JOHN PAUL RICHARD I.

MINDANAO
BS NURSING

CASE STUDY 1
Mr. Jones is a 62-year-old man who lives next door to you. He comes over while you are
out inyour yard and says, “You’re a nurse, so I havethis question for you. I have had this
annoying heartburn all day that just doesn’t go away nomatter what I do.” He points to
his epigastric area. “It just feels like this pressure right hereand makes me a little sick to
my stomach.” Mr. Jones looks pale and a bit diaphoretic.

Questions:
1. What is your best response to this situation?
A. Call the medical services and ask for an ambulance immediately.
B. If emergency medical services are not available, Mr. Jones must be driven to a
hospital immediately.
C. If Mr. Jones has access to an aspirin tablet, he must be asked to chew and swallow
one.
D. If Mr. Jones becomes unconscious, CPR must be performed immediately, until
further help arrives
2. What could these signs and symptoms indicate?
 These signs and symptoms may indicate myocardial infarction

3. What would you expect Mr. Jones to do at this point?

A. Mr. Jones should call the medical services and ask for an ambulance.
B. If possible and if available, Mr. Jones should immediately take an aspirin tablet.
C. If emergency services are not available, he should have his friend take him to a
hospital immediately

4. Are there any other questions you could askthat would provide additional
information abouthe potential seriousness of his complaint?
 Ask if he is also experiencing: shortness of breath, pain radiating to his arms,
unexplained numbness in arms, neck or back, and pain in the jaw, and dizziness.

CASE STUDY 2
Your grandfather is 85 years old and tells you at a family gathering that yesterday he had
some blurred vision and numbness down his right arm.He didn’t tell his wife or anyone
else because thesymptoms went away within 10 minutes, but he wanted to tell you just in
case he should have itchecked out.

Questions:
1. What should you tell your grandfather? Whatdo his symptoms possibly indicate?
 My grandfather suffered from a stroke.
a. He felt numbness down his right arm. Sudden hemiparesis is a classic sign of stroke.
b. Another complaint was his blurred vision. Stroke victims are known to experience
blurring of vision.
c. Since it only lasted for 10 minutes, he probably had Transient Ischemic Attack.

2. What risk factor does he have for stroke?

 The risk factors may include high blood pressure, diabetes, smoking, high LDL
cholesterol levels, age and poor lifestyle.
 3. What other questions should you ask to gainmore information?
 Ask if he is also experiencing other symptoms of stoke including weakness, slurring of
speech, and vertigo.

4. What is the next step of action that your grandfather should take?
 He need to consult his physician right away.

5. Should anything be discussed with his wife? If so, what?

 Yes, since the wife is the legal family member of the patient and she was the person
lived together with the patient, she must be informed regarding the medications her
husband to take including (time, dosage and route of administration), interventions to
reduce the risk of having stroke again and reoccurrence of the signs and symptoms and
what is needed to monitor in her husband and changes in ability and when to seek for
help.

6. At this point, are there specific topics that should be taught to your grandfather?
 The topics that are need discussed to him includes: interventions to prevent the
reoccurrence of symptoms, food that he need to eat, actions that he can do and he
must not do and interventions to relieve the symptoms.

CASE STUDY 3
Dr. Johnson is a 62-year-old dentist who runs abusy practice in a large suburb of
Chicago. He hadbeen a smoker for over 30 years but recently quit.For some time he has
noted little spots of blood in his urine, but he did not have pain, so he attributedit to
some prostate problems he has had in thepast. Dr. Johnson hears a couple of his
patientsdiscussing a mutual friend with bladder cancerwho has similar symptoms and
this prompts himto visit his family physician for a checkup. Afterseveral tests and a
cystoscopy, Dr. Johnson is diagnosed with early stage bladder cancer.

Questions:
1. What risk factors did Dr. Johnson have for bladder cancer?
 The risk factors for Mr. Johnson have for bladder cancer are:
a. Smoking- contributes to bladder cancer.
b. Gender- since only male does acquire prostate cancer.
c. Age- 9/10 cases of bladder cancer are diagnosed in persons over age 55.
d. Previous disease- since he have a history of prostate problems which can induce
prostate cancer due to pressure it exert against the bladder (ei. prostate cancer.)

2. What primary sign did he exhibit?

 The primary sign that he exhibit is experiencing blood in his urine or hematuria during
urination.

