Care Management Plan for a Patient with Complex Conditions: A Report

This report presents a comprehensive care management plan for a 60-year-old patient, Sara, diagnosed with chronic osteomyelitis, alongside pre-existing conditions of diabetes and hypertension. The report begins with a case study, followed by an assessment of Sara's complex health conditions, emphasizing the risks associated with each. The care plan focuses on managing osteomyelitis through pain management, infection control, and mobility improvement, considering the patient's reluctance for hospitalization. It also addresses diabetes management through dietary modifications and blood glucose monitoring, and hypertension management via blood pressure tracking and dietary adjustments. Furthermore, the plan incorporates strategies to address Sara's anxiety and social isolation by providing psychological counseling and encouraging social interaction. The report details the care strategies, including medication, dietary plans, and regular assessments, and emphasizes the importance of family involvement and effective communication. The clinical decision-making process within a multi-agency context is also discussed, highlighting the need for continuous evaluation and adaptation of the care plan to ensure optimal patient outcomes. The report considers the patient's vulnerability due to her age and pre-existing conditions, and the importance of addressing the comorbidities associated with osteomyelitis, diabetes, and hypertension.

Running head: CARE FOR A PATIENT WITH COMPLEX CONDITIONS
CARE FOR A PATIENT WITH COMPLEX CONDITIONS
Name of the Student:
Name of the University:
Author Note:

1CARE FOR A PATIENT WITH COMPLEX CONDITIONS
This paper intends to discuss a care management plan for a patient with complex
conditions. A complex condition can be defined as a medical condition of the patient, where the
patient is in need of a special care due to the presence of multiple disease conditions in the
patient or if there is some life risks are involved.
Firstly, the paper is going to focus on a case of a patient with complex condition along
with a proper rationale. After that the assessment of the complex conditions in the patient is
going to be made along with identification of the care that is required. Then a discussion on the
management plan for the patient with complex condition will be developed. Lastly an evaluation
on the clinical decision making in the context of multi-agency arena will be made.
A hypothetical scenario concerning a 60 years old patient named Sara can be taken into
consideration. Sara was diagnosed with diabetes mellitus about 20 years ago. She had a history
of hypertension and she has been living alone in a housing complex after the death of her
husband 1 year ago. She has one daughter, who lives about 20 minutes walking distance away
from Sara. Sara was feeling feverish for past five days along with experiencing a severe pain in
her feet, which was swollen. Upon losing the ability to move freely, she finally decided to see the
doctor on the sixth day, accompanied by her daughter. After the diagnostic assessment of her
blood culture, erythrocyte sedimentation level and C-reactive protein level, X-ray report along
with the biopsy report the doctor diagnosed her with chronic osteomyelitis. She did not want to
be admitted in a hospital. Hence a nursing staff was appointed in order to provide a proper care
for her at her own house.
Osteomyelitis is a rare disease which involves microbial infection in the bone marrow
(Urs et al. 2016). The patients who are most at risk of this condition have weaker immune
system due to various additional disease conditions (Wang, Luo, Huang and Xie 2016).

2CARE FOR A PATIENT WITH COMPLEX CONDITIONS
Osteomyelitis involve inflammatory reactions at the bone in response to the microbial infection.
Various microorganisms including S. aureus, P. aeruginosa, Salmonella sp., Serratia sp. and
various other fungi and mycobacteria can be detected as the causative agent for this disease
condition (Inzana et al. 2016). Those additional disease conditions involve sickle cell anemia,
rheumatoid arthritis, AIDS, diabetes and various others (Tseng et al. 2015).
Both the conditions of diabetes and hypertension are important comorbidities of osteomyelitis.
There are various risk factors in the diabetic patients including the ulceration and infection,
which may lead to impaired sensation, alteration in the immunological response (Bodavula et al.
2015). Sara also had a hypertension condition, which is also a comorbid condition that is to be
considered in case of a patient with chronic osteomyelitis (Tseng et al. 2015). According to
Denes et al. (2015), chronic osteomyelitis condition may take a severe turn within only a week or
ten days if left untreated. The diagnosis of Sara with osteomyelitis was already 5 days late. Her
treatment also should have started few days prior from when she first experienced the swelling
and the pain in her foot to avoid further spreading of the disease.
When considering the pathophysiology of osteomyelitis, the bone gets affected via either
bloodstream or from some nearby infection sites or even from penetrating trauma (Hofmann et
al. 2016). When the bone is infected, the cells of immune system such as leukocytes enter the
bone in order to reduce the level of infection, which may result in the lysis of the bone from the
enzymes released. Hence around the area of necrosis, the body will attempt create new bone,
involucrum. The whole event may lead to sclerosis of bone and deformity, when it proceeds to
chronic condition. Once the causal microorganism is able to escape the bone cells, the infection
is spread to other sites and infects the bone cells (Birt et al. 2017). As evidenced by Tillander et

