Case Study: Home Nursing Care for a 62-Year-Old Woman with Multiple Health Problems

International Journal of Nursing Terminologies and Classifications, Apr-Jun 2009 by Cirminiello, Christine, Terjesen, Margaret

PURPOSE. This case study illustrates the characteristics of, and challenges for, a woman in the United States with multiple health problems.

DATA SOURCES. Data were obtained through the authors' experience and knowledge of community health nursing and from published literature.

DATA SYNTHESIS. NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification were utilized to identify appropriate nursing diagnoses, interventions, and outcomes for the client.

CONCLUSION. This case study illustrates and provides appropriate nursing diagnoses, interventions, and outcomes relevant to a woman with many health concerns. It provides guidance for nurses in community health settings when caring for patients with multiple health problems.

IMPLICATIONS FOR NURSING PRACTICE. Utilizing the standardized nursing languages of NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification can provide the necessary framework for enhancing and improving the management of care for patients with many health concerns in the community setting. Search terms: Nursing diagnosis, health outcomes, nursing interventions, arthritis, diabetes, obesity, home care

L.S. is a 62-year-old African American female who is 5 ft 4 in. tall and is considered morbidly obese (247 lbs). She lives in a two-story house with A. L., her close friend and roommate. L. S. has many health problems, including hypertension, coronary artery disease, arthritis, asthma, diabetes for 44 years, and potyneuropathy. She is unable to care for herself independently and often requires assistance from her roommate. L. S. has difficulties in completing activities of daily living and counts on the help and support of others to maintain her health and safety. She recently experienced increased symptoms of osteoarthritìs with further decline in ability to safety ambulate and thus qualified for home healthcare services. After evaluation, a local home health agency certified L. S. for Medicarereimbursed visiting nurse service two times a week, a home health aid (HHA) 4 hr a day for 5 days a week, and a physical therapist (FT) two to three times a week. The nurse assesses her cardiopulmonary status, genitourinary status, gastrointestinal status, and mobility and provides nursing interventions as indicated. The nurse helps L. S. to accurately follow the medication regimen and provides referrals as needed for signs or symptoms of complications.

With L. S. 's excess weight and severe knee and ankle arthritis, her ability to walk was severely limited. She often ambulated for only short distances with frequent rest periods and use of a walker. L. S. becomes short of breath and feels fatigued easily and often complains of knee pain upon ambulation. The HHA assisted L. S. with personal care activities such as bathing and grooming, washing her clothes, ambulation, grocery shopping, preparation of meals, and other household chores. The HHA also accompanied her to and from her physician appointments.

On her last home visit, L. S.'s blood pressure was 140/80 at rest 20 min after taking her prescribed antihypertensive medications. Her heart rate was 80 beats per min with regular rate and rhythm, temperature was 98.80F, and respiration was 20 per min. Her fasting fingerstick blood sugar at 6:30 a.m. before breakfast was 125 mg a deciliter. She generally monitors her blood sugar before each meal and at bedtime. L. S.'s insulin regimen is to take 5 units of homolog insulin three times daily and 35 units of Lantus insulin (Sanofi Aventis, Bridgewater, NJ) subcutaneously before bedtime with a snack. L. S. is independent in measuring her blood glucose and in administering her insulin. She follows the medication regimen independently and verbalizes adequate understanding of all medications and the times of administration.

L. S. is an active participant in her care and stated she is working hard to regain her independence. The PT assists her in therapeutic exercises, ambulation techniques, strength training, balance, weight bearing, stair climbing, and gait training. The PT also worked with L. S.'s roommate, A. L., to teach her how to assist L. S. with safe stair climbing using a walker. L. S. verbalized the need to lose weight, change her eating habits, and incorporate more exercise into her normal daily routine.

L. S. is a kind, caring, and motivated woman. She spoke to the nurse about the help that she receives and how much she truly appreciates the help. She wishes to be able to do more on her own and work toward regaining her independence.

What is the best diagnosis of L. S.'s responses to health problems and life processes?

Case Study: L. S.

Analysis of Data: Nursing Diagnoses, Outcomes, and Interventions

L. S. 's health problems of diabetes, hypertension, arthritis, and being overweight have existed for many years but have worsened in recent years. The services she receives from the visiting nurse, the PT, and the HHA are needed now and are reimbursed by Medicare. These health problems are chronic, however, and Medicare only reimburses home healthcare services for acute health problems or acute exacerbations of chronic conditions. Prior to receiving visiting nurse services, L. S. had been doing the best she could under the existing circumstances. She will benefit from these services for about 9 weeks and then she will be reevaluated for continuation of services.