The Story of Mr M
I visited Mr M - a frail, elderly gentleman living alone and recently discharged from hospital after a long stay in intensive care, suffering blood poisoning and renal failure. His ex-partner had contacted me as she was worried about his health status, as he lived alone and was alcoholic. She was anxious that he have home nursing visits to keep an eye on his health and prevent him from returning to hospital.
Mr M was pale, underweight, undernourished and had a very low temperature. He also had an old leg wound and mouth ulcers which were slowly healing. He had been discharged from hospital without follow up, which was unusual. A dietician had recommended a daily supplement drink, which he took and also had Meals on Wheels delivered.
For me, it was a matter of engaging him, doing an assessment, creating a Care Plan and empowering him to assist with his own recovery.
Mr M was enjoying the supplemental drinks AND the Meals on Wheels, which I expected to improve his nutritional status and weight. His BP and pulse were normal. The fact of his temp being low was a concern because the body does not function optimally when it is too low. However, he was dressed appropriately for the winter weather. He had previously been on BP tabs but in hospital they had been ceased. Mr M’s weight was low too – only 59 kg – he had previously been 65kg to 70 kg. With all of these issues I decided to adopt a wait and see approach.
Mr M was compliant and interested in getting back to a state of health. He accepted my recommendation to try to drink at least 1.5 L fluid a day to maintain the health of his kidneys. He reassured me he would take the recommended mouth wash and ointment for his mouth.
The following week Mr M’s mouth ulcers were slightly improved, he had put on weight and his temperature had come up a little bit.
Mr M appeared to enjoy the nursing visits and had decided to take his own pulse and BP every day and keep a log. He also weighed himself every day. Each week Mr M made a slight improvement. Soon his BP readings were quite high, so with my recommendation he went to his GP and was recommenced on his earlier anti-hypertensives.
There were fortnightly phone calls to his ex-partner to keep her up-to-date with Mr M’s health status – with his approval and knowledge.
Over the course of about 6 weeks Mr M put on weight, his temperature normalised, wound and mouth ulcers healed and he states that he feels much better and stronger than before.
Without home nursing visits, it is possible that Mr M’s wound may not have healed, he may have discontinued his mouth ulcer treatment, he may not have known to drink enough fluid to help with kidney function, he may have become dangerously hypertensive without knowing it, he may have relinquished the Meals on Wheels and supplemental drinks without knowing how vital they were to his well being and recovery.
Because of his alcoholism and kidney dysfunction, Mr M is at increased risk of ill health and hospitalisation. Home nursing visits help to detect health issues and problems before they become dangerous.