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Case Exemplar Essay

1599 words - 7 pages

Joseph has recently lost 15 pounds at the advice of his primary care physician. His body mass index (BMI) is 24.0, meaning he is at an ideal body weight for his height of 71 inches. His physician also advised him to remove as much sodium from his diet as possible due to increasing blood pressure readings and his cardiac history. According to Joseph, his last blood pressure reading was 152/92 (J. Barbera, personal communication, March 12, 2013). He states the only pain he experiences is in his calves if he walks too far. He does not exercise regularly and he has recently lessened the amount of time he spends gardening. He states he does feel safe at home and since his wife is becoming more ...view middle of the document...

He does not require insulin; he controls his blood sugars with diet and Metformin.
Safety/Stress
Joseph previously stated that he does feel safe at home. He lives with his wife and he has a sister and brother in law who live next door. One of his children also lives nearby as well as many friends. His stress level increased immensely two years ago when his wife fell and broke her leg and wrist while traveling to Europe. With his wife incapacitated, Joseph was responsible for running the household, bringing his wife to appointments, helping her with her personal needs, et cetera. Intense physical therapy helped her to become stronger and thus she is now able to help around the house reducing the burden on Joseph. During her incapacitation, occupational therapy and physical therapy made recommendations for home safety, which are still in place today. Scatter rugs have been removed, grab bars were installed on the bathroom walls and shower stalls, and no skid treads were placed on the wooden stairs to prevent falls. Joseph laughed stating that the house is now “child proof and old people proof” (J. Barbera, personal communication, March 12, 2013).
Social/Familial/Spiritual Support
Joseph and his wife have lived in the same town for almost 50 years and therefore they have a wonderful network of family and friends to offer help or support whenever needed. He is also quick to offer support to others when in need. He and his wife remain very active with their church and often visit friends or go to the local casino for a weekend. He and his wife get together with their children and grandchildren at least once a month. Joseph credits the support of his friends, family, and pastor in helping him get through the loss of his oldest son three years ago to illness. He stated, “Everyone took care of us and were so kind when Joey died” (J. Barbera, personal communication, March 12, 2013).
Modification Plan
Joseph has already made several changes, recently and remotely, to benefit his cardiac and respiratory status such as quitting smoking (40 years ago) as well as his recent weight loss and a reduced sodium diet. However, Joseph would benefit greatly from a simple exercise program. His age and cardiac history make it important for him to check with his primary care physician before starting any exercise program. Once he has the go ahead from his physician, it is imperative that he starts slowly and increase gradually avoiding respiratory distress (Edelman & Mandle, 2010, p. 621).
Gentle exercise in this age group is a great way to prevent diseases such as osteoporosis, cardiac and respiratory issues, and improve circulation. Walking and weight bearing exercises are two exercises often recommended for older adults. Walking is economical and can be done during all weather conditions. Many malls have walking programs especially during the winter months or inclement weather. “Weight bearing exercises are shown to be highly effective in reducing...

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