3CARE FOR A PATIENT WITH COMPLEX CONDITIONS
al. 2017, the condition becomes more complex and dangerous if the bacteria are found to be
antibiotic-resistant, which may increase the risks of disability and amputation.
The progression of osteomyelitis is most likely affect the mobility of the patient, which in
turn may affect her social life as well as her mental health due to the feeling of helplessness
(Abulaiti et al. 2017). Impaired mobility will result in her limited interaction with society which
in turn may result her isolation from the society. Limited interaction with society is often
associated with the feeling of loneliness (Ye and Lin 2015). Additionally since her negative
physical condition is the only thing that is restricting her from making the interaction, it may
cause the feelings of depression in the patient (Domènech-Abella et al. 2017).
Hence the condition of Sara can be considered as complex from her three health
conditions. Her old age along with hypertension and diabetic condition had already kept her
vulnerable with various symptoms associated with those two disease conditions. Additionally the
diabetes and hypertension are considered as important co-morbid conditions as there are
increased risks of heart disease, vascular complications and various other diseases that present
mortal risks to a patient (American Diabetes Association 2015).
In order to develop a care plan for Sara, few assessments are required to be made while
taking her various disease conditions into consideration. The most important and risky condition
that can be identified in Sara is the complications regarding osteomyelitis. The assessments must
be made in order to observe the progression of the disease by assessing the levels of pain the
patient is experiencing, the swelling in her foot along with the level of mobility in the patient.
The diabetes and hypertension also should be subjected to monitoring since they are
comorbidities that present the risks to the health and the well-being of the patient. The diabetes
can be assessed by the diabetes self-management questionnaire (DSMQ) tool in order to track the

4CARE FOR A PATIENT WITH COMPLEX CONDITIONS
glycemic control in the patient along with determining whether there is requirement of
improvement in the care plan (Schmitt et al. 2016). The progression of hypertension in the
patient should be tracked on a regular basis by checking the blood pressure in the patient.
Another assessment that is required to be performed in case of Sara is an assessment regarding
her anxiety level and mental condition. This assessment can be done by using various anxiety
assessment tools such as OASIS, HARS and many others, which are mainly questionnaire
designed for the assessment of the level of anxiety in the patients (Vojvodic et al. 2019).
The care plan for Sara is required to be focused on all her disease conditions. The
condition of osteomyelitis require the focus on the pain management, reduction of the swelling
and the prevention of further progress of the disease by lowering the infection in the patient.
There should also be a plan to improve the mobility of the patient, so she can carry out the
everyday activity by herself. The next plan should focus on the diabetic condition of the patient.
The focus of the care plan should be on the dietary habits and improved life style in the patient.
The increased physical activity cannot be included in the care plan though, since the
osteomyelitis condition in the patient has impaired her from that privilege. The diabetes
management plan should also include a regular tracking of the body weight and blood glucose
level in the patient (Handelsmanet al. 2015). The plan focusing on the management of the
hypertension should include the regular tracking of the blood pressure in the patient. The dietary
plans made for the patient must also consider this condition in the patient. The regular tracking
of the additional risks associated with the hypertension must also be included in the nursing care
plan for the patient, such as the risks of heart disease and the diseases involving the blood
vessels. The focus of the care plan should be on keeping the anxiety level low in the patient
(Blacher et al. 2014). The plan should involve keeping the patient cheerful and hopeful on the

