During the PSW outreach, the nurse care manager identified that the patient had recently moved out of the area and was out of nutritional supplies. The nurse care manager was able to assist the patient in finding a new nutritional supplement provider and order more supplies.
Unfortunately, the patient continued to have severe abdominal pain while receiving services in the home and was unable to tolerate their enteral nutrition. They began to lose weight and were declining in level of mobility and strength. Despite having their tube evaluated and determined to be working properly, the patient continued to raise concerns over their abdominal pain that was not being addressed. This began to have an impact on the patient's mental health by increasing anxiety and depression.
The PSW nurse care manager continued regular follow-up to support their physical and emotional needs. The nurse care manager advocated for the patient's concerns about pain, and helped to secure an appointment at a local facility to have their tube replaced. The patient's pain was relieved following the procedure, and they are working with the PSW nurse care manager to support needs related to weight management and nutrition. The patient has also reported that having the PSW nurse care manager's support was very important to help reduce their anxiety and depression.