Running head: COMMUNITY CASE STUDY

Community Case Study

Kristina Aoki
NURS 210 - Health Promotion Across the Lifespan
4/25/14
Professor Janice Ferguson

COMMUNITY CASE STUDY

2
Community Case Study
Introduction

N.V. is a 64-year-old Filipino female. She was born in Baguio City, Philippines.
She received a Bachelor of Arts in Secretarial Education from a local college in the
Philippines. After graduating from college, she worked as a college teacher for 20+ years.
She met her husband in the Philippines and married in 1973. They had six children, five
sons and one daughter. In 1996, she moved to Oahu, Hawaii with her husband, three sons
and daughter. She currently works as an Educational Assistant at a public elementary
school.
Psychosocial/Moral Development
Based on her age, N.V. is in Erik Erikson's seventh stage of psychosocial
development: Generativity versus Self-absorption and Stagnation (25-65 years).
Individuals in this stage of development feel the need to create or nurture things that will
outlast them, often through personal or social involvement such as having children and
sharing ideas, services and products. Their concern for future generations is expressed
through parenting, teaching and guiding. (Giddens, 2013, p.5). N.V. is currently
employed, but plans to retire within a few years. As an Educational Assistant, she feels it
is very important to provide children with the proper education and guidance because
"they are our future". She stated, "My work now is so meaningful. I didn't feel that way
when I was younger". She does feel a sense of anxiousness about retiring soon,
particularly because she believes her replacement may not do her job properly. As a
mother of six children, she has been able to nurture her children and help them grow. In

addition, she does have another guiding role as a Catechist at her local church, where she
teaches young children about the Catholic religion and how to live a Catholic lifestyle.
Kohlberg's Theory of Moral Development stems from Piaget's cognitive theory,
but focuses on the development of moral reasoning across the lifespan (Giddens, 2013,
p.4). Moral reasoning is divided into three levels, with each level comprised of two
stages. Based on my interactions with this client, I believe N.V. is thinking at Level III
(Postconventional), Stage 5 (Social Contract Orientation). Individuals at this stage have
developed their own set of moral guidelines that may or may not fit the law. "Laws are
seen as agreements by society about basic rights and values" (Giddens, 2013, p.6), but
what is morally right and legally right may not always be the same. An example would be
in her belief that although gay marriage is legally acceptable in some states, she
personally does not believe it is morally right. Her family and Catholic religion have
influenced many of her values and beliefs.
Functional Abilities
According to Giddens (2013), "functional ability is the physical, psychological,
cognitive and social ability to carry on the normal activities of life" (p.11). N.V. is alert,
well-groomed, well-spoken and very independent. Based on the Functional Abilities
Evaluation, she received a Level 0 (Independent) on all the following demonstrated
abilities: feeding, bathing, toileting, bed mobility, dressing, grooming, general mobility,
cooking, home maintenance, and shopping. N.V. wears glasses, attends regular eye
exams every year, and has no difficulty seeing when using her glasses. She is hearing
impaired in her left ear, does not wear a hearing aid, and has declined any difficulty
hearing. I have observed N.V. moving around her household completing household

chores such as hanging the laundry, washing dishes and cooking. She is able to walk including up and down the stairs - steadily, with no assistance. N.V. has declined any
psychiatric problems and did not appear acutely distressed.
N.V. currently works full-time as an Educational Assistant at a public elementary
school. She does not perform any labor-intensive tasks. Outside of work, she tends to a
private garden in her backyard and volunteers at her local church as a catechist. During
our initial interview, N.V. was not physically activity, but during a follow-up
conversation two weeks later, I learned her son had purchased a treadmill and she is
trying to walk on it at least three times a week for 30 minutes.
Family Dynamics
Client has a husband, six children and six grandchildren. She lives with her
husband and four children. Her other two children live off island, one of her sons lives in
the Philippines with his family, and the other lives in Virginia with his family. Her
grandchildren live off island and the last time she visited with them was more than a year
ago. She has stated, "Although I love my children, they are all grown now and I wish I
could be around my grandchildren more". She described her family relationships as
"loving and respectful, with members supporting each other". Three of her sons are
especially helpful in supporting the family because they give her money each month to
help with living expenses, such as rent and groceries. In addition, they regularly eat
together at the dinner table and have open conversations with one another.
Health Care and Culture
N.V. was born in the Philippines and raised as a Catholic. Throughout her life, she
regularly attended church, prayed and believes in the power of God and the saints.