5CARE FOR A PATIENT WITH COMPLEX CONDITIONS
view of life, by providing her with psychological counselling sessions (Lee 2015). The nursing
staff should also consider her social life and make plans in order to keep the level of social
interaction normal for the patient and prevent her social isolation, which can be achieved by
encouraging the patient to join some social groups, which are consisted of the people with
similar conditions as her (Spiegel and Riba 2015). The care plan should also be focused on her
family in order to involve them in the care of Sara, along with lowering the anxiety level in them
as well. It has been found from the studies that an effective communication with the family and
friends is very effective in lowering the anxiety level in an individual. Along with that if the
members of the patient’s family is aware of the thoughts of the patient, they feel better equipped
for helping the patient, which in turn lowers the anxiety level in them (Spiegel and Riba 2015).
The care strategies should be adapted can be described as followed in this paragraph.
The first strategy focused on osteomyelitis should be lowering the pain and swelling in the
patient’s foot. This can be achieved by prescribing medications to lower the pain and the
swelling. The level of infection can be lowered by administering proper antibiotics. In order to
improve the mobility in the patient, she should be encouraged to practice movement of her feet
considering the pain (Mutluoglu and Lipsky 2016). The tracking of the progression of the disease
can be done by checking the level of swelling and asking the patient questions to be sure of the
level of the pain the patient is experiencing along with the patient’s ability to move her feet.
Along with that, the patient must be kept under strict scrutiny in case of further spreading of the
infection into a nearby area (Kavanagh et al. 2018). If the infection is found to have spread
further, the surgical approach can be considered along with changing the dosage of the
medications (Pourtaheri et al. 2016). There should also be tracking the level of improvement in
the patient by the implemented strategies to determine whether any improvement in the care plan

6CARE FOR A PATIENT WITH COMPLEX CONDITIONS
is required. This tracking should be done in an interval of one week (Glowacki 2015), (Kalia
2018). The care strategies for the management of diabetes in the patients should involve
developing a healthy diet plan for the patient that must be cholesterol and fat-free, should include
green vegetables, fibers and omega 3 fatty acids (Tao, Shi and Zhao 2015). The patient must be
informed about the risks of consuming alcoholic beverages and smoking, so she refrains from
developing such habits. The bodyweight of the patient should be subjected to measurement every
day. The blood sugar level of the patient should also be determined on a weekly basis. The
strategies regarding the control of hypertension in the patient should also involve a controlled
diet, which must contain a low level of sodium, low fat, along with a high level of potassium and
fibre (Siervo et al. 2015). The blood pressure of the patient should be subjected to measurement
on an everyday basis. The level of the anxiety in the patient should also be kept in check by
communicating with patients effectively, informing her about her disease conditions in detail
along with explaining all the strategies that are being implemented in order to help her (Munshi
et al. 2016). The risk of the development of other diseases should be assessed by focusing on the
possible symptoms that the patient is experiencing. The social life of the patient can be restored
by encouraging her to go outside by the use of a wheelchair or inviting people in her own home
and keep a healthy level of communication going on, so she does not feel lonely. The daughter of
the patient should be informed about all the conditions of the patient as well, along with
encouraging her to be involved in the care of Sara. The care strategies should also be discussed
with her along with inviting her to make suggestions, so she understands exactly how her mother
is being helped and to what extent (Arnold and Boggs 2019). The care plan does not require a
team-based approach unless there is a sudden progression with the disease conditions.