3. Since his cancer was detected early, what treatments might be options in his
case?
 Cystoscopy which is done every 3 to 6 months to determine signs and symptoms if the
cancer has reoccurred.
 4. If Dr. Johnson’s cancer becomes invasive, whatother options are available for
treatment?
 It is most often treated with transurethral resection (TURBT) with fulguration followed by
intravesical therapy within 24 hours once the cancer become invasive.

5. Describe the nursing implications and care required if Dr. Johnson needed to
have a cystectomy.
 The nurse must:
a. Monitor and record vital signs. An increase in pulse (tachycardia) and a decrease in
blood pressure (hypotension) may indicate a sign of hemorrhage.
b. Assess the patient's ability to void at least 24 hours after the procedure.
c. Observe the color of urine to watch for hematuria.
d. Encourage increased fluid intake as indicated.
e. Encourage deep breathing exercises.
f. Provide warm sitz baths and administer mild analgesics as ordered.
g. Watch out for signs of serious complications.

6. How would you explain a cystectomy to his family?

 Cystectomy is done to treat:
a. Cancer that begins in the bladder or that begins nearby and grows to involve the
bladder.
b. Birth defects that affect the urinary system. Neurological or inflammatory disorders
that affect the urinary system

CASE STUDY 4
Mrs. Valdez is a 65-year-old woman who comes to the physician’s office
afterexperiencing enlargement of her right breastupon self-exam. The nurse observes
duringthe physician’s physical examination that Mrs. Valdez’s right breast is twice as
large asthe left one and has a puckered appearance. The physician tells Mrs. Valdez that
she will need to have some tests and a biopsy and thenhe leaves the room. Mrs. Valdez
looks at the nurse and asks, “What does he mean? What is wrong with me?”

Questions:
1. What should the nurse explain to Mrs. Valdez at this point? What educational
materials might she need?
a. . Mrs. Valdez may be given a summary of the potential reasons for the enlargement of
her right breast.
b. A quick rundown on breast cancer, its causes, incidence and treatment will help Mrs.
Valdez prepare herself for what to expect in terms of the upcoming tests that the doctor
has prescribed.
c. Mrs. Valdez may be briefed about diagnostic procedures like ultrasound,
mammogram, magnetic resonance imaging and biopsy.
d. It must be mentioned to Mrs. Valdez that all this does not mean that she is affected
with breast cancer.

2. What tests would the nurse expect the physician to order?

  Diagnostic test that can be ordered by the physician to the nurse includes: ultrasound,
mammogram, MRI and biopsy.

3. Are there possible risk factors for breast cancer that Mrs. Valdez might have? If
so, what are they?
 The risk factors of breast cancers includes: certain breast changes, being a woman,
genetics, and pregnancy history.

4. Given the physical observations, what would the nurse expects to see done for
this patient?
 The patient will undergo in breast biopsy to remove tissue or sometimes fluid from the
suspicious area. It is the nurse obligation to inform the patient in this procedure if she
had any questions.

CASE STUDY 5
Mrs. Chiu is a small, 100-pound, 90-year-oldChinese woman with fractures of the
vertebral spine. Because of kyphosis and pain associated with osteoporosis, Mrs. Chiu
has been bed bounding a nursing home for several months. Her family visits regularly
and has many questions about hercondition, especially if it is something that herteenage
granddaughters might develop.

Questions:
1. What are Mrs. Chiu’s known risk factors for osteoporosis and resulting fractures?
The following are risk factors for osteoporosis specific for Mrs. Chiu, who is petite, 90 year
old Chinese woman, weighing just 100 pounds:
a. Being female
b. Having small frame
c. Advanced age
d. Being Asian

2. How should you answer the family’s questions?

 Answer the questions base on the truth and fact with honesty.

3. Are the granddaughters at risk because Mrs.Chiu has osteoporosis? If so, what
can they do to prevent it?
1. Yes, they are at risk. They should:
a. Eat foods that are rich in calcium and vitamin D.
b. Engage in regular exercise.
c. Avoid smoking and limit alcohol to 2-3 drinks per day.

4. What teaching should be done with this family?

 Encourage the family to have a healthy diet and increase calcium and alcohol intake.
 Encourage maintaining being active through regular exercise.
 Encourage family to avoid smoking and drinking of alcohol.
 Encourage them to have annual check up.
CASE STUDY 6
Mrs. Booker has recently been diagnosed with ARMD. She is distressed to feel she is
going blind and there is nothing she can do about it. She expresses these frustrations to
the nurse and asks for help.

