Luigi’s Story
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salbutamol 100 mcg inhalation QID
ipratopium bromide 200 mcg inhalation BID
Metformin 500 mg BID
Pantaloc 40 mg po OD
Lasix 40 mg po OD
Captopril 12.5 mg po OD
Lipitor 40 mg po OD
Multivitamins once per day
Tylenol as needed
ipratopium bromide 200 mcg inhalation BID
Metformin 500 mg BID
Pantaloc 40 mg po OD
Lasix 40 mg po OD
Captopril 12.5 mg po OD
Lipitor 40 mg po OD
Multivitamins once per day
Tylenol as needed
Background
Luigi is an 82 year old man from Italy who came to Canada in his early 20’s with his wife of 57 years, Rosa. They have 4 adult children and 12 grandchildren, most of them living locally. Luigi is a retired, previously self-employed, bricklayer who enjoys spending time with his garden as well as making wine from the grapes he grows. Luigi has an active social life visiting friends and family. Luigi and Rosa would attend their local community center twice weekly to swim. On Sunday’s they would attend church services followed by having family and friends over for dinner.
Diagnosis
Luigi has COPD, GERD, HTN, CAD, high cholesterol, PVD, cataract surgery to both eyes, stage C heart failure and type 2 diabetes which has led to frequent hospitalizations over the past four years. Most recently he suffered from a right brain CVA resulting in left sided weakness, unclear speech and difficulties swallowing resulting in seven weeks of hospitalization. Luigi’s medical condition is now stable, and he was discharged home. He is currently total care, and PT has been working with him on strengthening exercises, but progression is slow and he’s losing hope he will be able to work in his garden again.
Concerns
Luigi wants to eat the great food Rosa cooks, but did not pass the swallowing assessment prior to discharge. He currently is receiving nutritional intake via a PEG tube. Luigi is not ambulating so needs a mechanical lift to get into the wheelchair. He is also incontinent of urine and has sensation with his bowels so can use a commode.
Formal / Informal Supports
Rosa is worried about caring for Luigi as they live alone and although the family is close; they all work full time and have their own families to care for as well. Rosa too has been showing signs of forgetfulness. The family was hoping that Luigi could be transferred to a transition facility, but Luigi wanted to go home. Luigi and Rosa own their home but have limited income and not able to pay for private care. They are currently receiving four hours of home support under long term care with a small daily per diem. Community health workers come to assist in the early in the morning to help with care, at lunch to help get him out of bed, late afternoon to help get him back to bed, and then in the evening to help settle him at night.
Follow-up Visit
Rosa calls the health unit crying. She is feeling quite panicked and said Luigi ate something for breakfast and has been coughing ever since. She is worried that Luigi’s health is declining and that he is “not himself”. Rosa states that she doesn’t know how to help him.
Reflection
01
What are your priorities for your next visit and what concerns might you identify in advance?
02
What would be your plan for follow-up?
03
What could you anticipate for the future of this client?