Frank
Variation in Case Management
Peer: Frank
Variation in Case Management
This week’s case study represents a complex situation of a female patient, as it involves intimate partner violence, psychosocial needs, and acute medical risk, such as diabetic ketoacidosis (DKA) and non-fatal strangulation, but with swelling of the right carotid artery and soft tissue in the neck. The management given to DJ appears to be adequate in terms of the initial priority of ensuring the patient’s physical stability, which includes securing the airway, controlling DKA, and preventing complications. However, some aspects could have been improved to offer more comprehensive care to the patient. It was essential that DJ receive immediate psychological support, with the help of an emergency psychologist or counselor to support her emotionally, especially since she had a history of Post-Traumatic Stress Disorder (PTSD) and the recent event had been very traumatic. In addition, it was crucial to involve a social worker or domestic violence specialist from the beginning to ensure her safety and that of her children, exploring options such as shelters or protective measures. Coordination with social services was also needed to inform about the situation of children, who had witnessed the violence and could be at emotional risk. On the other hand, DJ needed clear education about her DKA, explaining how stress and poor management of her diabetes affected her health, so that she could better understand her situation and avoid future complications (Edelman, 2023).
Recommended Actions
Comprehensive Clinical Care
• Continue aggressive management of DKA in the intensive care unit with a multidisciplinary approach (endocrinology, neurology, and critical care nursing).
• Monitor complications of DKA and strangulation, such as vascular or neurological damage (Eledrisi & Elzouki, 2020).
Safety Assessment
• Conduct a detailed risk assessment for future violence.
• Provide DJ with empowering resources, such as contact information for helplines, shelters, and legal advice without compromising her privacy (Holmes et al., 2023).
Follow-up Plan
• Schedule a follow-up appointment with endocrinology to optimize diabetes control and reduce glycated hemoglobin below 7%.
• Provide nutrition, exercise, and healthy lifestyle education (Eledrisi & Elzouki, 2020).
Prolonged Psychosocial Support
• Refer her to specialized intimate partner violence support services.
• Provide ongoing counseling to address trauma and anxiety, including stress management techniques.
• Treat her using Cognitive Behavioral Therapy techniques to address the impact of stress on her diabetes management and modify risk factors (Holmes et al., 2023).
Suggested Trauma-Focused Care Components
Trauma Sensitivity
It is critical to recognize that DJ’s history of violence and PTSD influence how she perceives and responds to medical care. Therefore, the team should use compassionate language and avoid practices that may reactivate traumatic memories. This includes asking permission before performing physical procedures and explaining in detail the need for each exam, fostering an environment of trust (Edelman, 2023).
Multidisciplinary Coordination
The approach to her case should include specialists in PTSD and intimate partner violence within the care team. In addition, it is crucial to collaborate with social services and shelters to ensure that DJ has continuity in medical and social support once she is discharged (Edelman, 2023).
Safety and Privacy
To protect DJ, it is essential to ensure that her partner does not have access to her information or be able to locate her while she is hospitalized. Security measures should be implemented in the hospital, such as notifying security personnel and restricting access to her personal data (Edelman, 2023).
Empowerment
DJ should be given clear and realistic options regarding her medical, social, and safety management, allowing her to actively participate in decisions that affect her well-being. It is also important to provide her with educational materials that she can consult privately, fostering her autonomy and independence (Edelman, 2023).
Reducing Future Risks
The medical team should work with DJ to identify ways to improve her diabetes control, taking into account the circumstances of her daily life. In addition, it is vital to help her identify safe support networks that can offer her emotional and practical support in the long term. In general, providing her with comprehensive care, which allows not only to address DJ’s immediate needs, but also to empower her and provide her with the necessary tools to reduce future risks and improve her quality of life (Edelman, 2023).
References
Edelman N. (2023). Doing Trauma-Informed Work in a Trauma-Informed Way: Understanding Difficulties and Finding Solutions. Health services insights, 16, 11786329231215037.
Eledrisi, M. S., & Elzouki, A. N. (2020). Management of Diabetic Ketoacidosis in Adults: A Narrative Review. Saudi journal of medicine & medical sciences, 8(3), 165–173.
Holmes, M. R., King, J. A., Miller, E. K., King-White, D. L., Korsch-Williams, A. E., Johnson, E. M., Oliver, T. S., & Conard, I. T. (2023). Innovations in Trauma-Informed Care: Building the Nation’s First System of Trauma-Informed Recreation Centers. Behavioral sciences (Basel, Switzerland), 13(5), 394.
