Can anyone tell me what the care management issues are for the below patient? -

patient A is 79 years old and has chronic obstructive pulmonary disease (COPD), a condition which she has had for the last 10 years. She has just been discharged from hospital after being treated as an in - patient for a chest infection. She has been prescribed a 7 day course of oral antibiotics and a reducing course of oral steroids. She has also been prescribed salbutomol via an inhaler which she must take using the spacer. This is the first time she has been prescribed this medication. She lives alone in a 1st floor warden aided flat. Her husband died 3 years ago and her daughter (her only living relative) lives some distance away. She relies heavily on the warden and her friends from the local community centre for company, shopping and social support. Patient A worries a lot because her vision is not as good as it used to be and she feels unsteady on her feet. She is not able to leave the house on her own. Past Medical History COPD since 1997 Type II Diabetes diagnosed 1997. Hypertension 1994 Medication No known allergies Salbutomol inhaler Cefuroxime 500mg BD Metformin 500mg TDS Bendrofluazide 2.5mg OD Aspirin 75mg OD Atorvastatin 10mg OD Prednisolone reducing dose from 50mg – 5mg over two weeks Vital Signs BP 150/90 Pulse 90 reg Respirations 20 breaths/min HBA1C – 8%

Has the patient been assessed in her home regarding activities of daily living? Would she benefit from a walking aid? When is her next eye exam scheduled? Steroid use dampens infection response and often results in fungal infections, so does the use of antibiotics so oral candidiasis may be an issue. Her diabetes will need to be managed. You could take each disease process and write a care plan on it and you would have a good quot;cover allquot;.