Questions:
1. What should the nurse’s response be?
A. Mrs. Booker can be briefed about ARMD and how it is common among older people,
and that’s Mrs. Booker need not to be unduly alarmed about it.
B. Mrs. Booker must be informed about new therapies that show promise.
C. Low vision aids, like implanted telescopes, have special lenses and electronic
systems that enhance vision in affected patients.

2. What initial adaptations need to be made early in the disease process?

A. Encourage the patient to take anti oxidant vitamins (C,D ,E and betacarotene)
B. Encourage consultation if there is family history of macular degeneration.
C. Encourage the patient to exercise, avoid too much exposure to sun, maintain healthy
weight and nutrition such as green leafy, fruit, fish and foods that are high in vitamin
C,D E and betacarotene.

3. Are there any things that Mrs. Booker can do now to help modify her environment
for this progressive vision loss? What would those things be?
 Yes, these includes:
A. Better lightning in the hallways
B. Minimizing glare from lamps and shiny floors
C. Decorating living room with contrasting colors.
D. Avoid any clutters in the floors.
E. Visual adaptive devices such as magnifying lens and and reading lamps may
provide temporary help as the vision worsens
F. Auditory devices such as books on tape and adaptation to the environment to the
visual impairment may help to maintain independence.

4. To which resources should the nurse refer Mrs. Booker for further information and
support?
A. American Academy of Opthalmology
B. American council of the blind
C. American Printing house for blind
D. Eyecare America
E. Lighthouse international
F. Macular degeneration foundation
G. National Eye Institute

CASE STUDY 7
Eloise Mitchell is a 90-year-old female who lives alone in a senior living apartment. She
has three children, none of whom live nearby. Although she has been in good health, Ms.
Mitchell has recently experienced weight loss and frequent “colds.” She was recently
diagnosed with shingles and comes to you, the nurse for the senior living complex, for
some help. How would you respond to the following questions from Ms. Mitchell?
Questions:
1. What caused the shingles?
 Ms. Eloise Mitchell have had chickenpox years ago and which caused the shingles.
Varicella-zoster can become active again, even many years after you've had
chickenpox.
 Weak immune system, stress, aging, and illness may reactivate the virus.
 Use of medications that suppresses your immune system can also trigger the virus.

2. The doctor says it’s like chicken pox, but Iwasn’t exposed to that, so how did I get
it?
 The virus that causes shingles are varicella zoster virus (VZV). It can spread from a
person with active shingles and cause chickenpox in someone who had never had
chickenpox or received chickenpox vaccine.

3. Why is there so much pain with this problem? Is there anything I can do to get
relief? The medication doesn’t help that much.
 Ms. Eloise Mitchell has what's called post herpetic neuralgia (PHN), the result of the
shingles virus damaging the nerves of the skin. So, she felt pain but it is mild. In others,
even the slightest touch from clothing or even a breeze can be excruciating.
 Wet, cool compress, in addition to taking a bath to relieve pain and itchiness associated
with a shingles rash, apply a cool, moist compress. Take a cool bath or shower to soothe
skin. The coolness of the water can ease pain from shingles blisters and calm itchiness.

4. Can I really have sores on the bottom of my feet and in my mouth?

 Yes, Shingles affects the nerve cells, it is common for the rash to appear as a band
across the body or down the leg along the path of a nerve.

5. How long am I contagious?

 Most cases of shingles last 3 to 5 weeks but in some cases it can take around seven
days only.

6. When will I start to feel better? I had a friend who was under the weather for
months! Is that usual?
 Most of the time, symptoms go away in three to five weeks. It hurts, burns, itches, and
tingles. The pain can range from mild to intense. Shingles may also give you a fever or
headache and make you feel really tired.

7. Can I ever get this again? If so, how can I prevent it? It’s awful!
 Yes, varicella zoster, the organisms that caused shingles never leaves the body.
Vaccination is the only way to reduce your risk of it and reduce the likelihood of recurrent
shingles.

