The Case of Frank Mills has cerebrovascular disease (CVD), hyperlipidemia, prostate cancer, glaucoma, and recurring deep venous thrombophlebitis (DVT)

The Case of Frank Mills has cerebrovascular disease (CVD), hyperlipidemia, prostate cancer, glaucoma, and recurring deep venous thrombophlebitis (DVT)

The Case of Frank Mills

Frank Mills, a 94-year-old retired army colonel, businessman, and college teacher residing in a continuing care retirement home, presents a complex medical profile. He has been a longstanding patient in your practice and has a history of several medical conditions, making his case multifaceted.

Frank Mills has been diagnosed with cerebrovascular disease (CVD), hyperlipidemia, prostate cancer, glaucoma, and recurring deep venous thrombophlebitis (DVT). His medical history is marked by his diffuse degenerative lumbar arthritis with spinal stenosis, which has progressed and contributed to chronic back pain, leg weakness, gait instability, and several recent falls. This condition has necessitated the use of an indwelling bladder catheter due to bladder atony.

His cerebrovascular disease (CVD) is diffuse, with a history of transient ischemic attacks, scattered small deep lacunar infarcts, and white matter disease observed on magnetic resonance imaging. This CVD manifests as gait slowness and instability. Frank also receives bicalutamide (Casodex) and leuprolide (Lupron) treatments from an oncologist for his prostate cancer, with his prostate-specific antigen (PSA) levels remaining low. Fortunately, there has been no recurrence of his DVT or new transient ischemic attacks in the last couple of years while he has been on warfarin therapy, maintaining an international normalized ratio (INR) around 2.0 without significant bleeds.

His hyperlipidemia has been managed effectively with atorvastatin for an extended period. Despite frequent ophthalmology consultations and adjustments to his glaucoma management, his vision is steadily declining. Additionally, a mild chronic memory deficit has become more noticeable in recent months.

NURS 6512n Week 3 – Digital Clinical Experience Orientation – Patient: Tina Jones

Recent concerns have arisen regarding Frank’s well-being. The nursing director has reported that he is not eating as well as usual and has lost approximately 5 lbs in the past 60 days. Furthermore, the fitness center director has observed a decline in his enthusiasm for exercise.

Considering his medical history and the recent changes in his health, it is imperative to evaluate Frank Mills comprehensively. Here are some key points to consider:

1. Frailty Assessment: Mr. Mills may be considered frail due to his age, history of falls, declining functional status, and recent weight loss. Frailty is often characterized by vulnerability to stressors and a decline in physiological reserves.

2. Risk Factors and Comorbidities: Frank Mills has several risk factors, including his advanced age, history of CVD, prostate cancer, glaucoma, and recurrent DVT. These comorbidities contribute to his complex health status and functional decline.

3. Contributors to Functional and Physiologic Decline:
– Chronic pain and musculoskeletal issues from degenerative lumbar arthritis and spinal stenosis
– Neurological deficits from CVD
– Side effects of cancer treatments
– Vision impairment due to glaucoma
– Cognitive decline

4. Multilevel Plan of Action:
– Comprehensive geriatric assessment to evaluate physical, cognitive, and functional status
– Pain management strategies
– Nutritional assessment and intervention to address weight loss
– Physical therapy for gait instability and weakness
– Medication review and potential adjustments
– Ophthalmological consultation for worsening vision
– Cognitive assessment and potential cognitive rehabilitation

5. Referrals:
– Physical therapist for gait and mobility issues
– Dietitian for nutritional support
– Pain specialist for chronic pain management
– Ophthalmologist for vision assessment
– Neuropsychologist for cognitive evaluation

Frank Mills’ case is intricate, requiring a holistic approach to address his multifaceted health issues and functional decline. A collaborative effort involving various healthcare professionals is crucial to optimize his quality of life and well-being.

References:
(Include scholarly citations per APA 7th edition guidelines)

Week 3: Learning Materials

Readings

Required

Read the following in your Kennedy-Malone textbook:

– Chapter 4: Nutritional Support in the Older Adult, pp. 38–41 (malnutrition)

Read the following articles:

• American Association of Nurse Practitioners. (2019). Standards of practice for nurse practitioners.
• Hartford Institute for Geriatric and Nursing. (2020). ConsultGeri: Assessing nutrition in older adults.
• Kumeliauskas, L., Fruetel, K., & Holroyd-Leduc, J. M. (2013). Evaluation of older adults hospitalized with a diagnosis of failure to thrive. Canadian Geriatrics Journal, 16(2), 49–53.
• Richards, K., Demartini, J., & Xiong, G. (2018). Understanding sleep disorders in older adults. Psychiatric Times.
• Robertson, R. G., & Montagnini, M. (2004). Geriatric failure to thrive. American Family Physician.
• Suzuki, K., Miyamoto, M., & Hirata, K. (2017, March 30). Sleep disorders in the elderly: Diagnosis and management. Journal of General and Family Medicine, 18(2), 61–71. The Case of Frank Mills has cerebrovascular disease (CVD), hyperlipidemia, prostate cancer, glaucoma, and recurring deep venous thrombophlebitis (DVT)