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Case Study: Elderly

Using the PHN Practice Model, go through the following patient scenario:
You are a Public Health Nurse (PHN) for a large metropolitan county. You receive a
referral requesting that you visit an elderly 80 y.o. man. His name is Walter Jones. The
referral was sent from Kaiser Permanente, Harbor City. The discharge planner writes that
he was recently hospitalized after falling down 5 stairs and would like you to follow up
on him, as his caretaker states that she is stressed out about his care.
You call the discharge planner for clarification and more information. On the phone, the
discharge planner states that the client has dementia and Parkinsons Disease. He
recovered well in the hospital, ate well, and had many visitors. His caretaker is his
girlfriend, Bonnie, and she told the nurses that she was not sure how much longer she
would be able to look after him.
You decide to go out to the residence that afternoon.
The client lives in a mobile home park. His mobile home is well kept and clean. You
notice that there are stairs leading up to the residence.
1. For your initial visit, what other assessment data would you need? How would
you ask questions to obtain this assessment data?

Upon your initial assessment, you find that the client and his girlfriend/caregiver have
been together for 4 years. W.S was also dxd with dementia and Parkinsons 4 years ago.
W.S was in the military. Bonnie is not pleased with the care W.S. received in Kaiser. She
states that W.S. was continent before entering into the hospital and now he is not. She is
very frustrated by this. She is additionally stressed out because they are getting evicted
from the mobile home later this month and does not know of or have another place to go.
While your interview with Bonnie is taking place, you note that WS does not address you
& he is pacing the room that you are in. He does not seem like he is in distress. He is
dressed and clean.
2. What are the priority issues to address for each person? List them from most
important to least important (ie what are you going to address first, and what can
wait?). What is your rationale for this priority?

Because of the eviction issue you ask how much money they receive each month. Bonnie
states that they receive $5500 per month from W.S military pension. Rent is $900 with
utilities included.
3. Does this information change your priority issues? Please explain rationale.

4. What is your dx for this family?

5. What outcomes would you plan for this family?

6. Who are your public health partners or people that can help you in this case?

7. What interventions will you do for this family? (Minnesota Wheel) At what level
of prevention are these interventions?

8. How will you evaluate your interventions?

9. What issues will you follow up on for your next home visit?