Case Management Action Planning Case Study (250 words)

A case manager, Marie, is meeting with Michael Cornell, an individual in need of services, and his granddaughter Jennifer. Michael age 86, took a bad fall six weeks ago and has been receiving rehabilitation services at a local nursing facility. Discharge planning was not thorough as Michael insisted he was ready to go home with services in place or not. Jennifer is not able to provide Michael with all the assistance he needs, but is willing to help as much as she can. However, it has become apparent to both Michael and Jennifer that he will not be able to remain at home without assistance. As a result of the fall, Michael had a hip replacement and a broken arm which was put in a cast. He also has diabetes, (two toes amputated in the last two years), and macular degeneration. Michael has become quite confused since his stay at the nursing facility and currently his decision making skills are severely impaired. He needs extensive assistance with dressing, bathing, toileting and transfers. Michael is not eating well and continues to lose weight. Michael tells Jennifer and Marie that he has no energy, feels down a lot and doesnt even care about tending to his garden this year. He previously enjoyed socializing with people and hobbies like woodworking, gardening and painting, but they dont interest him much now. Michael attended the local Congregational Church, but has not been to church services since his fall. He agrees that it might be helpful to talk with the pastor, have people around during the day and is willing to accept services that will help him to be able stay at home. Michael and Jennifer are interested in agency directed services at this time and clearly want to receive case management services. Michael, Jennifer and Marie are now developing Michaels Action Plan together.

Some simple questions to start:

List all the potential issues regarding Michaels needs

What goals do you think Michael might have?

List all the possible services Michael would need

For each goal (based on the issues), write a plan including strategies and timeframes

Remember to:

Address the following in the plan:

The processes involved in addressing the clients needs

Recommendations regarding services, supports and referrals

Details of (potential) meetings conducted with the relevant professionals

Continuous improvement strategies

Support from the literature

Instructions: Below is the illustration of approaches to family nursing, your task is to discuss each approach in your own perspective/view and relate its significance in working in any given family. Write down your answers in a separate sheet of paper. (see rubrics for scoring)

1. Family as Context

2. Family as Client

3. Family as System

4. Family as Component of Society

TASK 2. FAMILY CASE STUDY
Instructions: All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Write down your answers in a separate sheet of paper. (see rubrics for scoring)

Case Scenario: Mikral Family
Family Members:
• Rafael: father; 52 years old; part-time lecturer at a local university (married Michelle 18 years ago), first marriage.
• Michelle: mother; 50 years old; full-time employed at a government office, second marriage with no children from the previous marriage.
• Cristina: oldest child; 17 years old; daughter, 11th grade.
• Iana: middle child; 14 years old; daughter, 9th grade.
• Isaiah: son; 11 years old; son, 6th grade.
Family Story:
Rafael (52 years old) and Michelle (50 years old) have two teenage daughters, Cristina (17 years old) and Iana (14 years old) and one son, Isaiah (11 years old). They have been married for 18 years. Rafael is a part-time college professor. Michelle has a full-time position as a director at a government office. When Rafael lost his full-time job 17 years ago, the couple moved in with Rafael’s mother (Princess, age 86) and lived with her for more than 5 years until Michelle’s income was sufficient to cover a mortgage and family expenses. Since moving out of Princess’s house, the couple and children visit and have dinner with her every weekend, which has become the family routine. Children are expected to spend the night with their grandmother after the dinner; however, recently Cristina has refused to spend the night at grandmother’s house. Rafael’s sisters and their families live in the same state and visit Princess at least once a month. Princess has chronic health conditions, which cause unexpected emergency department (ED) visits (several times a year). After divorcing her ex-husband, Michelle started to study in a graduate school in a different state, where she met Rafael. Because Michelle’s family lives far away, she barely sees them and sometimes feels isolation and loneliness. Rafael has been a part-time employee at local colleges most of his life. While Rafael has spent most of his time working on computers at home (online teaching), Michelle has worked at a local government agency. Since Rafael has produced minimum income, Michelle provides for most of the family expenses. The house has five rooms: master bedroom, Rafael’s office (he stays at home most of the time), and three rooms for the children. The girls used to share the same room until the family added an additional room last year so the children could have their own room. Since moving to a new room upstairs, Cristina brings her friends’ home frequently and a couple of close friends spend the night with her on weekends and during the summer break. The parents caught Cristina and her friend leaving the house secretly to meet a group of boys after midnight; Cristina was grounded for a month as a result. Last month, Michelle found Cristina and her friend on the street (instead of going to school) while she was driving to work. Cristina’s boyfriend lives nearby, and they meet frequently at the park or each other’s home. Michelle suspects that Cristina might have a sexual relationship with her boyfriend. This is the first marriage for Rafael and second marriage for Michelle. Michelle was a survivor of domestic violence from the first marriage (which lasted less than 1 year). Because Rafael has strong family-centered values, they eat dinner as a family and once or twice a week with Rafael’s mother (Princess). Cristina has started skipping the family dinners frequently, stating that she is not hungry. She also has been experiencing several fainting episodes due to irregular eating habits. She frequently skips breakfast and lunch. The couple noticed that Cristina is eating fast food in her room or eating food after midnight by herself. Cristina’s eating pattern is getting irregular, and Iana has begun to imitate her older sister’s pattern and is refusing to participate in family dinners. Both girls are generally skipping breakfast, although Michelle has made various attempts to get them to eat breakfast. All children are in good health and have pleasant dispositions. The children are generally happy, but loud at home and frequently fight and yell at each other. The girls argue over clothes and cleaning and are frequently cranky and difficult for the couple to deal with. Rafael and Michelle sometimes argue because of different parenting styles: whereas Michelle wants to raise the children in a Christian way, Rafael opposes Michelle’s parenting belief. Cristina is becoming rebellious and fights with Rafael frequently. She is losing interest in her schoolwork. Earlier in their married life, Michelle mainly was responsible for household chores. Cristina expressed resentment against her father regarding his minimal house chore contribution. Over the years, as a result of numerous heated arguments, Rafael agreed to share a significant portion of household responsibilities, including outdoor chores. Still, Michelle spends weekends doing grocery shopping, laundry, housecleaning, and attending to the children. During the weekdays, the couple takes the children to various lessons (piano, violin, cello, art, karate, and soccer), which sometimes causes schedule conflicts and builds marital tension. Rafael and Michelle have mutual friends, but seldom participate in social gatherings as a couple. Michelle usually takes the children to church events, and Rafael takes Isaiah to soccer practices or sports events. Michelle feels social support and comfort by attending church and church related activities; but Rafael considers it as his wife’s over commitment to religion. The family is affiliated with a Methodist church, which they used to attend every Sunday; Rafael stopped going to church 6 months ago. Cristina sometimes refuses to go to church as a family. Because of Michelle’s full-time job and frequent family gatherings with in-laws, and Princess’s frequent ED or hospital admissions, Michelle has limited time to socialize with her own friends. Over the years, Michelle has experienced chronic fatigue and stress from caring for the children and handling family responsibilities. She also experiences insomnia and hot flashes due to menopause. Over the last 3 years, she has gained 30 pounds and is trying to lose weight without success.

