Question

Mary is a 60-year-old woman who lives alone in the Midwest and works full time. Mary has a history of chronic obstructive pulmonary disease (COPD) but so far is able to manage it with medications and lifestyle. Her parents Steve and Joan (ages 88 and 85, respectively) live in Florida in their own home. When they moved to Florida more than 20 years ago there were many retired couples nearby, but the neighborhood is changing and has more working class families with young children now. Many of their old friends and neighbors have died or moved. Joan had a stroke several years ago and has right hemiparesis. Joan can do most of her own ADLs with minimal assistance; however, Steve helps her with showering and dressing. He also helps with all Joan’s IADLs, and does all the cooking, laundry, driving, shopping and managing finances. Mary talks with her parents several times each week. She has noticed that her dad seems depressed and his short-term memory has gotten worse. She is concerned about his ability to continue to care for her mom, take care of household tasks, and pay bills. Mary has broached the possibility of having Steve and Joan move to a retirement community near her, but her dad insists that he and Joan are managing just fine. Mary is concerned about their health and safety, but she doesn’t know what to do.

As a health care professional, what are your biggest concerns about Mary, Steve, and Joan? What assessments would you recommend?

Student provides detailed answer to case study questions related to issues with distance care-giving, use of smart technology to provide care, and concerns/other assessment recommendations with rationale supported by references.

Answer 1

1.Assessments for Mary

Psychosocial assessment

Healthy coping is a challenge for COPD patient and the family. People with COPD frequently have to deal with many lifestyle changes that may involve decrease ability to care for themselves , decreased energy for care fro themselves, decreased energy for social activities and loss or change in job

Emotions frequently encountered include gulit, loneliness from social isolation, denial and frustation from increased dependence. Guilt may result form knowledge that diseases was caused largely by cigarette smoking. As a result many of the patients struggle with depression and anxiety. It is very important to convey a sense of understanding and caring to the patient. The patient with COPD may benefit from stress management technique (massage and muscle relaxation

Effect of moving on patients

Patients frequently ask whether moving a warmer or drier climate will help. In general, such a move is not significantly beneficial. Discourage moves to places with an elevation of 4000 ft or more because of the lower partial pressure of oxygen

A disadvantage of moving may be that a person leaves their job, friends,and familiar environment which could be psychologically stressful. Any advantage gained from different climate may be outweighed by the psychologic effects of the move

Patients need to know that symptoms can be managed , but COPD cannot be cured.

Assessment for Steve and Joan

With comprehensive assessment of older adults information rearding strengths, limitations and resources, the nurse and the older adults identify needs and problems

A thorough assessment requires the nurse to actively engage older adults and provide them enough time to share important information about their health

Nursing assessment takes into account five key points to ensure an age-specific approach:

• The interelational between physical and psychosocial aspects of aging
• Effects of disease and disability on functional status
• decreased efficency of homeostatic mechanisms
• the lack of standards for health and illness norms
• altered presentation and response to a specific disease

Assessment of cognitive changes

The three conditions affecting cognition are delirium, dementia and depression. Distinguishing among these three conditions is challenging. Complete a careful and thorough assessment of older adults with cognitive changes to distinguish among them

• It is important to assess both the nature of psychosocial changes that occur in older adults as a result of life transitions and the loss and adaptation to changes
• During the assessment, ask how the older adults feel about self as one who is aging and what coping skills and methods have been useful
• Areas to address during the assessment include family, intimate relationships, past and present role changes, financing, housing, social networks, activites, health and wellness, and spirituality
• Assess patients potential for social isolation by identifying their social network, access to transportation and willingness and desire to interact with others
• Assessment of safety, a major component of older adult's environment, includes risks within the environment and the older adult's ability to recognise and respond to the risks