Nursing

Chose to write a care plan for George. Although your plan of care will not be specifically developed for Alice, understanding her situation is a very important component of the plan you will develop for George.

George and Alice, both 75 years old, both grew up a town of about 1000 people. They were high school sweethearts. Soon after George’s return from military duty in Vietnam they were married and started their family. They raised five children while working hard on a small dairy farm about 10 miles from the same town where they grew up.

George was recently discharged from the Veteran’s Administration Hospital (VA) about two hours away from their home, following an exacerbation of congestive heart failure (CHF). About five years ago he was told that he had ‘a bad case’ of diabetes and needed to lose 100 pounds if he wanted to live another five years. With the support and help of Alice, he did lose nearly 80 pounds. After the weight loss, he has been able to manage his diabetes with diet and oral medication. He was diagnosed with CHF about two years ago and has been hospitalized three times since then due to exacerbations. Because of wanting to make the best use of his veteran’s benefits, he travels two hours each way for his health care at the VA.

Alice suffered a stroke two years ago that left her with marked left sided weakness and expressive aphasia. She can get around in the house with a walker, and requires only minimal assistance from George with activities of daily living. She is unable to drive. George tells you that he and Alice communicate effectively, but that it is very difficult for her to communicate with anyone else.

The children all live over three hours away. They call and talk with George every week on the phone. They coordinate visits so that one of the children travels to visit George and Alice every month. One son is retired and has been able to bring George for his scheduled check ups at the VA. The children have been trying to convince their parents to move to an assisted living arrangement closer to one of their homes and the VA where George receives care. George and Alice have been resistant as all of their friends live in this rural community and Alice trusts her local small town doctor of the last 40 years. George continues to go out for coffee with his friends every weekday morning, after Alice is up and dressed for the day. George feels comfortable driving in their local community, but no longer will drive on major highways.

George and Alice made it clear to their children years ago, that if they became seriously ill, they did not want their children to do anything ‘extraordinary to save them’. However after Alice had the stroke, George has confided to his children that he needs to stay well to care for her.

You are the home health nurse making an initial visit following George’s discharge from the VA. The couple has never received home care services before this time. Alice is in tears. George shares that he is perplexed by some of the discharge instructions from the VA and feels like he has no control over anything. He tells you that he has been able to handle pretty much everything without help so far in his life, but after this last hospitalization, the future frightens him.