NURS FPX 6610 Assessment 4 Case Presentation


NURS FPX 6610 Assessment 4 Case Presentation

NURS FPX 6610 Assessment 4 Case Presentation


Capella university

NURS-FPX 6610 Introduction to Care Coordination

Prof. Name


Importance of Case Study in Healthcare

Case studies play a critical role in the healthcare industry. They provide a brief and accurate description of patient medical information. Case studies are crucial because they include comprehensive details regarding the patient’s medical condition, diagnoses, potential health issues, and treatment options. By incorporating actual patient scenarios, case studies serve as an excellent means to track patients and revisit these documents when necessary (Hinchliffe et al., 2020). Today, I will focus on transitional patient care and discuss how multidisciplinary teams can collaborate to ensure their patients receive the best treatment possible.

Transitional Care Plan and Goals of Continuing Care

In this case presentation, I will first discuss transitional care in healthcare settings. Transitional care focuses on the care of patients as they move from one healthcare setting to another. This care is necessary to ensure the patient’s welfare during the transfer process (Daliri et al., 2019). Additionally, the goal of hospital medical personnel is to make the transfer process as stress-free and feasible as possible for the patients. In this case, we will discuss a 56-year-old patient named Mrs. Snyder, who needs to be transferred from one medical center to another due to her critical condition. Continuing care aims to provide quality care to Mrs. Snyder while respecting her religious and cultural beliefs (Jewish) as she suffers from serious health issues.

Stakeholder Part in Patient Health and Safety

Stakeholders are essential in establishing the patient’s quality of care and well-being (Lianov et al., 2020). It is their responsibility to ensure that their patient is cooperative and not under excessive burden. In Mrs. Snyder’s case, healthcare professionals must focus on transferring her from one organization to another without causing her any trouble. Given that Mrs. Snyder is Jewish, healthcare providers involved in the transfer process need to ensure she receives complete care that respects her religious and cultural beliefs. Mrs. Snyder’s needs and wants must be fulfilled according to her religious and cultural values, including providing kosher food to accommodate her dietary needs (Lianov et al., 2020).

Elements of Continuous Care

The first component of continuous care is identifying the medical records of the patient and her family, which helps detect the exact root cause of the problem. Studies confirm that diabetes can be inherited (Pervjakova et al., 2022). Individuals with a family history of diabetes have a higher risk of developing the condition. Accurate patient evaluation is another essential component of continuous care, serving as a cornerstone for treatment. Additionally, as medical documents are main sources of data transmission, healthcare organizations must focus on collecting accurate medical records of patients (Asmirajanti et al., 2019).

Patient Assessment

Mrs. Snyder has several health issues that pose a danger to her well-being. Understanding her medical background is essential for effective transitional treatment. Villa Hospital’s medical personnel ensured that her evaluation was accurate. The details of Mrs. Snyder’s evaluation are as follows:

Mrs. Snyder has ovarian cancer, a chronic disease that can be fatal (Khanlarkhani et al., 2021). Her condition is extremely critical, and doctors have indicated she has little time to live. Additionally, she suffers from diabetes and hyperglycemia, which increase the risk of high blood sugar levels and potential death (Demir et al., 2021). Her weight has increased due to improper healthcare management and family stress, which also causes her blood pressure to fluctuate.

Mrs. Snyder was undergoing chemotherapy, which negatively impacted her health, causing physical pain (Khanlarkhani et al., 2021). Due to these issues, she is experiencing significant stress and depression. As a housewife who always cares for her family, she does not want to burden them. With strong cultural and religious beliefs, she prefers to move to another institution that respects cultural differences and allows her to practice her beliefs freely.

Interprofessional Care Team

Every medical procedure requires excellent coordination and communication to evaluate and control the audience’s needs effectively. Mrs. Snyder’s interprofessional team includes thyroid doctors, heart specialists, cancer specialists, and nurses due to her multiple medical issues. This ensures that all treatment guidelines are followed correctly. In Mrs. Snyder’s case, the nurse’s role involved referring her to other healthcare sectors for specialist consultation and treatment. Nurses can assist by adjusting her therapy and medication doses. For example, medical experts advised transferring Mrs. Snyder to a healthcare institution rather than staying at home to receive better care and treatment (Ansa et al., 2020).

Factors Affecting Patient Outcomes

Various factors can impact patient care, including economic conditions, poor lifestyle choices, and inadequate social support and surroundings (Chung et al., 2020).


The underlying assumption is that Mrs. Snyder practices Judaism and thus requires kosher food, making it essential to consider her dietary restrictions during treatment. Additionally, her family is under economic stress, and her son struggles with addiction. Ensuring the patient does not feel insecure and overstressed in the limited facilities is crucial. This can be achieved by frequently monitoring the patient and encouraging visits from her relatives.

