Question

Please answer following questions: You are an APRN working at UCSF AIDS clinic

·       How would you prepare for this home visit? Explore the practical concerns, the equipment you need to bring, and your goals for the patient's care.

·       What might you want to know from the case management and supportive services team?

·       What specific things would you assess at this visit?

·       What are the essential elements of the history and physical today?

·       What is your assessment?

·       What is your plan

You are seeing a patient Chief Complaint: Fever , AIDS, 40 year old male diagnosed with AIDS, end stage, addiction, non compliant with antiretroviral therapy due to his inability to regularly take medications, agoraphobia presents with fever X2 weeks, no thermometer available, diarrhea with 3-4 brown soft to liquid stools daily, no blood, eats 2 small meals a day. He denies SOB, pain, and smoke pack of cigarettes. Declined fever work up, he is not been in touch with the case management team, he miss appointments because of his extreme anxiety in public places. You are aware that there is a special hospice for homeless people with AIDS and perhaps it might be time to consider a referral for more supportive services.

medications : Motrin occasionally for fever

allergies none

PMH-SEE PHI

Vital signs: 100/70 64 18 99.8 BMI:17

O2 SAT 95%

Gen: thin white male, alert, oriented, unshaved, personal hygiene clean.

skin: dry and flacking multiple nevi ruddy complexion, red flaky, rash on naso/ labial folds, and scalp + DANDROFF, NO LICE.

HEENT:  Poor definition, gengevitus, shotty lymph nodes posterior / Anterior cervical.

Answer 1

¤The following things has to be done to make an honest visit

• Ensure that documentation can be done and papers related to it are carried and a prescription pad compulsorily
• Equipments like sphygmomanometer ,pulse oximeter, stethoscope ,glucometer ,thermometer ,weighing scale
• Gloves ,face mask
• Medications for fever (injection)

The goals for patient care are to bring down the temperature to normal ,assess the nutritional status and inform necessary changes ,inform about supportive care services in the community ,to stop diarrhoea

¤From the case management team get a complete history or the personal health information regarding the past and current treatment given and advised for .The adherence of the patient to treatment regimen and follow up visits.

From the supportive service team collect information about the patient condition and the prognosis to the treatment or care provided

¤The specific things to be assess in this visit are

• Body temperature to know the fever level and treat accordingly
• Weigh the patient to know the nutritional status and guide accordingly
• Medication adherence
• To reduce his anxiety level through psychological support and counseling
• Other signs and symptoms which can detoriate the patient status

¤The essential elements of physical and history are

• The chief or current complaint of the patient
• Drug history :addiction
• Medical history
• The patient's past medical history
• Allergies history

¤The assessment of the visit are

• The patient condition is detoriating because of lack of medication adherence, visits, poor nutritional intake
• Agoraphobia ,diarrhea, fever needs to treatment

¤The plan for this patient are

• To treat the chief complaint
• Inform the community support team to help the patient
• Hospice care services has to be provided to the patient.