Case Studies 8a and 8b

Valerie Yanowski, RN, CM

Motivating “Mr. Z”• 55 y.o. male h/o ischemic cardiomyopathy w/ EF of 15%-has BVICD• Frequent hospitalizations for acute on chronic CHF systolic /diastolic• H/o W/C back injury-disability; recent job loss• Has one child w/ disability• Co-morbidities: lumbar stenosis, OSA, Depression, Obesity,

pulmonary HTN, MI-2006, COPD• Stay-at-home husband• Frequent dietary indiscretions• Recent Hospitalization-BNP 1198, severe SOB• CM plan:

– Education / Motivation / Recognition / – Nutrition consult, PT consult

Care Management of the Psychiatric Patient

• 28 y.o. Female • Long term psychiatric hx-SI, frequent

suicidal attempts• Multiple hospitalizations for same• Most recent: took multiple psych meds,

then calls ambulance • Has psychiatrist, S.A.M. counselor• How to care manage w/o being a psych

nurse?