NRS223 - Bob’s Story Case Study - Clinical Analysis - Nursing Assessment Answer

Assessment Task

Assessment 2

case study analysis: Bob’s story

Bob is an 80 year old man who lives with his wife, 79 year old Johanna, in their own home. They have raised six children, most of whom live within a 45 minute drive of their home. Bob and Johanna are no longer keen about driving to visit their children and grandchildren but have retained their drivers’ licences and are able to attend local community gatherings/events of their choice, shopping, visiting friends and medical appointments.
Bob’s early working life was as a farm labourer and shearer. His labouring work included fencing; ploughing, sowing and harvesting assorted grain crops; hay and grain carting; and, some stock droving. After purchasing their own home in a small rural town, Bob was employed at a local stock feed mill for many years. Following several respiratory tract related illnesses Bob left the stock feed mill and worked as an agriculture assistant at the local high school until he retired. He is not a highly social man, preferring his own company and occasionally that of a few close friends.

Johanna maintains an active interest in the community through volunteer work and PROBUS. Some of her siblings live in the district and she talks with them on a semi-regular basis. She also maintains contact with work colleagues (all retired) during a monthly luncheon gathering.

In the past Bob has been a very heavy drinker, consuming at least 8-12 cans of beer each day, and adding two flagons of sherry on weekends. In recent years he has curbed his alcohol intake to three glasses of whiskey per day. He was also a heavy smoker, giving up following a cardiac episode 10 years ago. Since retiring at age 63 years, Bob has continued his wood working interests, spending many hours ‘tinkering’ on projects for his family or community organisations. For many years he maintained an extensive vegetable garden that  could ‘feed the neighbourhood’ during the warmer months. In the past few years water restrictions and changes in his health have meant his capacity for planting and maintaining the garden have become increasingly limited. The vegetable garden is now an extended area of grass and weeds for mowing.

Bob’s current medical history reflects his employment history and lifestyle choices. He suffers from a chronic back injury that has restricted his capacity for exercise; chronic obstructive pulmonary disease (COPD); congestive cardiac failure; intermittent angina; type 2 diabetes; and, gastric ulcers. He wears glasses for reading and has well-fitting upper and lower dentures. Three months ago he was admitted to hospital with severe abdominal pain. A CT scan revealed an abdominal mass.

Bob is overweight (90 kg) and until the last few months has had a ‘good’ appetite, with a tendency to indulge his love of sweets such as lollies and chocolates, particularly in the evenings. He usually structures his day around taking his frusemide to ensure he has timely access a toilet.

Bob has consistently opted for conservative management of his various chronic conditions, a decision Johanna has supported. Current medications, as reported by Bob:

Frusemide,                           40mg BD
Potassium chloride, 

 slow-release                      600 mg mane
Arginine    PRN
Diltiazem hydrochloride   180 mg once daily
Metformin,                        500 mg BD
Ibuprofen,                        2 tablets 4-6 times per day
Paracetamol                   500 mg, 2 tablets PRN

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