Advanced Pathophysiology
Competency 724.2.4
Safety, Communication, and Placement for the Older Adult
Darcie M. Walker, RN
February 12, 2013

Part A: Assessment of the Situation: Mr. Trosack sustained injuries from an accident that occurred while falling down stairs taking out the trash while at his apartment. Upon review of the information given, a case manager would find that discharge to home is uncertain and could cause more problems with a high potential for injury. One issue that needs to be identified is the probability of Mr. Trosack having a pre morbid self-care deficit. He had expired medications in his cabinet, was unaware of the vitamins he takes daily, and has not been to a physician in ten years for a regular wellness check. He was unaware he had hypertension and non-insulin dependent diabetes. These diagnoses can be asymptomatic, but they would have been found during a routine physical. According to Mr. Trosack, he was in perfect health. Collectively these concerns are showing a lack of self-care, and the ability to doubt if Mr. Trosack will be able to maintain his needs properly after discharge. Another issue Mr. Trosack is at risk for is medication noncompliance. He has stated that he does not want to take his “darn” medications, but insists that he will be able to care for himself and administer his own prescriptions. The expired medications in his cabinet were previous prescriptions that he was not compliant in finishing, and the fact he isn’t able to verbalize the type of vitamins he is taking shows a high risk for needing education. If he is not provided with the appropriate information, he will be at a very high risk of overdose, or not taking the medication at, all leading to an exacerbation of his current issues with hypertension and non-insulin diabetes. There is a clear safety risk for Mr. Trosack with several topics. Living in an apartment without elevator access is a large fall risk. His assistive device will be a walker which will not fit and is not appropriate on stairs. If he decides to go up the stairs without his walker, he will not have it for mobility in his home. He also has many rugs throughout his apartment which could cause the walker wheel to become stuck, or himself to trip and fall causing further damage. The clutter in his home also presents a fall risk. His bathroom does not have any safety features such as a bath/shower chair, hand grips, non-skid surfaces, or elevated toilet seat. According to the description of the room, it may be too small for the walker to assist him into the bathroom. His family is not available to help out as much as they are needed, and that makes it a challenging task for Mr. Trosack to pick up his medications, attend follow up appointments, possible physical therapy, or to be able to get groceries living on the second floor. The risk is greater than the benefit of Mr. Trosack being discharged to his home without any reliable care in his house whether relatives or professional. From a safety perspective, his home environment, medication history, and lack of self-health promotion are all valid reasons for not allowing him to be discharged without a revised plan of care to work around and help problem solve his deficits with his family or other interdisciplinary team members. All members of an interdisciplinary team have very critical roles in promoting positive outcomes for patients who are lacking resources. Mr. Trosack is in need of many disciplines to get him ready for increased independence safely. A case manager is very important to assist in coordination of care. Case managing is a collaborative process of assessing, planning,