Admitted to the hospital is an 86-year-old female with COPD, CHF, DM, & hypertension. Her BMI is 32. Home medications include an oral antidiabetic, corticosteroids, a beta-blocker, and aspirin. She lives with her son in his home. She is in the upstairs portion of the home requiring steps to the living areas. The son does not like to cook, and care manager has the patient set up on Meals-on-Wheels; her daily diet lacks adequate amounts of vegetables and fruit. The patient states that in the last 6 months she has noticed some loss of vision in spots of his visual field as well as dryness of his eyes. Occasionally, she sees black dots and continue to run into things as she turns corners.  Soft wheezing is heard throughout anterior and posterior lung fields with slightly diminished breath sounds in the bases. Slight Edema noted in lower legs. Vital signs are blood pressure 180/80 mm Hg; heart rate 75/min, sinus rhythm; respirations 28/min; temperature 98.6° ; and pulse oximeter reading 93% at rest on room air. With activity pulse ox is 88% with no oxygen. Blood glucose is 175 mg/dL.

Patient Presentation and Assessment

The patient, an 86-year-old female, has been admitted to the hospital with a medical history that includes chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes mellitus (DM), and hypertension. She has a body mass index (BMI) of 32, indicating that she is obese. Her current home medications include an oral antidiabetic medication, corticosteroids, a beta-blocker, and aspirin. The patient resides with her son in a two-story home, which requires her to navigate steps to access the living areas. The patient’s son does not like to cook, so the care manager has arranged for Meals-on-Wheels to provide her daily meals. However, her diet lacks sufficient amounts of vegetables and fruits.

The patient reports experiencing a gradual loss of vision in spots in her visual field over the last six months. She also complains of dryness in her eyes and occasionally sees black dots. These visual impairments have led to her having difficulties turning corners and she often bumps into objects. Upon auscultation of the patient’s lungs, soft wheezing is heard throughout the anterior and posterior lung fields. There is a slight diminishment of breath sounds in the bases, indicating potential COPD exacerbation. Additionally, there is slight edema noted in the patient’s lower legs. Vital signs indicate a blood pressure of 180/80 mm Hg, heart rate of 75 beats per minute in sinus rhythm, respiratory rate of 28 breaths per minute, temperature of 98.6°F, and a pulse oximeter reading of 93% at rest on room air. During activity, the pulse oximeter reading drops to 88% without supplemental oxygen. The patient’s blood glucose level is measured at 175 mg/dL.

Implications and Potential Interventions

The patient’s multiple comorbidities, including COPD, CHF, DM, and hypertension, elevate her risk for various complications and indicate the need for comprehensive management. Her high BMI suggests obesity, a known risk factor for these conditions. Given the patient’s limited mobility due to her residence on the upper floor of her son’s home, it is vital to assess her ability to safely navigate the steps and consider any modifications or assistive devices that may be necessary to prevent falls and injuries.

The patient’s diet, provided by Meals-on-Wheels, lacks sufficient amounts of fruits and vegetables. This deficiency can contribute to the patient’s chronic disease management and overall health. Nutritional interventions should focus on educating the patient and her son about the importance of a balanced diet and encouraging them to incorporate more fruits and vegetables into their meals. It may be helpful to involve a registered dietitian to develop a tailored meal plan that meets the patient’s specific dietary needs and preferences.

The patient’s complaints of vision loss, dryness, and black dots in her vision require further assessment from an ophthalmologist to determine the underlying cause and provide appropriate treatment. Vision impairments can significantly impact the patient’s daily functioning, especially as she reports difficulties turning corners and frequently bumping into objects. Addressing these visual impairments may involve prescribing corrective glasses or other interventions, such as medication or surgery, depending on the specific diagnosis.

The patient’s wheezing and diminished breath sounds raise concerns for a COPD exacerbation. Prompt intervention is necessary to prevent further respiratory deterioration and potential hospital readmission. Treatment options may include inhaled bronchodilators and corticosteroids, supplemental oxygen therapy, and pulmonary rehabilitation. Additionally, it is important to address any known exacerbating factors, such as cigarette smoking or environmental pollutants, to optimize the patient’s respiratory function and quality of life.

The presence of edema in the patient’s lower legs indicates a possible fluid imbalance, which may be related to her CHF. It is crucial to closely monitor the patient’s fluid status and consider interventions to manage and prevent fluid overload, such as diuretic therapy and dietary sodium restriction.

The patient’s elevated blood pressure and blood glucose levels suggest inadequate management of her hypertension and diabetes. Blood pressure control may involve adjusting the current antihypertensive regimen or adding additional medications. Blood glucose management may require revising the current oral antidiabetic medication regimen or initiating insulin therapy.

Conclusion

This case presentation highlights the complex medical condition of an 86-year-old female with multiple chronic diseases and risk factors. The patient’s obesity, limited mobility, inadequate dietary intake, vision impairments, respiratory symptoms, edema, and poorly controlled hypertension and diabetes necessitate a comprehensive approach to her care. By addressing each of these areas with appropriate interventions, the patient’s overall health and well-being can be optimized. A multidisciplinary approach involving healthcare professionals from various specialties, such as cardiology, pulmonology, ophthalmology, nutrition, and endocrinology, will be essential for the successful management of this patient’s complex medical needs.