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Case Study: #1 Gregory Johnson is a 73-year-old who was born on April 20, 1950, in Edmonton, Alberta and currently lives in a long-term care facility in Edmonton. He was admitted a year ago after his son could no longer take care of him in their home. Gregory is an insulin-dependent diabetic that had a right below the knee amputation along with multiple toe amputations to his left foot, and he is currently at risk of another below the knee amputation to his leftleg due to a non-healing wound on his $overrightarrow{text { left }}$ ankle. $Mr$. Johnson worked in the oil patch as a heavy equipment operator until he was in his 50 ‘s then took over his father’s plumbing business and retired at age 68 after having a heart attack. At this time, he was told to start taking things easier by his family doctor. He was married once to Sandra who is the mother of his 2 children, Amy, and Zac, but they divorced after 23 years of marriage. His daughter Amy is married and lives in Calgary, Alberta and has 2 boys. His son Zac lives in Edmonton and is single and shares custody of his daughter with his exgirlfriend. Gregory had 4 siblings, 2 of them are deceased, but his living sister who is 67 lives in Edmonton and his older brother is in a long-term care facility in Grand Prairie. Most days Mr. Johnson has at least 2 visitors come to see him each day, and more on the weekends when his grandkids are around. Gregory was raised in a Catholic household and married in the Catholic church; however, no longer is a practicing Catholic. Gregory is noncompliant with his care and medications and does not follow his diabetic diet. Many times, he will not eat the meals provided by the long-term care facility and will often have his family bring in fast food or buy snacks from the vending machines. His family has tried to encourage healthier eating habits and compliance with his care and medications, but Gregory argues with them whenever it is brought up. He moves around in a wheelchair and is not concerned about the potential second amputation he may need to have. Mr. Johnson is on a diabetic diet and can feed himself independently, though he regularly refuses most of the meals and eats his own food brought in by family or ordered from a restaurant/fast food place. When he does eat meals or eats what he likes he tends to eat all the food on his plate. Between meals he will snack on chocolate bars, chips and other junk food, along with request extra snacks of sandwiches, pudding and yogurt from the health care staff. He has an allergy to eggs & fish. He is continent of urine and stool; he will use the urinal when in bed at night but is able to self-transfer to the toilet in his room with a 1-person assist. Typically, he has 1-2 soft brown bowel movements each day. Today Mr. Johnson is oriented to person, place, and time. He complains of his left foot “feeling funny,” he is teary eyed and expresses concems over losing his left leg. When completing a wound assessment and dressing change on his left ankle it is noted that the wound has a foul odor, necrotic tissue is starting to form, and the wound has a large amount of purulent exudate. You check his pedal pulse and note that it is faint, and his foot is cool to touch, and it is more purple in color than yesterday. The following are Mr. Johnson’s current statistics. Vital signs: Temperature $37.2^{circ} C$; pulse 82 ; respirations 20 breaths/min; BP 125/74; SPO2 $96 %$ on Room Air, states a pain rating of $2 / 10$. Blood Glucose Level: $14.6 mmol / L$ prior to breakfast Height: $160 cm$ Weight: $82.6 kg$ Other notable information: – Lung sounds: clear with adequate air entry bilaterally – Heart sounds: clear S1 and S2 with an irregular rhythm – Abdomen: soft, non-tender, bowel sounds x4 present. – Diet: Large diabetic diet – Religion: Does not follow any specific religious or spiritual practices. – Allergies: Penicillin; No known allergies foods, or environment The following is the list of medications Mr. Johnson is taking: Current scheduled medications: – Metformin $500 mg 1$ tab PO TID with meals – Lantus 30 units SC at HS – Metoprolol $25 mg 1$ tab PO daily with breakfast – Humulin R 8 units TID with meals

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Nursing Assessment Form Client Name: Gregory Johnson Medical Diagnosis: Client
Perception of Health Needs: Client Goals for Health: Allergies (food, meds, environ.)
Medications (include complete medication research) Dietary considerati… Show more
SCIENCE
HEALTH SCIENCE
NURSING
NUR 149

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