CASE STUDY 8
Mrs. Jones is 72-year-old Caucasian female who lives alone and was found on the floor
by her neighbor, who comes for coffee each morning. The patient reported “I think I
slipped on something,” although the neighbour reported no obstacles or wet floor. Mrs.
Jones also commented she had been feeling a little dizzy since yesterday. Mrs. Jones
has a history of heart disease, high blood pressure, and diabetes. She had her blood
pressure medicine, “the diuretic, and “increased two days ago.
Questions:
1. What are the potential fall risk factors for Mrs. Jones?
Potential fall risk factors for Mrs. J:
Mrs. J is 72 years old, and has been feeling dizzy since she had diuretics two days ago.
Diuretics are known to cause side effects that may have contributed to Mrs. J’s fall.
Following are a few side effects of diuretics, relevant to Mrs. J’s case:
 Extreme tiredness
 Muscle cramps
 Dizziness, blurred vision
 Light-headedness, headache, confusion
 Loss of appetite, nausea, vomiting
Additionally, functional decline and illnesses are also reasons for falls in older adults.
General risk factors that could have contributed to Mrs. J’s falls include:
 Age associated physical changes
 Failing vision
 Reduced vestibular and proprioceptive function
 Weak cognition and musculoskeletal function
 Illnesses and disease states

2. What assessment would you perform?

Fall risk assessment to be performed on Mrs. J. There are many fall assessment tools that
can be employed to assess Mrs. J’s risk of falls. A few examples of fall assessment tools are:
 Tinetti Performance-Oriented Mobility Assessment
 Timed Get Up and Go Test
 The Morse Fall Scale
 Hendrich II Fall Risk Model

The first two tools are very sensitive in identifying fallers from non-fallers. All fall assessment
tools assess all or some of the following:
 Fall history
 Mental and mobility status
 Sensory deficiency
 Medications
 Primary and secondary diagnoses

3. What are the likely findings?

 Likely findings after assessment on Mrs. J. includes: extreme weakness, muscle cramps,
dizziness, blurred vision, and confusion among other symptoms, Mrs. J’s fall might have
been due to the increase in the diuretic dose 2 days ago. The Tinetti Performance-
Oriented Mobility Assessment (POMA) tool may be used to assess Mrs. J to measure
her gait and balance abilities. Mrs. J would have likely got a total score (balance + gait)
of 19-23, which means that she is at a medium risk for fall.

4. What interventions might you discuss with Mrs. Jones?

Interventions to be discussed with Mrs. J
 Non-restraint fall prevention interventions include:
A. Using non skid footwear
B. Removing obstacles and clearing clutter in the room
 C. Moving the bed closer to the restroom
D. Having the call light, bedside table, and other needs within easy reach
E. Wearing glasses and hearing aids all the time
F. Physical restraints and raised side rails should be avoided as they increase the risk
of falls, and cause serious injury.
G. A low raise bed reduces the severity of injury in case of fall.
H. Mrs. J must also be apprised of chemical restraints, which is used to restrict the
movement of a patient.

5. What educational information would you provide?

Educational information to be provided to Mrs. J
 Hospital Elder Life Program employs volunteers to help in walking patients who are
cognitively impaired.
 Mrs. J may be referred to the following websites to learn more on fall prevention:
 AOTA – The American Occupational Therapy Association, Inc. HELP – Hospital Elder
Life Program
 Total Home Health

CASE STUDY 9
Peter Douglas is a 77-year-old nursing home resident with congestive heart failure
andinsulin-dependent diabetes mellitus. He is alertand oriented times three and needs
maximumassistance with all mobility needs. He wasrecently admitted to the nursing
home aftera 6-week hospitalization for pneumonia andcongestive heart failure. When he
was admitted to the nursing home, the nurse admittingMr. Douglas documented that he
had a pressureulcer on his sacrum. She described thispressure ulcer as measuring 3 cm
by 5 cm by0 cm. The wound bed presented with 100%yellow necrotic tissue, a moderate
amount ofdrainage, and a foul odor. He was underweightand his albumin level was 2. He
was admitted tothe nursing home for physical therapy to providea program to improve
strength, balance, and mobility after his long hospital stay. A nutritionalconsult and a
wound consult were ordered by the physician.

Questions
1. What factors put Mr. Douglas at greater risk of developing pressure ulcers?
 Factors that put Mr. Douglas at greater risk of having pressure ulcers:
A. Mr. Douglas is 77 years old, and aging is one of the risk factor.
B. Mr. Douglas is also has diabetes which results in tissue damage that further exposes
him to the ulcers.
C. Mr. Douglas has inactive lifestyle and poor mobility.
D. His weight loss also contributes to the development of the sores because he has little
body cushions because nutritional status can also be the risk factors of having pressure
ulcers.

2. What factors would delay wound healing for this patient?

 Factors that delay wound healing:
A. Mobility: Limited mobility/poor mobility of the patient
B. Diabetes: Diseases contribute to the reduction of the body’s immunity; the patient
has high blood sugar which affects his immunity. This makes it difficult for the body
to fight bacteria and other infections that affect wounds.
C. Nutrition: malnutrition can also slow the healing process and may have protein
deficiency in the body.
 D. Age (older age): The body’s capacity to repair the skin diminishes as we get older.

