Question

Work out a care plan for Rex to help her better manage her medical conditions. Provide at least as 4 different professions (Use the template attached below).

Rex is a 75 year old woman with diabetes, hypertension, osteoarthritis, anxiety, and glaucoma who presented to the Emergency Department (ED) two weeks ago after a fall. She complained of knee pain for which x rays were taken in the ED and showed no fractures. She has not seen a doctor for almost a year as it has been increasingly difficult to leave her home. Your clinic is closer to her home and easier to get to. She is here for follow-up of her ED visit and to establish care in your clinic. You have some records (see below) from the ED.

Vital signs: Temperature: 37.2 C, Pulse: 72, Respiration: 14, Blood pressure: 152/89, O2 Saturation: 100% on room air, Height: 5 feet 2 inches, Weight: 155 pounds

Prescription Medications: Lantus 15 units at bedtime, Glipizide 20 mg twice a day, Lisinopril 10 mg daily, Hydrochlorothiazide 12.5 mg daily, Aspirin 81 mg daily, Lipitor 80 mg daily, Neurontin 900 mg three times daily, Betaxolol 1 drop daily right eye, Pilocarpine 4% 1 drop four times daily right eye, Vicodin 5/500 mg 1-2 tabs two times daily as needed for pain, Lorazepam 0.5 mg three times daily as needed for anxiety

Labs/Studies: (from ED visit 2 weeks ago)

Cholesterol 285 mg/dl (high)     Na⁺ 140 mmol/L (normal)        

K⁺ 4.0 mmol/L (normal)

HDL 38 mg/dl (low/normal)      Cl^- 101 mmol/L (normal)

BUN 18 mg/dl (normal)

ALT 35 U/L                 Creatinine 1.3 mg/dl (abnormal)

AST 40 U/L                  GFR 51 mL/min/1.73 m² (mildly decreased)

Total bilirubin 1.0 mg/dl (normal)         

HbA1c 8 (high)                        

Studies: (from ED visit 2 weeks ago)

Right knee x-ray: marked tricompartmental joint space narrowing consistent with moderate degenerative joint disease

Problem	Assessment (i.e. physical examination suggest problem is likely due to…)	Plan & responsible team member’s roles and responsibilities (i.e. balance training etc. with patient will be conducted by PT/OT by 10/30/17)
Please provide at least 4	Feel free to provide additional assessment that may not be available in the case study (i.e. physical examination of home environment reveals uneven steps in addition to shaggy carpets)	Please provide at least 2 interventions/goals for each problem and cite your source to indicate evidence based practice. Include interventions for interprofessional team. For example, a pharmacist, physical therapist and nurse may work on the same problem but have different focuses.

Answer 1

Problem	Assessment (i.e. physical examination suggest problem is likely due to…)	Plan & responsible team member’s roles and responsibilities (i.e. balance training etc. with patient will be conducted by PT/OT by 10/30/17)
Diabetes	The hbA1C levels are 8, which means sugar levels needs to be controlled	Food which is rich in proteins like cereals, rich in fibre like beetroot, carrot https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889846/ consult Diabetes specialist or endocrinologist
Hypertension	the levels of cholesterol are high-285, HDL is also high	The intake of sodium and salt should be restricted, dietary intake of fruits, low fat dairy products, vegetables as per DASH regime is recommended, advise to be taken from Dietician https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366416/
Degenerative Joint disease	For knee pain and osteoarthrits	Recommend to take physiotherapy by an expert and take hot and cold fomentation. Weight loss is encouraged. https://emedicine.medscape.com/article/330487-treatment
Anxiety	anxiety levels may impact hypertension and glucose levels	Meditation and Yoga therapy is recommended along with cognitive behavioural therapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573566/