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1. Introduce and describe your role in this case. What your profession does and explain why you should be involved in this case.
2. Discussion of the case:
Discuss which aspects of the case you can address. From the perspective of your professional role, what are the strengths of the patient? What are the strengths of her social and physical environments? What are your concerns? How might professionals in your disciple address these concerns?
3. Developing a plan and priorities:
Identify the three most critical issues for Helen’s return to home.
Helen’s Case Study
Helen is a 79-year-old woman who was seen in the hospital for left knee replacement surgery. She is 5’2” and weighs about 150 pounds. In addition to her knee surgery, she was diagnosed six months ago with Type II Diabetes. Helen also has high blood pressure that is controlled with hydrachlorathiazide and garlic pills.
The day after surgery, she was given a continuous motion machine that passively moves her knee joint to keep it from getting tight. Helen was able to stand with partial weight-bearing (weight of leg only) on her operated leg while using a walker. Helen was able to walk 10 feet with a walker (with moderate fatigue), but could not do stairs safely without a railing. She is stiff and sore and moves slowly.
A care conference was held with the team (including Helen and her husband) on the second day to plan for her discharge home. The team members included a physician, nurse, pharmacist, physical therapist, occupational therapist, social worker, and dietician.
Helen lives with Ed, her husband of 58 years, in an older home in the inner city. Their home is a typical older home, with 6 steps up to the porch, and one step into the home. They have no railings at the entrance in the home. The living room, dining room, half bath, and kitchen are on the first floor, laundry is in the basement, and 3 bedrooms and a bathroom with a tub shower combination are on the second floor. Ed and Helen met when they both worked at Honeywell, Ed as an engineer and Helen as clerical staff.
Ed reported that on a few occasions Helen fell at home when she was trying to get to the bathroom in the middle of the night. Although each fall did not result in serious physical damage, he is worried that she could have been much more badly hurt, and is interested in doing whatever is needed to make things safer for both of them.
Helen and Ed have been coping well, but between Helen’s diagnosis of Type II Diabetes and the knee problems, things have become more difficult. Ed is struggling with the cooking. Helen has had problems with seeing to read her blood sugar monitor. She has also had trouble with keeping her diabetes under control because she has been less active. In addition, while her hypertension has been well-controlled with medication up until now, it was elevated since the surgery.
Helen has always been healthy and active. She enjoys gardening, singing in her church choir, and taking walks with her dog. Both Helen and Ed report that they have been having more difficulty keeping up with things, such as snow removal, lawn care, and shopping, and that they seem to tire more easily. Ed and Helen want to stay in their own home, and are willing to pay for services or remodeling to make that happen. Their friends are in this neighborhood where they have lived for 50 years, and they don’t want to move. Both Helen and Ed drive, and report no problems.
They have two children Tony and Susan, who are very close to their parents emotionally, but live a day away. Tony visited this summer, and had concerns about his parents’ driving and getting up and down the stairs in their home, particularly when entering the home carrying groceries, and when Helen carried the laundry up and down the stairs to the basement. One week after treatment began, Tony called the social worker to say that both he and Susan want their parents to move into a high-rise in a different neighborhood, and they that do not want their parents to make changes in the home because it will be a waste of money. He told the social worker not to encourage Ed and Helen to stay in their home, and to tell them that they should move out. He asked that the evaluation notes for all members of the team be faxed to him.