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Running Head: COMMUNITY CASE STUDY

Community Case Study


Ihilani Lum
Kapiolani Community College

COMMUNITY CASE STUDY

Community Case Study


On Tuesday, April 14, 2015 W.P. was interviewed at his house in
Kaneohe. W.P. is an 80-year-old male who is originally from Molokai. His
first medical encounter was at the age of 13 for Appendicitis. He was
diagnosed with hypertension in his 40s. He had a myocardial infarction
in 1991 on the treadmill at the cardiologists office. He was diagnosed
with Type II Diabetes Mellitus at the age of 60 and had an aneurysm in
his abdomen at the age of 61. He had back surgery for his stenosis in
2008 and had a transient ischemic attack (stroke) in April of 2014.
Developmental Assessment
According to Ericksons theory, W.P. is in the Integrity & Despair
stage for psychosocial development. At this stage older adults reflect
on their lives and come to a conclusion of either being satisfied with
their lives or see themselves as failures (Potter & Perry, 132). W.P. is
satisfied with the life that he had by verbalizing that he raised four
children that are doing well on their own. He was also happy because
he helped raise his grandchildren and got to see most of them grow
up. He had a good job that is now helping him pay for all of his
medical bills. The only loss that W.P. is experiencing at this moment is
the loss of his independence.
According to Kohlbergs theory, W.P. is in Stage5: Social contract
orientation of Level III: Post conventional reasoning for moral
development. Stage 5 is when the individual follows the laws but

COMMUNITY CASE STUDY

recognizes the possibility of changing the law to improve society


(Potter & Perry, 136). W.P. abides to the laws and social norms. In his
opinion, family should stick together and help each other when in
need. He shared his values of loyalty with others by coaching for little
league baseball. While coaching he shared his wisdom with the
children on his team.
Functional Assessment
W.P.s functional ability has decreased significantly since he had
his stroke last year in April. Before the stroke, W.P. claims that he was
totally independent for his ADLs and IADLs. He used a cane when
walking but other than that he didnt depend on other to complete his
daily tasks. Now that he is post stroke he requires minimal to moderate
assistance with a ADLs and total assistance with his IADLs. Refer to
Appendix A for further information.
Family Dynamics
W.P.s family seems really close. Since his stroke his family has
dedicated themselves to care for him as much as possible. W.P. is not
in a nursing home, instead he lives with one of his daughters. His
girlfriend comes every once in a while for moral support. His siblings
that are still alive come to visit. His children are his caregivers and
provide assistance with his ADLs and his IADLs. Some of his older
grandchildren are also caregivers and help out the family, the rest of

COMMUNITY CASE STUDY

the grandchildren come to visit and give moral support. Refer to


Appendix B for EcoMap of W.P.s family.
Culture
W.P. is half Chinese and half Hawaiian. He identifies more with his
Hawaiian side than his Chinese side. W.P.s attitude towards healthcare
is a mix of Hawaiian and Western. He believes in using alternative
medicine before western medicine. Some alternative medicine W.P.
uses is nonie juice. Nonie juice is believed to prevent illness and
therefore W.P. makes his own nonie juice and drinks it everyday.
Another alternative medicine is guava shoots to prevent diarrhea.
When his children had diarrhea he would make them eat guava shoot
to cure the diarrhea. He would also use kukui nut oil to rub on their
stomachs when they would have an upset stomach. To manage his
back pain he refers to Western medicine such as Oxycotin. He takes
medication when and if the doctor prescribes it.
Nutritional Assessment
W.P. is 5 feet 6 inches and approximately 130 pounds. His BMI is
21.3. Since he had a stroke it is difficult for W.P. to chew, therefore his
foods consistency is chopped. W.P. has no fluid restrictions and drinks
think liquids. In his 24 hour diet recall he had a total of 7 oz. of protein,
7 oz. of grains, 1 5/16 cups of vegetables, 1 cup of fruits, 1 cup of milk,
and a total of 1320 ml of liquids. According to Choose my plate, older
adults are suppose to eat around 5-5.5 oz. of protein, 5-6 oz. of grains,

COMMUNITY CASE STUDY

2-2.5 cups of vegetables, 1.5-2 cups of fruits, 3 cups of dairy, and 6-8
cups of fluids per day (USDA, n.d.). W.P. is slightly over on his proteins
and grains while slight short on fluids, dairy, vegetables. Refer to
Appendix C for detailed 24-hour diet recall.
Interventions
The first nursing diagnosis for W.P. is: Risk for falls related to
history of falls, wheelchair use, 65 years of age or older, use of
assistive devices for mobility, impaired physical mobility, muscle
weakness, & difficulty with gait (Gulanick & Myers, 64). W.P. has fallen
and gone to the ER because he wasnt using his assistive device
properly when ambulating and he wasnt being supervised. His stroke
has also affected his left side and decreased his strength in baring his
weight independently.

Reference:
Giddens, J. (2013). Concepts for nursing practice. St Louis: Elsevier.
Gulanick, J. & Myers, J.L. (2014). Nursing care plans: Nursing
diagnoses, interventions and outcomes, (8th ed.). St Louis:
Elsevier.
Potter, P. & Perry, A. (2013). Fundamentals in nursing (8th ed.). St Louis:
Elsevier.

COMMUNITY CASE STUDY

USDA. (n.d.). Meal and snack patterns and ideas. Retrieved from
http://www.choosemyplate.gov

Appendix A
Feeding
Bathing
Toileting
Bed Mobility
Dressing

2
3
3
3
2

Grooming
General Mobility
Cooking
Home Maintenance
Shopping

3
3
4
4
4

Functional level codes:


Level 0: Independent
Level I: Requires use of equipment or devise
Level II: Requires assistance or supervision from another person
Level III: Requires assistance or supervision from another person and equipment
or device
Level IV: Is dependent and does not participate

Appendix C: 24-hour diet recall


Breakfast:

COMMUNITY CASE STUDY


1 cup of papaya with lemon juice
4 oz. of oatmeal
1 oz. of scrambled egg
1 toast with butter and jelly
240 ml of coffee
360 ml of Metamucil with orange juice
Lunch:
Ham sandwich
o 2 oz. of ham
o 2 slices of bread
o cup of tomatoes
240 ml of chocolate milk
Dinner:
cup of poi
cup of green beans
1 tablespoon of limu eleele
4 oz. of chicken adobo
1 slice of custard pie
240 ml of hot tea
Snack:
240 ml of jello