This case study documents an ongoing interaction between a wife and her husband who live in a spacious home in a gated community.

When Dan (now 80) and Jane (now 65) began dating more than 15 years ago, both were emotionally charged to begin their lives anew. Well-educated and financially secure, they had a lot in common. Dan was a protestant minister, and Jane’s deceased husband had been a protestant minister. Both had lost their spouses. Jane’s first husband had suffered a catastrophic cerebral aneurysm 2 years earlier. Dan had conducted the funeral service for Jane’s husband. Dan’s wife had died of terminal cancer a little over a year earlier. Dan’s first wife had been a school counselor; Jane was a school teacher. Both had children in college. They shared a love for travel. Dan was retired but continued part-time employment, and Jane planned to continue teaching to qualify for retirement. Both were in great health and had more than adequate health benefits. Within the year they were married. Summer vacations were spent snorkeling in Hawaii, mountain climbing in national parks, and boating with family. After 7 years, Dan experienced major health problems: a quadruple cardiac bypass surgery, followed by surgery for pancreatic cancer. Jane’s plans to continue working were dropped so she could assist Dan to recover and then continue to travel with him and enjoy their remaining time together. Dan did recover—only to begin to exhibit the early signs and symptoms of Alzheimer’s disease. One of the early signs appeared the previous Christmas as they were hanging outdoor lights. To Jane’s dismay, she noted that Dan could not follow the sequential directions she gave him. As time passed, other signs appeared, such as some memory loss and confusion, frequent repeating of favorite phrases, sudden outbursts of anger, and decreased social involvement. Assessments resulted in the diagnosis of early Alzheimer’s disease. Dan was prescribed Aricept, and Jane began to prepare herself to face this new stage of their married life. She read literature about Alzheimer’s disease avidly and organized their home for physical and psychological safety. A kitchen blackboard displayed phone numbers and the daily schedule. Car keys were appropriately stowed. It was noted that she began to savor her time with Dan. Just sitting together with him on the sofa brought gentle expressions to her face. They continued to attend church services and functions but stopped their regular swims at their exercise facility when Dan left the dressing room naked one day. Within the year, Jane’s retired sister and brother-in-law relocated to a home a short walk from Jane’s. Their intent was to be on call to assist Jane in caring for Dan. Dan and Jane’s children did not live nearby so could only assist occasionally. As Dan’s symptoms intensified, a neighbor friend, Helen, began to relieve Jane for a few hours each week. At this time, Jane is still the primary dependent-care agent. She prides herself in mastering a dual shower; she showers Dan in his shower chair first, and then, while she showers, he sits on the nearby toilet seat drying himself. Her girlfriends suggested that this was material for an entertaining home video! Although Jane is cautious in her care for Dan, she often drives a short distance to her neighborhood tennis court for brief games with friends or spends time tending the lovely gardens she and Dan planted. During these times, she locks the house doors and leaves Dan seated in front of the television with a glass of juice. She watches the time and returns home midway through the hour to check on Dan. On one occasion when she forgot to lock the door while she was gardening, Dan made his way to the street, lost his balance, reclined face-first in the flower bed, and was discovered by a neighbor. Jane has given up evenings out and increased her favorite pastime of reading. Her days are filled with assisting Dan in all of his activities of daily living. And, often, her sleep is interrupted by Dan’s wandering throughout their home. At times, when the phone rings, Dan answers and tells callers Jane is not there. Jane, only in the next room, informs him “Dan, I am Jane.” Friends are saddened by Dan’s decline and concerned with the burdens and limitations Jane has assumed as a result of Dan’s dependency.

Critical thinking activities

1. Examine this case study through the dependency cycle model (Fig. 14.3). The outer arrows show a progression through varying stages of dependency. The inner circle represents who can be involved in the dependency cycle. Where are Jane and Dan in this cycle?

2. Using the basic dependent-care system model (Fig. 14.4), assess Dan and Jane. Identify the basic conditioning factors (BCFs) for each. What is the effect of Dan’s BCFs on his self-care agency? Is he able to meet his therapeutic self-care demands? Continue on to diagnose Dan’s self-care deficit and resulting dependent-care deficit. Now assess Jane’s self-care system.

3. Design a nursing system that addresses Jane’s self-care system as she increases her role as dependent-care agent for Dan.

 List and define the seven types of elder abuse that were identified by the National Center on Elder Abuse (NCEA).

• How would you approach the Ethical Dilemmas and Considerations that might arise regarding Euthanasia, Suicide, and Assisted Suicide?

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

 

Course reflection assignment is part of the portfolio that students must complete during last class of the program. This assignment is due on week #15. Course reflection assignment has a value of 100 points. It accounts for 20% of the final grade.

Please read guidelines, grading criteria / Rubric and all details regarding the Course Reflection assignment due on week #8 (Monday, October 19 at 11:59 PM EST).

 

Purpose of Assignment:

These case studies are real-life scenarios that will help you explore the concepts of the nervous and endocrine systems, diagnostic tests, and treatments.

Instructions:

Download MEA2203 Case Study Assignment Module 03

and read each of the patient scenarios. Then, use the lesson content from this module, your textbook, and perhaps additional research to answer the questions. Upload your completed document by following the instructions below. 

   

Exercise 2.5  

Diabetes affects a growing number of Americans. You have been invited to join a collaborative of community agencies interested in tackling diabetes from a community perspective.  I reside in Maryland, in Howard county.

1) What resources will you use to identify different outcomes related to diabetes? 

2) What outcomes related to diabetes are of most interest to community members? 

3) How will you compare the outcomes you select to monitor at the local level with state and national outcomes?

The objectives for Week 1 are:

Integrate key terms of epidemiology and population health to the Advanced Practice Nurse role.

Recommend primary, secondary, and tertiary prevention strategies as related to the objectives of HP2020.

Plan for inter-professional collaborations aimed at achieving HP2020 goals and objectives.

Compare and contrast sources of epidemiological data that are used to inform levels of prevention.

The last weekly objective, #4, uses the word “sources”. This correlates to Exercise 2.5’s use of the word “resources”. By this it means, where can a provider find data that inform them regarding outcomes? What is this data, what are the outcomes? Consider morbidity, mortality, incidence, prevalence, cases, various cultural populations such as racial or socioeconomic information. 

Data sources include but are not limited to these examples: State level public health departments, state-level health, and human services or task forces, federal level agencies, CDC, HP2020, Office of Minority Health

What resources will you use to identify different outcomes related to diabetes? 

I think it is helpful, to begin with defining population health outcomes. The next piece is to clearly understand how these outcomes are different than individual outcomes. What terms are used to describe population health-based outcomes?

After clearly identifying those pieces, the next step is to know where a provider can find that information. Please respond to these questions in your reply post using the course textbook and Canvas readings to support the content.

Find an article in the library that is about population health outcomes. This can be outcomes for any health issue, diabetes, obesity, kidney disease, etc. It should be for the US. Please provide a link to the article in your reply along with a brief summary.

respond with a minimum of three (3) paragraphs each. 

You should address each bullet point in the exercise. 

Your work should have in-text citations integrating at a minimum one scholarly article from this week’s readings and course textbook. (  Curley, L. A., & Vitale, A. P. (2016). Population-based nursing: Concepts and competencies for advanced practice (2 nd Ed.). New York; NY, Springer Publishing Company).

APA format should be utilized to include a reference list. 

Correct grammar, spelling, and APA should be adhered to when writing, work should be scholarly without personalization or first-person use. 

 in addition to your textbook, Data sources include but are not limited to these examples: State level public health departments, state-level health, and human services or task forces, federal level agencies, CDC, HP2020, Office of Minority Health