Discussion Questions:

1. Illustrate the Mikral family genogram and family ecomap
2. Enumerate all the possible health assessment you can gather from the story. 3. Create a Family Nursing Goal/s for the Mikral Family.
3. Using the different theoretical approaches that can be used for assessing and intervening in the family for health promotion, discuss your implication/inference to each theory base don the given scenario:
a. Developmental and Family Life Cycle Theory
b. Family Systems Theory
c. Bio ecological Theory
4. Develop a Family Nursing Intervention.
5. What are the possible points of your family health teaching you can provide to the family?

Identify and discuss the most important changes in the class structure of British society, and in the relationship between social classes, during the period covered by the course. Show how these social changes—for example, the emergence of new classes, the decline of older ones--were related to the profound changes in the British economy during this period, paying particular attention to such factors as agricultural improvement, industrialization, population growth, technological innovation and urbanization.

Problem 6.45A a-c

Alice Oritz is the advertising manager for Value Shoe Store. She is currently working on a major promotional campaign. Her ideas include the installation of a new lighting system and increased display space that will add $25,830 in fixed costs to the $262,605 currently spent. In addition, Alice is proposing that a 10% price decrease ($35 to $31.50) will produce a 20% increase in sales volume (20,500 to 24,600). Variable costs will remain at $14 per pair of shoes. Management are impressed with Alice’s ideas but are concerned about the effects that these changes will have on the break-even point and the margin of safety.

Calculate the current break-even point in units, and compare it with the break-even point in units if Alice’s ideas are used.

Calculate the margin of safety ratio for current operations and after Alice’s changes are introduced.

Prepare CVP income statements for current operations and after Alice’s changes are introduced.

Would you make the changes suggested?

Analysis of Financial Statements: For this milestone, you will continue to develop material to be included in your financial analysis paper. You will need to research AMAZON and obtain the last few years (at least two) of financial statements (information that is available to the public online) in order to answer the following questions: A. Based on the information that you have gathered, explain the changes in financial ratios. Has anything changed in the few years of financial statements that you have obtained? i. What are the reasons for these changes? B. Based on the information you have gathered, analyze the changes in the financial reports regarding cash. Be sure to examine the statement of cash flows. i. What are the reasons for these changes? C. Based on the information you have gathered, analyze the changes in the financial reports regarding the account balance. i. What are the reasons for these changes? D. Describe the type of valuation method that AMAZON uses and explain why it uses this method. i. What are the benefits of this method? E. Based on industry trends, future plans of AMAZON, and the information you have gathered, predict how AMAZON will perform in the following year compared to competitors.

Are any changes taking place in the macroenvironment that might have an impact, positive or negative, on the Airline industry? If so, what are these changes, and how might they affect the industry? (Forces outside the industry)

explain how the oxygen's affinity to hemoglobin changes in your lungs. What happens to N-carbomates and to Bohr's protons all that moment? What changes take place in hemoglobin itself?

Describe the pH changes that occur in the two aqueous compartments of the mammalian mitochondria, the matrix and the inter membrane space, when the ETC has high flux. Describe the biochemical basis for these changes.