patient, and then up to five diagnoses (there may not be that many). Go in order of urgency, and make sure you list the professional or scholarly evidence you used to formulate the diagnosis. Just use in–text citations, please; we want to keep this short and sweet.
Thanks for taking this on!
• Patient Info:
• Most Urgent Nursing Diagnosis:
o Description Urgent:
• Treatment Urgent:
• Outcomes Urgent:
• Other Urgent:
• Nursing Diagnosis 2:
o Description 2:
• Treatment 2:
• Outcomes 2:
• Other 2:
• Nursing Diagnosis 3:
o Description 3:
• Treatment 3:
• Outcomes 3:
• Other 3:
Using a concept map to plan a patient’s care can be essential when the case and the patient’s overall needs are complex. In this simulation, you’ve used the details of a patient’s case to draft a concept map for his or her care.
Click the button below to download the text for your concept map draft. You will use this text to create a final concept map for your assignment in this unit.
After you’ve downloaded your text, you will put it into a concept map template. You may use the template provided in the assignment, another template, or your own concept map format for your final map.
Click any heading in your concept map to reveal the complete content.
The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid.
• Godshall, M. (2015). Fast facts for evidence-based practice in nursing: Implementing EBP in a nutshell(2nd ed.). New York, NY: Springer Publishing Company.
o Read Chapter 7.
• Blix, A. (2014). Personalized medicine, genomics, and pharmacogenomics: A primer for nurses. Clinical Journal of Oncology Nursing, 18(4), 437–441.
• Baker, J. D. (2017). Nursing Research, Quality Improvement, And Evidence-Based Practice: The Key To Perioperative Nursing Practice: Editorial. Association of Operating Room Nurses, 105(1), 3.
• Hain D. J., & Kear, T. M. (2015). Using evidence-based practice to move beyond doing things the way we have always done them. Nephrology Nursing Journal, 42(1), 11–20.
• Evidence-Based Practice in Nursing & Health Sciences: Review Levels of Evidence.
• Evidence-Based Practice in Nursing & Health Sciences.
• Evidence-Based Practice: What It Is and What It Is Not | Transcript.
• Concept Maps.
o This resource provides a general overview of concept maps. The guide is not specific to nursing, but may prove helpful to the initial conceptualization of your assessment.
• Taylor, L. A., Littleton-Kearney, M. (2011). Concept mapping: A distinctive educational approach to foster critical thinking. Nurse Educator, 36(2), 84–88.
o This article will help you decide how you would like to structure and conceptualize your concept map.
• Concept Map Template [DOCX].
• Concept Map Tutorial | Transcript.
o Information on working with the concept map and template to complete your assignment.
• Nursing Masters (MSN) Research Guide.
• Database Guide: Ovid Nursing Full Text PLUS.
• Kaplan, L. (n.d.). Framework for how to read and critique a research study. Retrieved from https://www.nursingworld.org/