Managing Multiple Care Plans

 Plagiarism free, APA is appropriate for this assignment, solid bookish autograph is expected, and three references of sources should be presented. Need aback on Tuesday March 20, 2018 by 6:30 p.m. Upon reviewing the three analytic vignettes (Lucinda, Robert and Paul) an chip analysis plan templates, complete an chip analysis plan on all three clients. Please accommodate the use of accustomed supports as a way to advance freedom and independence.  LUCINDA’S STORY The patient, Lucinda, is a 37-year-old ample Mexican-American changeable referred for chip case administration by allowance reviewers accurately attractive for patients who use abounding bloom services. She came to their absorption because a appeal was actuality fabricated for approval to abolish a addle toe. Lucinda has had abundant procedures, hospitalizations, and emergency allowance visits in the accomplished 2 years. During the accomplished 12 months, she has abounding 32 prescriptions for eight altered medications from six absolute physicians, one of whom is a diabetic specialist, one a analyst (for diazepam), and one a surgeon (for a affliction medication). Three prescribers are primary affliction physicians. Lucinda has four another physicians who accept submitted medical accuse for her affliction in the accomplished year. Her aftermost ad-mission was 2 weeks beforehand for 2 canicule and she has been to the emergency allowance three times in the aftermost month. During her hospitalization, at that time, she had claret amoroso levels of 400+, a addle toe, and a agitation of 104 degrees Fahrenheit. Her aftermost HbA1c was 9.2. ROBERT’S STORY Robert is a 49-year-old electrician for a ample architect who has been articular through the employer’s affliction administration report. The affliction administration aggregation at Robert’s worksite addendum that he has been on concise affliction for 4 months and would be a applicant for abiding affliction soon. Robert’s affliction manager, Charlene, is afraid that if Robert is placed on abiding disability, which has added accurate definitions of what constitutes disability, he will not abide able for affliction support. Robert would again acquisition it difficult to access another application because of his bloom history. Charlene indicates to her administrator that Robert has been apparent in the emergency allowance bristles times in the aftermost 2 months and has been in acquaintance with his claimed doctor alert monthly. He is on bristles medications, all assigned by his accepted practitioner, Dr. Couch, who, as a retired surgeon, is accession his assets accomplishing accepted convenance during a arduous economy. In accession to abiding lung disease, Robert has a continued history of all-overs with agitation attacks. There is, however, no brainy bloom able complex in his care. Back the company’s application bloom plan afflicted 3 years earlier, Robert has been affected to see Dr. Couch because his old primary affliction doctor was not in the new bloom plan network. Dr. Couch is. For three years, Robert’s assignment achievement almanac has deteriorated. Affliction and ancestors leave time tracking announce that he has taken time off for breath problems, chest pain, aback pain, headaches, anxiety, and flu like episodes. This is, however, the aboriginal continued leave that he has taken. Dr. Couch, who signs Robert’s affliction forms, projects that he will be assuredly disabled according to a altercation he has had with the affliction plan’s medical director. Since his aboriginal 20s, Robert has been advised for all-overs ataxia with agitation attacks, a action that runs in his family, but has chock-full activity to a therapist or analyst be-cause he can save abroad costs by accepting all of his affliction from Dr. Couch. Robert’s aftermost acceptance of 2 canicule was 6 months beforehand for chest pain. At that time, oxygen assimilation was 91% and FEV1 was 58% of predicted. Despite a accustomed affection archetype and little another affirmation of a cardiac agent for his chest pain, Robert banned to leave the emergency allowance because he anticipation he was activity to die. He smokes two packs of cigarettes per day. PAUL’S STORY Paul is a 13-year-old macho with truncus, arteriosis, a complete affection condition, for which he is currently accepting appropriate care. The acumen for the cardiology dispensary appointment was to appraise aerial levels of fatigue, which decidedly affect his adeptness to appear school. Consistently for the accomplished 9 months, Paul’s oxygen assimilation levels accept been active amid 85% and 89% (pO2 50–55), a alarmingly low range, and are boring acceptable progressively worse. His extremities accept a blue/purple tint, and there is cogent clubbing of his fingers. Paul has actual bound circadian activities. He becomes calmly fatigued back he goes out, and he has not abounding average academy back the alpha of the bookish year (nearly 6 months). Despite nonattendance at his school, he receives no apprenticeship or home ancestry and is far abaft in the appropriate affairs provided by his average academy teachers.  Medical administration consists of baptize pills and affection deepening medications. His cardiologist additionally recommends the use of oxygen while sleeping. However, Paul is actual afraid about cutting an oxygen affectation or alike nasal prongs. His parents accept not followed through to align for this and are not blame him. As a result, Paul has been to the emergency allowance six times in the aftermost 2 months for baptize bolus adjustments and oxygen supplementation. He has never been accepted to the hospital, admitting it was encouraged on three occasions. Paul’s cardiologist recommends cardiac catheterization to actuate the cachet of his affection condition. Paul and his parents, however, are actual aflutter about his ability this procedure. Paul underwent several surgeries during his aboriginal few years of activity to actual his cardiac defect. Paul’s doctors feel that accustomed the concrete abasement empiric in him, he will acceptable crave added antidotal surgery. Both parents are aflutter that anaplasty will annihilate Paul or that it would accommodate little account to their son’s affection of life.

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