Problem
Case Study of N.G.
You are the community nurse asked to assess a client. N. G. is an 84-year-old woman who lives on a farm in rural Appalachia. Her home was built in the 1950's when her in-laws lived on the farm and needs significant maintenance. N. G.'s husband died seven years ago; he had managed many of the household activities such as the banking. N. G. has three children: Two sons live near by and a daughter lives four hours away. One of the sons takes his mother to her medical appointments if they are close and helps her with grocery shopping, but he is not always available to help. The other son only contacts his mother by phone occasionally. The daughter comes to visit her mother every two months for a few days.
N. G. is obese, has lived with diabetes mellitus type 2 for 40 years, and hypertension. She takes an oral hypoglycemic (metformin), NovoLog insulin, and diuretics (hydrochlorothiazide and furosemide) to manage her hypertension. She suffers from stress incontinence and does not like to take her diuretics as this increases her need to urinate. She has not been prescribed any medication for the urinary incontinence and her provider has recommended she see a urologist for a surgical repair. She showers several times during the day due to the overflow of urine despite using incontinence undergarments and pads. She regularly has peripheral edema at 3+ because of her reluctance to take her diuretic medications. She also has had two surgeries on her right eye to stabilize a corneal transplant and has lost some vision in her right eye. She has poor mobility; she requires a recliner chair that has a hydraulic lift so she can elevate and uses a walker to mobilize. She cannot stand long without having significant pain in her legs and feet. She prefers foods that she can quickly warm up in the microwave. She had been using Meals on Wheels five times a week, but the meal is heavy in carbohydrates driving up her blood sugars and HbA1c (8.3 at last check) so she stopped the meal delivery. When making meal choices, N. G. still tends to choose foods she grew up with in her Appalachian community even though she knows these foods contribute to her hypertension and high blood sugar. N. G. is socially isolated due to her challenges in mobilizing outside of the home and the urine incontinence.
Her daughter would like for N. G. to come and live with her, but the daughter's home is small and would require the daughter to sleep on the couch so her mother could have her room. N. G. also has three small dogs who "are her life" and cannot bear the idea of being without their company. N. G. is on limited income and gets $15.00 monthly food stamp supplement, but her social security payment is $100.00 over the limit to receive Medicaid. Moving closer to town into an apartment is out of the question as she does not want to give up her pets, and she does not have the supportive income to allow her to live in an assisted living complex without selling the family farm which she wants to leave to her children. While she no longer attends church, she has a strong faith in God and believes that her current health status is "God's will" and she has little ability to control her status.
Use the link to the Barthel Index for Activities of Daily Living to determine the level of functional independence of N. G. Using one of the theories of aging (biologic, sociologic, or psychologic - state which one is used), provide an assessment of N. G.'s family dynamics, cultural patterns, and psychosocial functioning. From your full assessment of this client, identify three priority nursing actions you would recommend using a philosophy of "aging in place." When choosing your priorities, take into consideration N. G.'s personal preferences, and socioeconomic status. How would you advocate for this client?
We see that the best option for this client is to "age in place" but how?
What viable tech options exist to enable better monitoring of this client? What community resources can the nurse tap into to help this patient? What additional screening tools should be used in the care of a chronically ill patient?