7CARE FOR A PATIENT WITH COMPLEX CONDITIONS
The possible progression of the disease will invite the introduction of a few changes in
the care plan. If the infection associated with osteomyelitis is found to be progressing, an
appointment with a doctor must be made immediately in order to decide the further activities
regarding the patient care, which can be changing the dose of the medications or the medications,
admitting the patient in a hospital care facility in order to perform the amputation (Funk and
Copley 2017).
The implementation of the care plan requires proper funding and few resources. The
resources like nearby healthcare center and diagnostic center are required. In order to perform all
the diagnostic tests and assessments to track the progression of the disease conditions, the
proximity of a diagnostic center necessary. In case of deterioration in the health condition of the
patient, she should be in proximity of a healthcare center for the ease of immediate admission
(Akhaddar 2016). The human resources, like the caregivers and the nursing staffs, who are
supposed to be involved in the everyday care of the patient, can be considered (Bogie 2016).
Proper funding will be required for the patient to afford all the expenditure of the treatment,
including the costs of various medications, the fees of the physician and the equipments to assist
her with her impaired mobility. The regular expenditure of the patient to carry out day to day
activity including the cost of her proper diet, house rent and various others also invite the
requirement of the funding, since the patient is currently unable to work to afford all the funding
by herself. Another field in the care plan can be considered that is in requirement of funding. In
case of her admission in a hospital or healthcare facility due to the progression of the disease will
require some immediate but very necessary funding (Geurts et al. 2018).
The involvement of the family in the care plan was aimed in order to achieve a better
outcome. The main focus of that particular intervention was to make the patient feel comforted

8CARE FOR A PATIENT WITH COMPLEX CONDITIONS
and safe, along with lowering the anxiety level of the family members regarding the health
condition of the patient (Oliver et al. 2018). The physical or mental vulnerable condition of an
individual is often improved by implementing the strategy of involving the near and dear ones of
that individual in their care. They feel comforted as they are able to trust that their care is being
monitored by their loved ones. The atmosphere around the patient is always better if they do not
feel lonely and isolated (Castellan et al. 2016). Improved mental health is always a necessity to
be addressed while aiming for better physical health since both are closely associated with each
other.
The involvement of professional caregivers is also supposed to result in better delivery of
the care to the patient. The professionals are experienced, have proper training to follow proper
protocols for care and they are able to make immediate decisions when the health and the well-
being of the patient are concerned (Cree et al. 2015). They are also able to answer any questions
the patient or their family might have concerning the physical and mental health of the patient
and the care plans, which provide some additional comforting feeling to both the patient and her
family that are useful in lowering their anxiety level. Another benefit of appointing professional
caregivers is that they have contact with various other professionals in the healthcare field. This
will lessen the difficulties if the patient is in need of a sudden requirement of admission in the
hospital or the advice of a physician or any other healthcare facilities (Badr et al. 2015).
The clinical decision making for a nursing staff involves considering the patient’s
situation, gathering further data on the patient’s condition, reconsideration of the patient
condition and finally deciding on an intervention that will provide the least risk to the patient’s
health (Aktaş and Karabulut 2016). In this case, Sara had three medical conditions mainly along
with her old age, which are osteomyelitis, diabetes and hypertension. A nurse must be able to

9CARE FOR A PATIENT WITH COMPLEX CONDITIONS
select the condition of the patient that requires the most immediate medical attention, in order to
prevent deterioration of the patient’s health to severe level. The patient was feeling constant and
severe pain in her foot along with suffering impaired movement, which could be easily identified
as the condition that required immediate medical attention. The intervention regarding this was
preventing the spreading of the disease further as soon as possible. The rationale behind this
intervention was to save the patient from the possibility of a permanent disability (Marais et al.
2016). The overall care plan designed for the patient is focused on lowering the risks of any
permanent harm to the patient, including death. The decision of focusing on this condition affects
the whole care plan since a care plan for this condition was the primary need for the patient (Birt
et al. 2017) If this condition in the patient was not addressed, the whole care plan regarding the
diabetic condition and the hypertension condition of the patient in order to promote the well-
being of the patient would have been in vain.
Hence it can be concluded from the above sections that complex care of the patient
involves consideration of all the disease condition of a patient. At first, the condition that
presents the most immediate risk to the patient’s health should be addressed, which was
osteomyelitis in this case. Then a brief consideration on all the disease conditions should be done
with proper justification. Then a nursing care plan must be developed addressing all the disease
conditions in the patient with proper rationale. Finally, clinical decision making must be made
regarding the condition of the patient.

10CARE FOR A PATIENT WITH COMPLEX CONDITIONS
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