Nursing

Tom is 80 years old and was proud of his physical health until recently. He adhered to an exercise regimen, has taken a diuretic for elevated blood pressure about five years (which kept his BP well controlled). He takes no other medications. He ate healthy meals with his wife, and walked to have coffee with his long time friends most mornings. He has lived in the same community of about 3000 people his entire life. All of his friends and social contacts live in this community. The physician who has cared for him the last 40 years lives here as well. His wife passed away suddenly, nearly a year ago. He has one son, Brian who lives about two hours away.

Tom has consistently lost weight since his wife passed away. He has fallen four times in the last six weeks without sustaining a serious injury, and tells you he has experienced “severe bouts of the blues” since his wife died. He has also experienced some difficulty with accomplishing his activities of daily living. His son Brian pays a home health aide to come into the home and help three times a week. The home health aide buys groceries, and helps with ADLs and household tasks three times a week. But, often when she arrives, Tom is unkempt and has not eaten for over 24 hours. It has become more difficult for Brian to visit as his wife is expecting their second child soon. Brian wants Tom to move somewhere safe where staff can keep him safe and manage his care.

Brian comes with Tom to the clinic for his regular check up. The physician advises Tom to move to an assisted facility closer to his son (which is about two hours from Tom's current residence). Tom, although very reluctant, agrees to do.

You are the nurse admitting Tom into the assisted living facility. Tom shares that he was not happy with the decision to move here, but needed to for his son. He tells you that at one time he had a very important job and managed over 50 people and now he can’t even take care of himself. He also shares that he does not want anything done to prolong his life and that he is looking forward to dying and joining his wife.