Elderly patient with COPD and hypertension: clinical profile

Client Evaluation

The client is a 78-year-old female. She has been divorced for 30 years. She is retired. Her social class is upper middle class. Her medical history is free from significant trauma. She had six hospitalizations, all for childbirth, and one surgery; a cesarean section combined with a tubal ligation. She has two chronic health conditions: high blood pressure and chronic obstructive pulmonary disease (COPD). She is a former smoker. She lives with an adult son and her other children live nearby. She was a domestic violence victim for the 20 years of her marriage and has some lingering physical problems (an improperly healed broken rib) and emotional problems from that period of abuse. Her parents, a younger brother, and two of her children predeceased her.

Medical Issues

The patient is not currently suffering from any acute medical issues. She does have two significant chronic medical issues: high blood pressure and COPD. She is also an alcoholic and drinks excessively on a daily basis. She is medication-compliant and, other than a refusal to stop drinking alcohol, follows doctor instructions regarding self-care and health-care. Her high blood pressure is controlled with medication and is not presenting any health-care problems. In contrast, her COPD has led to decreased levels of activity as lung-function has decreased. She has been sedentary for a significant period of time; she estimates five years of relative inactivity. Physical exercise is difficult because any activity more strenuous than slow-walking makes it very difficult for her to breath. She has been placed on oxygen and reports feeling more capable of movement, but is reluctant to use the oxygen when she is out in public. This had led to an increased rate of decline in function because her sedentary life style. She reports feeling mild depression because of the inability to go and do things that she previously did. This negative impact on lifestyle reinforces what is known about women with COPD (Raherison et al., 2014).

Medications

She is on lisinopril for the treatment of hypertension. She has been advised of the possible interaction between the medication and significant exposure to the sun, specifically of the risk of melanoma and avoids excessive sun exposure (Friedman et al., 2012). She is on several medications to help alleviate the symptoms of the COPD: albuterol, tioropium, and occasional prednisone. When she does develop bronchitis, she receives antibiotics for treatment. She has just finished a round of antibiotics and is discovering that, as she ages, the antibiotics seem to have a dramatic systemic impact; she has developed thrush after her last three experiences with antibiotics and has to take probiotics while on any antibiotics. She has chronic seasonal allergies and takes diphenhydramine to control allergy symptoms. The use of steroids to control the COPD has the potential for problems and is not as effective as it is in the treatment of asthma, but because she is still responsive to the corticosteroids and the side effects of other medications like there are currently no better options for the treatment of her COPD related symptoms (Hoonhurst et al., 2014).

Functional Status

The patient's functional status remains relatively high because she is capable of carrying out all of the activities on the Lawton Instrumental Activities of Daily Living Scale: telephone usage, shopping, food preparation, housekeeping, laundry, mode of transportation, responsibility for own medications, and ability to handle finances (Lawton & Brody, 1969). Moreover, she is completely able to carry out the activities of daily living such as bathing, dressing, feeding herself, and using the bathroom without assistance. However, it is important to note that while she can carry out each of the activities on the Lawton scale without significant assistance, she cannot carry them out at the same time. For example, she can do laundry, but a task that once took her a few hours now takes all day. She reports needing to rest while changing the sheets on her bed. She has hired a housekeeper to manage cleaning her home and is aware of her physical decline.

Living Situation

She lives with an adult male son who appears to be a good caretaker. Although the patient does not need help with daily living functions, she is unable to maintain her home on her own without assistance. Her son handles mowing the lawn, cooking dinner, and much of the grocery shopping. Her son also handles basic home maintenance. However, he is financially dependent upon his mother, living there, not only to help her but also to help himself. This creates a financial burden upon her, as she is worried about leaving sufficient funds to care for another child who has mild special needs. Another problem with the living situation is that the son is a current smoker. While he does not smoke in the house, even smoking in the yard provides problems for the patient's breathing. In addition, the patient reports an occasional desire to smoke when she sees her son smoking. She is upset that her current experience with COPD has not inspired any of her children who smoke to make attempts to cease smoking and has asked for an intervention explaining the full impact of COPD to them because of research she has seen that having a family member with COPD is linked to attempts to stop smoking (Goren et al., 2014).

Recommendations

The patient's living situation is stable and she is able to engage in a sufficient degree of self-care to prevent intervention at this point in time. She has sufficient financial resources to pay for those items of self-care that are difficult for her and there is no problem with her mental functioning. One proposed intervention is to have her son come in for smoking cessation treatments, to decrease her likelihood of having her COPD conditions exacerbated by second-hand smoke. She has declined discussing opportunities for becoming sober, and is advised against stopping alcohol consumption without medical supervision because of the fear of significant withdrawal symptoms.