3. What stage would you classify this wound?

 The wound may be in stage three. It is because the wound is not very deep according to
the measurement; however, we can see it is covered with dead tissue. If the tissue is
removed, the wound may be deeper than it actually looks. The wound is also producing
a foul smell which is common for wounds in stage three.

4. What are the signs and symptoms of an active infection in a wound?

The signs and symptoms of an active infection in a wound are:
 Pain, swelling, heat, redness on the area of the wound, wound drainage or pus, changes
in odor on the affected area, fever and loss of function and movement.

5. What products would you use on this type of wound?

 The wound needs to be properly dressed to prevent loss of moisture and exposure to
germs. One can use different dressings such as hydrocolloids.

CASESTUDY 10
Mr. Ronald Dea, 64 years old, had been planning for many years to retire from his
position as an accountant at a software company at his65th birthday. Then his wife of 40
years died of lymphoma last year. He now finds that he only gets out of his house to
work. He has let his racquetball membership, swimming club, and night out with his
neighbourhood friends slide. He finds he does not go out socially at all anymore except
for visiting his two children and their families, who live out of town, when invited. He is
no longer active in the Lions Club nor does he regularly attend his church where he and
his wife used to be very involved.Now he is deliberating whether to retire or not because
he is aware that his work has become the only thing in his life. He is finding he does not
have the energy he used to and that he is not excited about the weekend time he used to
enjoy so much. He also has found he does not enjoy food shopping, so Mr.Dea generally
buys his main meal at work and then snacks on crackers and cheese at night. He
generally eats a donut ora bagel for breakfast. On the weekends, Mr.Dea stays in bed
until noon and does not eat anything until night when he goes to the nearby fast food
drive-in window to pick up fried chicken or has pizza delivered. He has not changed
anything in his bedroom since his wife died nor removed any of his wife’s belongings
from the home. Mr. Dea has been delaying his regularly scheduled visits to his
hematologist for management of hishemochromatosis. He has been gaining weight,
approximately 14 pounds, since his wife was first diagnosed with cancer about 2.5 years
ago. He has also started smoking a cigar just about everyevening. It was after his nightly
smoke, when he was walking up the hill in his backyard one evening that he fell and
fractured his hip. Mr.Dea has just been discharged home from the rehabilitation center,
and you are the visiting nurse assigned to him. He has planned judiciously for his
retirement but has been afraid to prepare the paperwork. Mr.Dea confides in you that he
wants to remain independent as long as possible. He shares his concerns with you and
inquires what your opinion is of how he should proceed. One of his daughters is at his
home for the next 2 weeks to assist him and is pushing himto retire and move in with her
and her family.
Drawing from theories of aging, answer the following questions:

1. What are some of the challenges you believe Mr.Dea is dealing with?
 Challenges Mr. D is dealing with, in light of nursing theories of aging. Since none of the
previous aging theorists discussed what is aging or how to apply their theory for older
adult care, two new theories were authored by nurses, to offer situation-specific aging
theories to guide practice.
A. Functional consequences theory
 According to this theory, quality of life depends on functional capacity and the degree of
dependency. On the other hand, positive consequences are possible even in the
presence of age-imposed limitations. Hospitalization could causes acute confusion in
some patients leading to functional consequences.Mr. D is probably suffering from acute
confusion due to his hospitalization for hip injury, and also depression, due to his wife’s
death. These conditions are known to affect both the use of health care resources and
the functional status of individuals.
B. Theory of thriving
 According to this theory, people thrive when they are in accord with their physical
environment and personal relationship. When there is a lack of harmony between these
three elements, the person fails to thrive, displaying symptoms such as generalized
weakness, problems in social relatedness, physical and cognitive dysfunction and
depression. Mr. D has lost his desire to stay connected, has probably lost all meaning in
life, and is showing signs of depression.

2. What would you recommend to Mr.Dea regarding retirement?

Recommendations to Mr. D regarding retirement
 In light of the theory of successful aging, Mr. D is not aging well, because he is not able
to continue along the simple to complex adaptation process.
 People believe that they have aged well when they see their life has meaning and
purpose.
 Recommendation to Mr. D: Mr. D sees no meaning and purpose in his life. His early
retirement is only going to aggravate the situation for him. He must focus on how he can
contribute meaningfully at work and more so in the lives of his children and
grandchildren.
 Spirituality is important. Older people especially, should be capable of self-reflection and
be able to respond appropriately to both internal and environmental changes.
 Recommendation to Mr. D: Going to work and keeping oneself actively involved in daily
chores will help Mr. D be in touch with current reality, and slowly come to terms with the
death of his wife. Association with colleagues and others at work will initiate
introspection, which will help him see the world in a new light.

