Gestión de cuidados de un paciente complejo a través de un caso clínico.
Fecha
2015-06-24
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Jaén: Universidad de Jaén
Resumen
[ES]Caso clínico de un paciente de 48 años que sufrió un traumatismo craneoencefálico grave. Tras ser dado de alta del hospital y regresar a casa, la necesidad de
cuidados que se generó a causa del mismo y a los problemas asociados, justifican la presencia de la enfermera gestora de casos, para garantizar la continuidad
de los cuidados y actuar como elemento de coordinación entre los niveles asistenciales de Atención especializada y Atención primaria. Para ello, se elaboró un
plan de cuidados, siguiendo el modelo de valoración por patrones funcionales de Majory Gordon. Dicha valoración fue realizada por la enfermera gestora de
casos y su posterior ejecución se llevó a cabo mediante la coordinación con los diferentes profesionales implicados, incluida la enfermera de Atención primaria,
encargada del desarrollo del plan de cuidados. La evolución del paciente fue favorable en casi todos los diagnósticos enfermeros detectados.
[EN] Clinical case of a 48-year-old patient who suffered a severe head injury. After being discharged from the hospital and going back home, the need for care that was generated because of it and the associated problems, it justify the presence of the case management nurse, to ensure continuity of care and act as an element of coordination between levels of care and specialized as well as primary care. For this, a care plan was prepared, following the evaluation model for functional bosses of Majory Gordon. The above mentioned evaluation was realized by management case nurses and its later execution was carried out by means of the coordination with the different implied professionals, including the nurse of Primary health care, taking charge of the development of the plan of care. The evolution of the patient was favorable in almost all of the diagnostics detected.
[EN] Clinical case of a 48-year-old patient who suffered a severe head injury. After being discharged from the hospital and going back home, the need for care that was generated because of it and the associated problems, it justify the presence of the case management nurse, to ensure continuity of care and act as an element of coordination between levels of care and specialized as well as primary care. For this, a care plan was prepared, following the evaluation model for functional bosses of Majory Gordon. The above mentioned evaluation was realized by management case nurses and its later execution was carried out by means of the coordination with the different implied professionals, including the nurse of Primary health care, taking charge of the development of the plan of care. The evolution of the patient was favorable in almost all of the diagnostics detected.