Areas of Uncertainties

There will always be some degree of uncertainty; therefore, nurses should be well-trained to assist critically ill patients like Mrs. Snyder (Chung et al., 2020).

Determination of Required Resources

Several resources are required to care for Mrs. Snyder effectively (Howell et al., 2020). These include:

  • Checking blood pressure and sugar levels frequently
  • Consuming healthy food while avoiding excessive carbs, salt, and sugar
  • Proper and timely diabetes treatment
  • Daily exercise
  • Assistance from nurses for daily activities

Additionally, to provide the best quality of care, the organization must have all the necessary equipment for treatment (Howell et al., 2020).


Mrs. Snyder suffers from various health issues, including cancer, diabetes, and stress. To address these issues, she needs to be transferred to another healthcare center where she can receive satisfactory care. A transitional care plan is necessary for such transfers (Daliri et al., 2019). It is also important to provide the best quality treatment while respecting patients’ religious and cultural beliefs. With strategic initiatives, patient care quality can be enhanced, and mortality rates reduced. As healthcare providers, it is our duty to ensure our patients’ needs are met.


Ansa, B. E., Zechariah, S., Gates, A. M., Johnson, S. W., Heboyan, V., & De Leo, G. (2020). Attitudes and behavior towards interprofessional collaboration among healthcare professionals in a large academic medical center. Healthcare, 8(3), 323.

Asmirajanti, M., Hamid, A. Y. S., & Hariyati, Rr. T. S. (2019). Nursing Care Activities Based on Documentation. BMC Nursing, 18(1).

Chung, G. K.-K., Dong, D., Wong, S. Y.-S., Wong, H., & Chung, R. Y.-N. (2020). Perceived poverty and health, and their roles in the poverty-health vicious cycle: A qualitative study of major stakeholders in the healthcare setting in Hong Kong. International Journal for Equity in Health, 19(1).

Daliri, S., Hugtenburg, J. G., ter Riet, G., van den Bemt, B. J. F., Buurman, B. M., Scholte op Reimer, W. J. M., van Buul-Gast, M.-C., & Karapinar-Çarkit, F. (2019). The effect of a pharmacy-led transitional care program on medication-related problems post-discharge A before—After prospective study. Plos One, 14(3), 0213593.

NURS FPX 6610 Assessment 4 Case Presentation

Demir, S., Nawroth, P. P., Herzig, S., & Ekim Üstünel, B. (2021). Emerging targets in type 2 diabetes and diabetic complications. Advanced Science, 8(18), 2100275.

Hinchliffe, R. J., Forsythe, R. O., Apelqvist, J., Boyko, E. J., Fitridge, R., Hong, J. P., Katsanos, K., Mills, J. L., Nikol, S., Reekers, J., Venermo, M., Zierler, R. E., & Schaper, N. C. (2020). Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes/Metabolism Research and Reviews, 36(1).

Howell, D., Mayer, D. K., Fielding, R., Eicher, M., Verdonck-de Leeuw, I. M., Johansen, C., Soto-Perez-de-Celis, E., Foster, C., Chan, R., Alfano, C. M., Hudson, S. V., Jefford, M., Lam, W. W. T., Loerzel, V., Pravettoni, G., Rammant, E., Schapira, L., Stein, K. D., & Koczwara, B. (2020). Management of cancer and health after the clinic visit: A call to action for self-management in cancer care. JNCI: Journal of the National Cancer Institute.

Khanlarkhani, N., Azizi, E., Amidi, F., Khodarahmian, M., Salehi, E., Pazhohan, A., Farhood, B., Mortezae, K., Goradel, N. H., & Nashtaei, M. S. (2021). Metabolic risk factors of ovarian cancer: A review. JBRA Assisted Reproduction.

NURS FPX 6610 Assessment 4 Case Presentation

Lianov, L. S., Barron, G. C., Fredrickson, B. L., Hashmi, S., Klemes, A., Krishnaswami, J., Lee, J., Le Pertel, N., Matthews, J. A., Millstein, R. A., Phillips, E. M., Sannidhi, D., Purpur de Vries, P., Wallace, A., & Winter, S. J. (2020). Positive psychology in health care: Defining key stakeholders and their roles. Translational Behavioral Medicine, 10(3), 637–647.

Pervjakova, N., Moen, G.-H., Borges, M.-C., Ferreira, T., Cook, J. P., Allard, C., Beaumont, R. N., Canouil, M., Hatem, G., Heiskala, A., Joensuu, A., Karhunen, V., Kwak, S. H., Lin, F. T. J., Liu, J., Rifas-Shiman, S., Tam, C. H., Tam, W. H., Thorleifsson, G., & Andrew, T. (2022). Multi-ancestry genome-wide association study of gestational diabetes mellitus highlights genetic links with type 2 diabetes. Human Molecular Genetics, 31(19), 3377–3391.

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