Nursing

Write your plan for either John or Ann (not both), remembering that the household and environmental situation impacts the health and well-being of both and so must be considered in the assessment.

John an 80-year-old retired farmer, is the primary caregiver for his wife Ann, age 82. Ann was diagnosed with Alzheimer’s disease five years ago. Ann has experienced frequent urinary tract infections over the last few years. She has hypertension, which has been managed with a diuretic. They have two children who both live over four hours away and are busy with their own families. The two children communicate via phone with their father twice a week. They take turns visiting, with one of the children coming every month for about 24 hours. John tells you tearfully that his children address practical concerns related to Ann’s situation, but do not seem to understand how difficult the situation is becoming for him. He says they remind him of how he has always been able to handle any challenge independently. He tells you he understands that they are just trying to encourage him, but also that this is more difficult than prior challenges in his life.

John tells you that he feels 'pretty good', but admits to being exhausted and lonely. He tells you that he has some back pain from helping Ann up from the floor after falls, but he is dealing with that using over the counter medications.

John and Ann live in a rural community of about 800 people. Until six months ago, John walked to the local diner to have coffee every morning with a few of his life long friends. On two occasions when he came home, Ann was outdoors, wandering around the neighborhood. One time, she had gotten into their car and driven out into the country. Fortunately, the sheriff knew her and brought her back home. After these incidents, John decided that he could not leave her alone at home. John and Ann are lifelong members of the local church, but they have not attended in recent months because he is fearful of leaving her, and it makes her agitated if he takes her along.

You are a home care nurse and visit every other week. A home health aide comes to the home three times a week to help with bathing Ann, light housekeeping, and shopping. John’s biggest concerns related to Ann are increasing episodes of urinary incontinence; increasing unsteady gait that has led to a couple of falls over the last month; sporadic appetite (some days she eats a lot and other days almost nothing); and her continued behavior of following him from room to room in their home.

John confides in you that he is getting frustrated. He tells you that he and Ann have put aside money to pay for their grandchildren’s college education, but beside that fund their financial resources are limited.

John and Ann promised each other years ago, that they would care for each other. They also made it clear to the children that they did not want any extravagant or life saving or prolonging measures taken as they aged.