Case Studies, Chapter 1, Overview of Community-Based Nursing
1. Harold is a 61-year-old bachelor who lives alone on a farm in a rural area. His diabetes has been well controlled for 40 years. Harold had lived with his mother, who cooked for him and administered his insulin. After his mother's death last year, he went to the clinic three times in 3 months for problems with his diabetes. Harold stated, "Every time I went to the clinic I saw someone different. I would tell them the same story three times. Don't they ever talk to each other?" He was admitted to the hospital last week for treatment of a large ulcer on his ankle and uncontrolled diabetes.
This morning you interviewed him in preparation for his discharge. He told you that he has never cooked and doesn't plan to learn now. He would rather go to the bakery and get doughnuts and caramel rolls for breakfast and lunch, and eat cake and ice cream for dinner. He has refused to participate in any care related to his wound or even look at it. Harold seems very attached to his niece, who lives on a farm half a mile from him. She visits him every evening and has offered to help with his care.
Your first plan was to have a home health aide provide homemaking care for Harold. When you suggested this, he said, "No one is going to come into my house and cook in my mother's kitchen! That's what family is for!" (Learning Objectives 4, 6, 7)
a. Describe what you will assess under the following categories as you plan for Harold's discharge.
• In the context of the family and community
• Preventive focus
b. State nursing diagnoses for Harold for each level of prevention and list two client outcomes for each for Harold.
c. Which resources in your community would you suggest for Harold?
2. How can the nurse encourage self-care in the following client situations? (Learning Objectives 6, 7)
a. Jane is the 31-year-old mother of Jackie, a 4-month-old baby who has frequent apnea spells. Jane states, "I am afraid she will stop breathing at home. I can't figure out that monitor."
b. Stephan is a 60-year-old widower whose wife died 3 years ago. There is an increasing possibility that he will have to have his leg amputated below the knee as a result of a very large leg ulcer. Stephan has been hospitalized three times in the last 6 months because of uncontrolled diabetes. The last time he was admitted to the hospital there were maggots in his leg ulcer.
3. How can the nurse encourage a prevention focus in the following client situation? (Learning Objectives 1, 4)
Vivian is an 85-year-old woman you are visiting twice a week for wound care. She has been in the ER twice and the clinic once in the last few weeks because she has fallen in her home.
4. How does the nurse provide care in the context of Meg's family values and community values in the following situation? (Learning Objectives 3, 4, 6)
Meg and Bob have a 3-year-old child, Mark, who has cerebral palsy. Meg provides 24-hour care for Mark and never gets a break. You noticed on your last home visit that Meg has lost weight, is not sleeping, and has no energy. You suspect that she is suffering from situational depression. You recommend several counselors and respite care for Mark so Meg can get out. Meg states, "I come from a very large family. We never use a babysitter in our family."
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