Good Example OF Essay On Life Care Plan

Diagnosis

Chronic obstructive pulmonary disease as evidenced by a flattened diaphragm, decreased bullae, increased retrosternal air space and the hyperinflation of lungs.

MMI

Upon the request of Siphiwe Nkosi, I examined Mick Brumby in my office. The intention behind the examination was to establish the extent of impairment as a result of the chronic obstructive pulmonary disease and the functional capacity of the patient with as it relates to working.

Impairment Rating

Not applicable
Physical Demand Level
Mick Brumby cannot be considered in a competitive market labor situation. Mick Brumby lacks access to a competitive labor market of his lack of functional capacity as it relates to working. A minimal physical exertion renders him breathless, and as such cannot contribute productively in any labor activity. In this regard, Mick Brumby has a total loss in his earning capacity.

Medical Records Reviewed

I reviewed several medical records when preparing this life care plan. One of the medical records were his chest x-rays. The chest x-rays revealed a flattened diaphragm, hyper-inflated lungs, increased retrosternal air space and decreased vascular markings. This was an indication of emphysema, one of the conditions under the umbrella term of chronic obstructive pulmonary disease. I also reviewed records of pulmonary function tests. This was in order to determine the activity tolerance of the patient, progression of the disease, whether the disease was restrictive or obstructive. I also reviewed The forced expiratory volume over 1 second (FEV1) in order to determine the prognosis of the disease and the reversibility of the disease condition with the view of determining the appropriate therapies. Medical records with results from diagnostic tests on the functional residual capacity residual volume and total lung capacity were also reviewed. This was essential so as to establish whether there were any air trappings in the patient. This is important in chronic obstructive lung disease where the biggest percent of the total lung capacity is a result of air trapped in the lungs. Medical records containing results in arterial blood gasses were also reviewed. In individuals who are diagnosed and found to have chronic obstructive pulmonary disease, the levels of Pao2 are usually lower compared to normal levels while their Paco2 is usually reported either normal or slightly elevated. Medical records containing results on complete blood count and their differentials were also reviewed. Patients with advanced emphysema will exhibit increased hemoglobin in the blood. In order to establish the efficacy of a bronchodilator therapy, medical records presenting results of stress tests and exercise electrocardiogram were reviewed.

Chief Complaint and Subjective History of Present Injury By Patient

Mick Brumby's chief complaint was shortness of breath from time to time. This was accompanied by wheezing, copious excretion of mucous and tightness of his chest. He also complained of being limited in his ordinary physical exertion. This implied that he could no longer d the physical activities he usually did around his homestead.

Effects of Injury on Daily Living

Chronic obstructive pulmonary disease has had a negative effect in Mick Brumby's daily living. Firstly, he complained of a limited physical exertion. The shortness of breath could not allow him to take part in any productive labor activities. This has affected his ability to earn a living negatively. Additionally, it has also affected his ability to move around with ease. The disease has also impeded his ability to participate in different social activities.

Current Physical Complaints

At present, Mick Brumby is complaining of tightness in his chest and fatigue at the slightest physical exertion.
Past Medical History
The patient has not had a significant past medical history prior to this assessment.
Surgical history: None
Past illnesses: None
Prior-on-job injuries: None
Allergies: None
Family/Social History
Mick Brumby has been married for the last thirty years. She lives with his wife, with whom they have sired four children, among them two sons, and two daughters. His first son is 42 years old and lives and works in another state. The second child is a daughter who is aged 38 years and lives and works within a two-hour driving distance from Mick Brumby's home. The third child is a son who is aged 34. He works as mechanic and still lives at home. The fourth child is a daughter aged 27years. She is not working presently and lives at home with her parents. The chief source of care and support for Mick Brumby is his family. Her wife works as a nurse in a local hospital. When she is at work, her youngest daughter takes care of his father. The son who lives at home also helps even though he is away at work most of the time.

Current Medical and Rehabilitation Situation

Mick Brumby had been hospitalized at Blue Haven Hospital for five weeks prior to discharge was informed by decreased severity of the disease and the fact that the exceeded the limits for inpatient hospitalization on his health plan. Since this disease is chronic, Mick Brumby was linked with a nurse case manager. Presently, the nurse case manager pays him a home visit every week to evaluate the achievement of therapeutic goals and assess for any other health problems. During these visits, the nurse case manager conferences with Mick's wife and daughter who are responsible for his care. Mick Brumby is also seen by a physical therapist once a week. During this time, the physical therapist carries out an assessment so as to establish the degree of activity tolerance. Based on this information, exercise goals for the following week are made. The patient is also seen by a nutritionist once every month. During these home visits, the nutritionist assesses the nutritional status of the patient, and makes the nutritional goals and meal plans for the coming month.

Financial Summary

The health plan of the patient pay's for some of the home visits. The patient is also covered under the wife's health plan, and as such, this will come in handy in settling some of the medical bills. The nurse case manager will also help in cost reduction by mobilizing community resources to aid in the rehabilitation of the patient.

Expected outcomes

The expected outcomes of the life care plan include the following:
Maintaining the patency of the airways of the patient.
Improvements in the ventilation of the patient and the sufficient oxygenation of the body tissues as evidenced by arterial blood gases which are within the normal range.

Achievement of a progressive weight gain that is tending towards the goals targeted by the nutritionists.

A reduction in the frequency and severity of infections.
Increase in the tolerance to activity through subsequent assessments.
Conclusion
I have carefully considered the diagnosis, availed medical records and the disease condition of Mick Brumby. It is evident that Mick Brumby has emphysema, one of the disease conditions encompassed in the umbrella term of chronic obstructive pulmonary disease. Given the chronic nature of the disease, he will require lifelong management with significant support. Although he is not entirely immobilized, Mick Brumby is very dependent on his daughter and wife for care. His home is not very appropriate for his care. However, the adjustments that are essential are not very significant and financially intensive, and the family can manage. Mick Brumby is capable of doing some things. However, this does not counteract the need for an attendant around the clock. Ongoing medical care and management will be required, and the nurse case manager assigned to him will coordinate these efforts. Different members of the health care delivery team will pay home visits and conduct assessments and make subsequent plans for management. In case of exacerbations, the patient will be taken to Blue Haven Hospital for treatment. However, the most significant part of management will be done from the home setting under the supervision of the nurse case manager.

Appendices

Cost per year (subtotal) = 10243 dollars
Cost per year (subtotal) = 2390 dollars

References

Boka, K. & Mosenifar, Z. (2014). Emphysema medication. Retrieved 30 Dec. 2014 from http://emedicine.medscape.com/article/298283-medication#2
Jindal, S. (2011). Textbook of pulmonary and critical care medicine. New Delhi: Jaypee Brothers Medical Publishers.
Mayo clinic. (2014). Emphysema: Treatments and drugs. Retrieved 30 Dec. 2014 from http://www.mayoclinic.org/diseases-conditions/emphysema/basics/treatment/con- 20014218
Wise, R. (2014). Chronic Obstructive Pulmonary Disease (COPD). Retrieved 30 Dec. 2014 from http://www.merckmanuals.com/professional/pulmonary_disorders/chronic _obstructive_pulmonary_disease_and_related_disorders/chronic_obstructive_pulmonary _disease_copd.html