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. The couple has four adult children and twelve grandchildren, most of whom live locally. Luigi is a retired, previously self-employed bricklayer who enjoys spending time in his garden as well as making wine from home-grown grapes. Luigi has an active social life visiting friends and family. Twice a week, Luigi and Rosa would attend their local community center to swim. On Sundays the couple would attend church services followed by dinner with family and friends.
Diagnosis
Luigi has COPD, GERD, HTN, CAD, high cholesterol, PVD, cataract surgery to both eyes, stage C heart failure and type 2 diabetes, all of which has led to frequent hospitalizations over the past four years. Most recently he was hospitalized for seven weeks after suffering from a right brain CVA, resulting in left-sided weakness, unclear speech and difficulties swallowing. Luigi’s medical condition is now stable has been discharged home. He is currently total care and PTs have been working with Luigi on strengthening exercises. Progression is slow and Luigi is losing hope that he will be able to return to gardening.
Concerns
Luigi misses Rosa’s great cooking, but did not pass the swallowing assessment prior to discharge. He currently is receiving nutritional intake via a PEG tube. Luigi is not ambulating and thus requires a mechanical lift to get into his wheelchair. Additionally, he is incontinent of urine and has sensation with his bowels so is able to use a commode.
Formal / Informal Supports
Rosa is worried about caring for Luigi as they live alone; and although family is close, they all work full-time and have their own families. Rosa has also been showing signs of forgetfulness. Lately their children take-turns visiting daily, but hopes that Luigi could be transferred to a transition facility, although Luigi would rather stay home. Luigi and Rosa own their home but have limited income and are not able to pay for private care. They are currently receiving 4 hours of home support under long term care with a small daily per diem. Community health workers come to assist Luigi early in the morning, at lunch (to help him out of bed), late afternoon (to help him back into bed), and in the evening (to help settle him at night).
Initial Visit
Due to increased swelling in his legs, a large open area has formed on Luigi’s lower-right leg due to hitting it on his wheelchair. Rosa is overwhelmed and has trouble keeping track of her husband’s blood sugars, medications, and tube feeds. Luigi desperately wants to have something to eat. He admits he will occasionally consume some pasta whenever their children visit and Rosa insists on making dinner for everyone.
Reflection
01
What might you ask Luigi to contribute to your holistic assessment of his health and situation?
02
How might you engage with Luigi, Rosa and the adult children to support the care needs they identify?
03
What considerations need to be made with Luigi’s right to live at risk by eating?
04
What are some potential resources or other people that could be accessed to support Luigi?
05
What might be involved in co-creating a care plan for this family?