3. Would you recommend he sell his house and move out ofthe town he has lived in
for so many years?
Regarding Mr. D’s decision to sell his house and move out
 One of the goals of nursing is to ensure that people remain functional and minimally
dependent. It is therefore very clear that Mr. D must be encouraged to continue staying
in his house for as long as he can live independently.
 Since he is only 64 years old, there is plenty of time left for him to contribute positively to
the community that he has lived in for so many years. This will not just benefit the
community, but more so Mr. D himself.
  Once sold, Mr. D may not be able to go back on his decision. Not owning a house of his
own and moving to a new community may increase his feeling of dependence, and may
further bog him down into depression.
 Selling away his house will also rob him of memories of his loving wife.
 Therefore, as per Mr. D’s wishes, he must continue staying back in his own house, and
his daughter must not push him to sell his property.

4. What other living arrangements might be conducive for Mr.Dea?

Mr. D may consider staying in a nursing home temporarily, until his fractured hip heals. It
will also make it easier for doctors to continue treatment for his hemochromatosis.
 Assisted living will ensure that Mr. D gets to have proper custom-prepared food, instead
of the unhealthy kind he was getting used to at his home.
 Moving to a nursing home or an elderly care home will introduce Mr. D to a community of
new friends, who may help him out of his depression.
 Since hemochromatosis increases the risk for diseases like diabetes, heart attack,
arthritis, liver cirrhosis, etc., Mr. D may be advised on suitable changes in his lifestyle
that can prevent or postpone effects of these disorders.

5. Who would you suggest he and his daughter talk with regarding his everyday
needs if he chooses to stay in his house during his convalescence?
People Mr. D and his daughter can talk to, if Mr. D chooses to stay in his house during his
convalescence
 If a close relative or friend agrees to move in with Mr. D, it would prove life changing for
him. Mr. D and his daughter may consider inviting someone who is willing to stay with
and help Mr. D for a while.
 A better option would be for Mr. D’s daughter to come over and take care of her father,
until his condition gets better.
 If Mr. D’s condition is not very critical, they may consider talking to a home health care
agent to see if they can take the assistance of a home health nurse.
 Neighbors and friends (from Lion’s club, swimming club, racquetball game, etc., where
Mr. D was once active) are important people to talk to, and may take turns in providing
necessary help until Mr. D can take care of himself. The local pharmacist may help in
delivering medication as per Mr. D’s requirements.
 They might also consider talking to the church where Mr. D used to be an active
member.

6. What are his priority needs for promoting his health?

Priority needs for promoting Mr. D’s health
 Mr. D must be thoroughly updated on his health conditions, and their causes. The
genetic basis for hemochromatosis and related expected symptoms may be clearly
explained, so that Mr. D is prepared to face the comorbidities and also understands the
reasons for some of his changed lifestyle.
 Mr. D must be equipped, both physically and mentally, to live independently.
 Creative ways must be worked out to overcome challenges that Mr. D is facing.
 Mr. D must be assisted in cultivating and maintaining his cognitive status and mental
health. This can be achieved by encouraging him to continue his memberships in
various leisure clubs.
 He must also be encouraged to actively involve in volunteering for social causes and
participate in social gatherings.
7. How would these be best managed?
 Health counselor: In older patients, self-integrity lessens the effects of negative
psychology on their sense of well-being. Mr. D can see a health counselor who might be
able to help him clarify issues, explore options, and develop strategies to improve his
situation.
 Clinical nurse specialists: CNS specialized in gerontology may be able to focus on the
physical and medical needs of the patient.
 Family and friends: Aging successfully requires that Mr. D is physically, psychologically,
and socially engaged in meaningful ways. Such support must come from family,
neighbors and friends. Frequent visits and involvement in social activities must be
encouraged. Friends from church can play a vital role in helping Mr. D come to terms
with reality.
 Personal choices: Successful aging depends on the choices that the aging person
makes. Mr. D himself must choose a lifestyle that will enhance the quality of his life. No
amount of counseling or encouragement will work if Mr. D remains persistently stuck to
his depressed lifestyle.