Red Yoder is an 80-year-old farmer who lives alone in the farmhouse…

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. 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. During the assessment, the nurse discovers that Red is having sleeping problems and some urgency incontinence. He also makes statements that should cue learners that further assessments are needed of his diet, medication, and alcohol use, and to rule out elder abuse.

Name: Sherman “Red” Yoder

Date of Birth: 11-13-19xx

Gender: M Age: 80 Weight: 240 lb (109 kg) Height: 71 in

Race: Caucasian

Major Support: Jon (son) Support Phone: 869-555-3452

Allergies: No known allergies Immunizations: Influenza last fall; tetanus 4 years ago

Attending Provider/Team: Frank Baker, MD

Past Medical History: Diabetes type 2 diagnosed 6 months ago

History of Present Illness: Developed an ulcer on big toe 3 weeks ago. Has been soaking foot in attempt to heal the wound. When he revealed the wound to his family, they notified Dr. Baker.

Social History: Widower; son Jon lives nearby

Primary Medical Diagnosis: Pressure ulcer on right great toe; type 2 diabetes

Surgeries/Procedures & Dates: Laminectomy (L 4-5) 25 years ago; transurethral resection of prostate 6 years ago

Time: 10AM

Person providing report: Home health agency nurse manager

Situation: Red Yoder is an 80-year-old farmer who lives by himself. We have a referral from Dr. Baker to see him in his home to evaluate a reported foot wound.

Background: Mr. Yoder was diagnosed with type 2 diabetes about 6 months ago. He is on metformin and glipizide. His daughter-in-law, Judy, called Dr. Baker about a foot wound. He reportedly got a blister 3 weeks ago and it is getting worse. Judy is concerned about his foot and also about his ability to live by himself. Dr. Baker’s office nurse faxed some assessment tools (SPICES, Katz, and Epworth) to him with instructions to complete before your visit. They are very familiar with Red and are confident he is capable of completing them, with Judy or John’s help.

Assessment: Older adult with foot wound and family concerns regarding safety and self-care.

Recommendation: During the home visit, please assess his foot wound, review the assessment tools that Mr. Yoder should have completed: the SPICES, KATZ Index in Activities of Daily Living, and the Epworth Sleepiness Scale. You may wish to administer the Alcohol Use Screening, depending on whether or not you have concerns

RED:

Sitting comfortably in chair; alert and oriented; answers all questions.

Red: “Judy told me you wanted to check in on me and make sure I’m still o.k. to live out here by myself. Will you look at my foot first?”

“The sore on my toe happened when I wore my new shoes too long. I can’t feel anything; it doesn’t hurt. If you show me how to take care of it, I can manage I think. I’ve been soaking it in warm water every day.”

Answers to SPICES:

Sleep: Has trouble falling and staying asleep. Drinks a couple of beers (2) before bed to help him sleep and recently began taking 2 diphenhydramine “to help fall sleep”

Problems Eating/Feeding: no

Incontinence: Has urgency with urination on occasion, since surgery.

Confusion: No

Evidence of Falls: No

Skin Breakdown: On right big toe

Score on KATZ: 5

Bathes self uses shower chair if needs to sit.

Judy does his laundry. He usually wears something easy to put on.

Has urgency with urination occasionally since TURP.

Cooks simple meals. Judy brings over casseroles to get him through the week.

1) Based on our discussion about Red Yoder,

a.describe his strengths and weaknesses.

b.how would you assess the quality of care the home health nurse had provided to him?

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