Case

Presentation of a
St. Joseph of the
Pines Resident
Presented by
Heidi Livengood Chalflinch

Residents Medical History

46 year old, Mr. J. H.

Black male
Born with severe scoliosis
Rod placement in back at age 12
Chronic osteoarthritis
Chronic pain
Chronic obstructive pulmonary disease (COPD); O2 at
3l min.
Esophageal reflux disease
Hypertension
Abnormal posture
Muscle weakness
Paraplegia since 2008

Residents Social History

Originally born and raised in Georgia
The oldest of 4 children
Moved to North Carolina to live with his Grandmother
in 1989 after completing high school
Involved in an auto mobile accident in 1992 that
greatly increased his pain and decreased his mobility
Worked as a pizza maker for Pizza Inn after
graduation until 2008
2008 placed on disability due to inability to walk
unaided any longer; wheelchair bound
Utilized marijuana for pain relief and recreation from
1992 until 2014 when he came to live at St. Joseph of
the Pines, Southern Pines, North Carolina

Residents decision to enter St.

Joseph of the Pines Health Center
2014 resident was being cared for at home by a
cousin; the care was not adequate and the
resident was admitted to First Health Moore
Regional Hospital (FHMRH) with Stage IV decubiti
on his buttock and right hip as well as an open
lesion on his left eye
DSS for Richmond County was notified and the
process was started to find a safer and more
appropriate living arrangement for Mr. J. H.
Upon discharge from the hospital in the spring of
2014 Mr. J.H. has resided at SJOP
Ever since arrival and currently the resident is
happy with his living arrangement at SJOP

Ongoing Goals and

Interventions
Due to the chronic medical condition of Mr. J. H.
goals, interventions and safety precautions are
always of the utmost importance.
1. Safety: Enabler of a side rail will be utilized on
the right side of the residents bed; the left side is
pushed against the wall per his request.
Goal: the enabler 1/2 grab bar will provide safety as
well as mobility to pull up in bed and reposition self
x 90 days.
Interventions: I need one person to assist due to my
paraplegia sometimes.

Ongoing Goals and

Interventions
1. Risk of developing skin breakdown due to
paraplegia, non-ambulatory, history of pressure
sores, moisture associated skin damage and
severe scoliosis.
Goal: to be free of skin break down for 90 days.
Interventions: pad bed and wheelchair where I sit
with sheep skin, check for wetness or soiling every 2
hours, do peri-care after each episode, check my
skin each shift for redness and break down, check
air mattress for proper inflation each shift.

Ongoing Goal and

Interventions
1. Decrease in circulation and movement due to
lack of physical activity and paraplegia.
Goal: Nursing staff assist with restorative range of
motion (ROM) program 15 min. per day 5 days a
week; this aids in the flexibility of bilateral upper
extremities x 90 days.
Interventions: Encourage the resident to participate
in ROM exercises and utilize electric scooter within
the facility and courtyards to interact with his
environment and other residents.

Person-In-Environment
Systems
Factor I: Social-role problems: resident Mr. J.H. born
and raised in Georgia moved to N.C. after high
school to live with maternal grandmother.
Close to grandmother and mother whom are both
now deceased.
Oldest of 4 children only communicates with siblings
via telephone or Facebook.
Has had a very strained relationship with father a
recovering alcoholic until the past few years; they
now talk on the telephone.
Cousin that lived with the resident and looked
after him prior to his admission to the hospital and
SJOP never calls or visits unless Mr. J.H offers to give
him gas money for the trip.

PIE continued
Factor II: Environmental problems: Mr. J. H. has a
strong independent personality but due to his
physical limitations he is not able to maintain a
residence or personal care on his own unaided. He
is unable to care for even his most basic needs
(cook a meal, take medication, go to the grocery
store or pharmacy, take a sponge bath, go to the
bathroom, get outside of the residence in case of
a fire or emergency).

PIE continued
Factor III: Mental disorders: Mr. J.H. has a history of
some depression when he first came to SJOP and he
was extremely ill with stage IV decubiti ulcers and
getting adjusted to his new surroundings; currently
not on any anti-depressants.
Factor IV: Physical disorders: the resident has longterm, both acute and chronic health conditions that
plague him; the most severe is the paraplegia due to
scoliosis, and COPD in which he receives oxygen at
3l/min.

Interaction with the Resident Mr.

J.H.
Over the past 10 weeks I have meet with Mr. J.H. one
to two times per week getting to know him and
establish rapport. Mr. H. and I have more in common
than not. Aside from the fact that Mr. J. H. once was a
prolific pot smoker and I have never ever tried the
stuff and I am white female and he is a black male
that is where the differences cease. We both believe in
a higher power or GOD, we both are the oldest siblings
of unusual families, we both have had back surgeries.
Where Mr. J.H. amazes me is that he has an
unwavering ability to see and find good in every one
and everything. He has a great attitude toward his
family even those that have not always treated him
well.

The Residents Thoughts

Mr. J.H. loves to watch movies, listen to music, and
talk on the telephone and Facebook with family
and friends.
He states St. Joseph of the Pines is my new home
and family since arriving in 2014 everyone treats
me really great.
I talk with my younger brother and father that live
in Georgia by telephone or e-mail almost daily
life is good the Lord is in control.

Conclusion by Intern
*I was afraid the resident might not be accepting of me and
my questionsI was wrong Mr. J.H. was very receptive and
open about his life and personal history.
*The only true value differences between the resident and
myself was the fact that he had been a big marijuana
smoker in the past and I really hold no judgment there.
*Without a doubt the life experience that shaped Mr. J.H.
was the fact that he was born with severe scoliosis.
*The staff recommendation about diagnosis, treatment and
intervention has been listed on the power point.
*Research states that for Mr. J.H. Health Maintance (physical
and mental) is the best recourse.
*The only changes that I would recommend at this time
would be to encourage the resident to venture out of his
room more and interact with other residents if willing.

Competencies Used for

Case
Competency
Competency
Competency
Competency
Competency
Competency
Competency
Competency
Competency

1, behaviors: 1, 2, 3, 4, 5
2, behaviors: 6, 7, 8
3, behaviors: 9, 10
4, behaviors: 11, 12, 13
5, behaviors: 14, 15, 16
6, behaviors: 17, 18
7,behaviors: 19, 20, 21, 22
8, behaviors: 23, 24, 25, 26, 27
9, behaviors: 28, 29, 30, 31