Scenarios

Chapter 17: Health promotion and nursing in the community

Alice is 60; she has heart failure, poorly controlled type 2 diabetes and extensive pressure ulcers and leg ulcers. She has attended accident and emergency department four times in the last month and each time had taken her own discharge before getting treatment.

Alice lives with her son who works long hours and she has daughter with a young family who lives nearby, both have been struggling to cope with their mother's deteriorating condition. Alice is not known to any other services and is isolated and vulnerable.

• 1. What is available for Alice in the community to prevent her from being so isolated?

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  Correct answer:
  Your answer might include: Dial a ride, community volunteer groups, an expert patient programme where she would learn to manage her chronic condition, and an over-55s exercise programme in the local sports centre.

• 2. How can community nurses prevent Alice from needing to attend A&E?

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  Correct answer:
  District nursing services at home; transport to see tissue viability nurse; involve GP and practice nurse; diabetes specialist nurse outreach work to educate her in managing her diet. Practice nurse could teach her to recognize the warning signs of poor glucose management and see her regularly in the GP practice to monitor her blood glucose levels.