Mrs.

82 year old African American female

Originally from Statesville, Iredell County,
North Carolina
11th of 12 children, 6 boys & 6 girls
She grew up as the baby as the 12th child
died as an infant
Reared in the Presbyterian denomination
Graduated from Knoxville College in
Knoxville, TN with degrees in English & Music

PROUD member of AKA Zeta Pi Omega (even

though shes not active now, she said once a
sorority member, always a sorority member
she was wearing a pink sweater and said you
see me with all this pink on told me their
colors were pink & green)
Accomplished pianist and singer (taught to
play by late husband)
Began singing in high school musicals
She and late husband sang at weddings,
funerals, church, etc.

Moved to Fayetteville, North Carolina in 1962

when husband became a college professor at
Fayetteville State University
Retired high school English teacher who loved
teaching
Has 2 grown well-educated children & 2
step-grandchildren

Stage 1 Chronic Kidney Disease

Diabetes
Hypertension
Arthritis
Has six months or less to live (if
condition/disease takes its normal course)

Has a loving and caring family

Her daughter is her caretaker
When she went into education, she tried to
make all children feel special
She especially loved the children who no one
else seemed to care for she says I treated
them like they were mine
She thanks God for helping her through her
teaching years and for giving her wisdom and
knowledge to help her teach

No longer able to walk without assistance

Mostly uses wheelchair
No longer able to live alone
Needs assistance with her ADLs

Help patient and caregiver express emotions

related to the dying process
Help patient and caregiver emotionally and
spiritually adjust to changing environmental
conditions & life circumstances
Help patient verbalize personal feelings about
dying, increasing intensity of symptoms, loss
of family/professional role/altered
appearance
Reconcile relationships per her goals &
desires

Assess patient and family for suicidal

ideations, signs/symptoms of depression,
increased drug/alcohol use and financial
resources
Validate patient/caregiver concerns
Assess patient/family ability to cope, adapt to
changing conditions and risk factors for
maladaptive coping
Assess degree and stage of grief and risk for
complicated grief

Assess community resources to meet

patient/family needs
Provide reassurance that feelings of
ambivalence are normal
Use of books and materials to facilitate
grieving
Encourage patients questions about dying
and death

Afraid of the community when social worker

indicated patient lived right off Murchison
Road (the Murch)
Very sophisticated, privileged, cultured,
educated woman was not quite sure how
she would respond to a stranger asking
personal questions

Our values are closely related, such as loving

and appreciating our upbringing in Christian
homes, strong work ethic, love for people
We both love to watch soap operas, especially
The Young & The Restless

Her father was very strict and growing up she

thought he was the meanest man in the
world
Later on in life, she realized what a wonderful
father she had and learned to appreciate him
and her upbringing even more
She felt love from both parents (father lived
to be 96 & mother lived to be 90)
Taught the value of obtaining an education
Strong work ethic

She says she has had a good life and in a way,

she feels she has had a privileged life
She went to a one-room school that was only
for black children
Husband came from a very cultured and
educated family
Because of these differences, she was
exposed to and met a lot of important people
She was never intimidated but felt she was at
an advantage for having married him

Husband was the first principal at the first all

Black high school in Iredell County
He later taught History and Philosophy at
Bethune-Cookman College in Daytona Beach,
Florida
Moved to Fayetteville State University in 1962
where husband taught and retired
He became Minister of Music at College
Heights Presbyterian Church
He also gave piano, organ and violin lessons
for many years

See Assessment Goals and Interventions

Early detection can help to prevent

progression of the disease and any wellinformed patient must understand how the
kidneys work
Depending upon the diagnosis, it is
recommended to make diet changes to
diminish the symptoms and to slow the
progression of the disease.
Common changes include low protein, low
potassium, low phosphorus, low sodium, and
higher calorie

Too much sodium can cause thirst and blood

pressure to rise
Too much potassium can cause irregular
heartbeats
Too much phosphorus can develop
calcification in eyes, heart, skin and joints
Depending upon diagnosis, doctor may
prescribe certain medications, such as high
blood pressure meds, vitamins and
supplements

Continued psychosocial assessments and

evaluations with continued visits by the
nurse, social worker and chaplain
However, after speaking with the nurse and
social worker, it is very likely that Mrs. E will
be discharged from hospice services as she is
gets quarterly Procrit injections which is an
aggressive form of treatment for her kidney
disease and with such, her condition is not
changing/deteriorating

My recommendation is Mrs. E suffers from social

isolation
Social isolation is a state in which the individual
lacks a sense of belonging socially, lacks
engagement with others, has a minimal number
of social contacts and is deficient in fulfilling and
quality relationships
Social isolation is a major and prevalent health
problem among older adults, leading to
numerous detrimental health conditions
Social isolation impacts the health, well-being
and quality of life for numerous older adults

Recommend that Mrs. E continue to receive

her Procrit injections
Recommend Mrs. E continue to use walker
and have less dependence on wheelchair
Receive in-home physical therapy
Discharge from hospice services
Referral to continue to receive home health
services

Continue to attend weekly Sunday Worship

Services
Continue to attend weekly or monthly Senior
Adult activities at church
Attend local senior activity center
Encourage son to visit more frequently
Allow daughter/caretaker to take respite time
Recommend Mrs. E hire a paid caretaker to
allow respite time for daughter if family or
friends cannot provide help

Competency 1 Identify as professional

social worker and conduct myself accordingly
Competency 3 Apply critical thinking to
inform and communicate professional
judgment
Competency 4 Engage diversity and
difference in practice
Competency 5 Advance human rights and
social and economic justice

Competency 7 Apply knowledge of human

behavior and the social environment
Competency 10 Engage, assess, intervene,
and evaluate with individuals, families,
groups, organizations and communities