You are a new nurse case manager at a home health agency that provides in-home support
services to adults with disabilities. Youre excited about your role and
eager to meet some of the clients served by the agency. Youve worked with
many individuals with cognitive impairments as well as physical disabilities
in both the hospital and clinic setting, and are confident that your clinical
skills are up-to-date. During your job interview, you told the agency director
that youll need time to familiarize yourself with community resources
and options. The director has arranged for you to spend the first week of orientation
with Nancy, the nurse case manager who is leaving to go back to graduate school.
After you and Nancy drive
across town to the apartment complex that houses several of your adult clients
with Down syndrome, she introduces you to Marguerite, Leonard, Esperanza, Lejon,
and Esther. Jotting notes rapidly in the files youve brought along, you
note the issues that each adult discusses with you and Nancy:
- Marguerite is frustrated
with her physician, who wants her to go for a hearing test and vision exam.
"My eyes and ears are okay. He wants to do those stupid tests again.
And he wants to stick me with a needle to get more blood. I just want some
birth control pills. Can you talk to that man?" She also tells you that
her trust funds are not coming on time, and that shes supposed to apply
for some government benefits, but cant remember which ones.
- Leonard is happy to meet
you, and wants to know if you can talk with his job coach. "I like working
at the store. But they think Im dumb. I want to help the customers.
I dont like sweeping in the back." He also mentions that his feet
hurt when he stands up all day, and that hes too tired working five
days a week. In his apartment, you notice that the chart for testicular self-exams
hasnt been completed for the past month or so.
- Esperanza, shy and hesitant,
finally blurts out, "I forget a lot. Cry every day. Not happy here."
Checking her apartment, you notice that its dirty and cluttered, and
that there are a lot of fast food containers lying around. She shows you a
notice from her adult day center, asking when shell be returning to
the program. As you leave, you see several empty prescription bottles but
no current prescriptions.
- Lejon, boisterous and
loud, complains that his pants are too tight again. When you ask what he does
for exercise, he smiles and says, "I watch TV." In response to your
suggestions for organized sports and activities, he tells you, "No bus."
Listening to his heart sounds, you notice a distinct murmur that suggests
mitral valve prolapse.
- Esther hands you a jumble
of papers and flyers, asserting, "I want to go to one of these schools.
I like to learn." Leaning close to you, she confides that shed
like to live on campus "like the other kids." She also asks you
to help her register for a summer camp that has horseback riding, and to find
a good helmet and some riding lessons before she goes. Almost as an aside,
she mentions that her gums are so sore that shes not brushing her teeth
Taking a deep breath as
you and Nancy drive away at the end of the morning, you ply her with questions
and try to sort out the priorities of the adults in your caseload.