Case Study

A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual GYN examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg QD and HCTZ 25mg QD. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.

Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice of pharmacotherapeutics you would recommend, and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

The principal objective of utilization management is the reduction of practice variations by establishing parameters for the cost-effective use of healthcare resources. There are four main techniques or tools used in utilization management: demand management, utilization review, case management, and disease management. Utilization management helps MCOs control costs and improve quality.

Refer to the readings of this week and the Internet on the above information, and answer the following questions:

What are the challenges faced by MCOs regarding practice variations? What do you think can be done to meet these challenges?
Differentiate between the three main processes of institutional utilization management.
Determine the main purposes of each process of institutional utilization management. Which process do you think is the most important, and why?
Research the role of the utilization management nurse.
Explain the functions of the utilization management nurse, and compare and contrast the information from that organization.
Explain your understanding of disease management and case management. What is your opinion are one major similarity and one major difference between the two types of management?
Now, access information on disease and case management by searching the Internet by using the following keywords:

Care Continuum Alliance
Commission of Case Manager Certification
Based on your research, answer the following questions:

What is the purpose or mission of these professional organizations?
What standards do these organizations set for certification or membership?
How do these organizations define disease or case management and do they differ from the text definitions?

Describe the chronic relapsing inflammatory bowel diseases (ulcerative colitis and Crohn’s disease). Summarize the pathophysiology, clinical manifestations, evaluation, and treatment recommendations for each.

Describe the incubation periods, the onset of prodromal symptoms, duration, and characteristics of rashes and other clinical symptoms of the following viral diseases: rubella (German measles), rubeola (measles), roseola (exanthemasubitum), and varicella (chickenpox).

List the CDC-recommended childhood vaccination schedule applicable.

Talk about the nurse-client relationship and the use of therapeutic communication as an important part of that relationship. Please answer the following questions:

What are your concerns or fears about mental health nursing in general? Are you interested in mental health nursing, or do you approach the topic with some anxiety?
What do you feel are essential aspects of a good nurse-client relationship?
Please include an example of how you established good rapport and a good professional relationship with a patient in the work or clinical setting. What nonverbal and verbal techniques did you use in this relationship?