Oftentimes when someone in her family became ill, she would pray to her God and ask
for healing. In addition, while still living in the Philippines, her family typically relied on
faith healers or herbal remedies to cure illnesses. She recalls that when an individual
visited a doctor in the Philippines, they would almost always prescribe antibiotics for
every ailment. After coming to the United States, she noticed that doctors do not always
prescribe medications, but almost always instructs their patient to "drink a lot of water".
Although she does visit the doctor when sick and takes Western medication, she also
incorporates more natural remedies when she or someone in her family becomes ill.
When presented with a fever, she was taught to keep the body warm so the sickness could
be "sweated out". An ethnic practice for treating fevers also involved taking a sponge
bath with a vinegar and water mixture. She is unsure of the specific reason for doing this.
Another health care practice involves preparing and drinking a ginger or garlic tea to treat
the common cold.
Nutritional Assessment
N.V. is five feet tall, weighs approximately 129 pounds, and has a BMI of 25.2,
indicating she is slightly overweight. Based on my nutritional assessment and 24-hour
diet recall, N.V. appears to have a fairly balanced diet and consumes foods from the five
major food groups: grains, vegetables, fruits, dairy products, and meats. She receives her
daily serving of grains through foods such as thin wheat toast and white or brown rice.
She receives her daily servings of vegetables through foods such as steamed mixed
veggies, carrots, cabbage, and eggplant. She usually incorporates some type of pork or
beef into lunch or dinner meals, and obtains other sources of proteins through eating
beans and fish. N.V. receives her daily servings of dairy through foods such as light

Swiss cheese and almond milk. It appears that she is receiving adequate amounts of the
different types of food, except for fruits. She does drink approximately 6-8 cups of water
a day, which is sufficient at preventing dehydration.
Adults 65 years and older have a decreased need for energy because their
metabolic rate slows with age, so the type of foods she consumes may be different or less
than it was several years ago. However, vitamin and mineral requirements remain
unchanged from middle adulthood (Potter & Perry, 2013, p.1003). It was also noted that
with aging, thirst sensation diminishes; therefore, it is important to monitor fluid intake to
avoid dehydration (Potter & Perry, 2013, p.1004).
Nursing Interventions
Based on my interview with N.V., I would recommend she increase physical
activity and make a few changes to her diet, such as adding more fruits. Regular physical
activity and exercise enhance functioning of all body systems, including cardiopulmonary
function (endurance), musculoskeletal fitness (flexibility and bone integrity), weight
control and maintenance (body image), and psychological well being. It is recommended
that adults aged 65 and older should be moderately active for 150 minutes a week
(Wallace, Lees, Minou, Singleton, & Stratton, 2014). She is at low risk for sedentary
lifestyle related to lack of motivation and resources. N.V. stated that she does not
exercise because she "has no time". She spends all day at work and when she gets home,
she spends her evening cooking and cleaning. For my nursing interventions, I would
guide the patient in setting realistic short-term and long-term goals for increasing
physical activity and introduce the use of a pedometer to track steps per day. Setting

realistic goals helps maintain motivation, and pedometers are useful tools to quantify
activity level and track progress (Gulanick & Myers, 2014, p.121).
I would also recommend N.V. to consume more fruits, at least 1.5 cups per day,
as recommended by the United States Department of Agriculture (retrieved from
http://www.choosemyplate.gov). Fruits are important because they are naturally low in
fat, sodium and calories, and contain many essential nutrients. For my nursing
interventions, I would recommend consuming at least 2-3 different types of fruits per day
(maybe having one piece of fruit with each meal), and/or suggesting the use of nutritional
supplements between meals.
Conclusion
N.V. seems to be content at this stage of her life. She is still an independent,
active member of society, has a wonderful relationship with her family and is taking
positive steps to live a healthier life. She enjoys her job and the contributions she makes
to members of her church community. She does follow health care practices specific to
her culture and beliefs, but does not engage in any activities that puts her at risk for
adverse outcomes. After identifying some areas of improvement and sharing my
interventions, N.V. took to them openly and positively and mentioned she would make a
commitment to continuing to practice health promotion.

COMMUNITY CASE STUDY

24-Hour Diet Recall
Breakfast
1 slice thin wheat toast w/ light creamy Swiss cheese (75 calories + 80 calories)
1 apple (57 calories)
1 cup almond milk (60 calories)
Lunch
1 scoop brown rice (216 calories)
Steamed mixed veggies (70 calories)
Pancit noodles (390 calories)
Steamed fish (233 calories)
Dinner
1 scoop brown rice (216 calories)
Mixed vegetables - cabbage, beans, eggplant (33 calories + 127 calories + 20 calories)
Pork (218 calories)
Total Caloric Intake: 1,795 calories
*Throughout the day, client consumed approximately 6-8 cups of water

Based on N.V.'s height, weight and gender, a recommended caloric intake would be
between 1350 calories to 1550 calories (http://www.calorieking.com).

COMMUNITY CASE STUDY

FUNCTIONAL ABILITIES EVALUATION

Objective:
Demonstrated ability (functional code listed above) for:
Feeding

Grooming

Bathing

General Mobility

Toileting

Cooking

Bed Mobility

Home Maintenance

Dressing

Shopping

Functional level codes:

Level 0: Independent
Level I: Requires use of equipment or devise
Level II: Requires assistance or supervision from another person
Level III: Requires assistance or supervision from another person and equipment
or device
Level IV: Is dependent and does not participate