Question

Red Yoder is an 80-year-old farmer who lives alone in the farmhouse where he grew up. It is located 20 miles outside of town. Red has been a widower for 10 years. Red rarely cooks for himself and mainly eats packaged or processed foods. His son, Jon, manages the farm now, but Red is still involved in the decision making.Red’s current medical problems include insulin-dependent diabetes complicated by an open foot wound. He also has some incontinence and difficulty sleeping.

Red is awaiting a visit from the home health nurses. He relates that he has an open wound on his big toe that developed after walking in a new pair of shoes. When his daughter-in-law, Judy, saw the wound, she called the family doctor, who suggested a visit by the wound care nurse, who works with the home health agency. Red agreed as long as his VA benefits cover the costs. Red is aware that his son and daughter-in-law have concerns about him living alone, but Red insists that while he needs a little help from Jon and Judy at times, he is still capable of caring for himself.

What are Red’s strengths?
What are your concerns for this patient?
What is the cause of your concern?
What information do you need?
What are you going to do about it?
What is Red experiencing?

Answer 1

ANSWER 1:- Red's strength are that-

1. Even though now Red's farm is managed by son Jon, Red is still involved in decision making.

2. Red is having diabetes and wound in big toe and for treatment he is self sufficient even at 80 years of age as he has VA benefits which is his strength at this time.

3. Red's daughter-in-law Judy called family doctor immediately after she saw the open wound on big toe of Red, which shows she is a caring daughter in law. Jon, Red's son is also concerned about Red's health. So, his son Jon and daughter-in-law Judy are his strength morally.

ANSWER 2: My concerns for Red are-

1. Red cooks rarely because he lives alone and uses packaged food more often which is not good for health as they contain preservatives. Red being old and diabetic should eat fresh and self made food instead of packaged food.

2. Red is a diabetic patconcerns ad has open wound in big toe. In a diabetic patient, the healing ability of body decreases and a person also becomes immunocompromised. I am concerned about his wound healing and if his wound in big toe increases due to slow healing, he might require to get his toe amputated.

3. My bigger concern about Red is that he has some incontinence and sleep difficulties.

ANSWER 3: The cause of my concerns are as:

1. He is 80 year old and lives alone.

2. He is a known diabetic so his healing process is not good. And he has open wound in big toe. His toe might not heal he may need amputation.

3. He is finding difficulty in sleeping with incontinence that might be due Sleep apnea which is a serious issue.

ANSWER 4: I need more information about Red's incontinence and sleep difficulties. I want to know about what sleep difficulties does Red have, and does he feels his breathing stops and starts while sleeping. And about the urinary incontinence.

ANSWER 5: I will try to figure out if he feels as if his breathing stops and starts repeatedly sleep to rule out sleep apnea, which in turn will be a possible cause of urinary incontinence in Red. Then I will start management of sleep apnea immediately in red. I will ask Red to buy a device called Continuous Positive Airway Pressure (CPAP) machine. The pressure of air in this machine is greater than that in surrounding and is enough to keep your upper airways open and prevent apnea.

ANSWER 6: It seems Red is possibly experiencing sleep apnea that is causing urinary incontinence in him. In sleep apnea, patient breathing stops and starts repeatedly during sleeping which is a very serious condition. The urinary incontinence in sleep apnea is caused due to overactive bladder.