Red Yoder is an 80-year-old farmer who lives alone in the farmhouse where he grew up. It is located 20 miles outside of town. Red has been a widower for 10 years. His son Jon manages the farm now, but Red is still involved in the decision making. Red's current medical problems include insulin dependent diabetes complicated by an open foot wound. He also has some incontinence and difficulty sleeping. 

Red is awaiting a visit from the home health nurses. He relates that he has an open wound on his big toe that developed after walking in a new pair of shoes. When his daughter-in-law Judy saw the wound, she called the family doctor, who suggested a visit by the wound care nurse who works with the home health agency. Red agreed as long as his VA benefits cover the costs. Red is aware that his son and daughter-in-law have concerns about him living alone, but Red insists that while he needs a little help from Jon and Judy at times, he is still capable of caring for himself. 

I understand you want to hear my story; well I’m not much for talking, but I can give you the highlights. There’s a lot that’s happened over my 80 years. From the top. My name is Sherman Yoder, but I answer to “Red.” No one around here even remembers my real name. I was born in this house in the downstairs bedroom. Mom had already delivered six kids and there was no way I was waiting for Dad to finish feeding the hogs and get Mom to town before I come out. Mom used to love to tell that story. Dad bought this farmhouse and the first hundred acres right before he went off to WWI. The folks saw good times and bad in this ol’ place and so have I. All my brothers and sisters left the land as soon as they could. I was the only one of the lot to care about this place and want to carry on what Dad started. I really haven’t gone far from this spot in my entire life. The one time I got it in my head to try something different; I wound up in Korea with an Army uniform on. I was glad to get back to this place after that stint and here I’ve been ever since. Married the neighbor girl Bessie when I got back. Her dad wasn’t so sure that it would work out since she was 8 years younger than me and she intended to go off to the state college. We sure did prove him wrong; we celebrated our 50th anniversary the week before Bessie died. The ladies at the church had the hall all decorated up and we brought Bessie home from the hospital for the afternoon. She was bound and determined to live for that day; no way did she want her friends to go to that much work for her to not show up. I couldn’t believe it when the ladies had to prepare for the reception after we buried Bessie in that same hall one week later. We had such a good life together. That was 10 years ago. I don’t do much of the farm work anymore. Our son Jon takes care of the crops and the few animals we have. I still go out to the hen house every morning to collect the eggs. I’m a little stiff in the morning, but I get loosened up enough to walk out to gather some fresh eggs to go with my bacon for breakfast. I get in to town at least once a week; on Monday morning me and my buddies meet at the VFW for our coffee and donut break. I get caught up on all the town gossip and we laugh and bellyache about what’s going on in the world. Three weeks ago I celebrated my 80th birthday. My daughter in law, Judy, organized a big “to do” at the church after the Sunday service with cake and ice cream and all the fixins’ for my party. I had a big piece of cake but skipped the ice cream. Doc Baker was there and I knew he would scold me about too much sugar. Six months ago he told me I had diabetes and I started taking a pill for it, but a few weeks ago he put me on insulin. I figure I should be able to eat what I want; come on, I’m not going to live forever, and it was my favorite cake, German chocolate. I ate it in the kitchen so the Doc wouldn’t see me; wouldn’t you know, his office nurse Helen came in the kitchen with a load of dishes just as I was putting the last bite in my mouth. She just winked at me and smiled. After the party I went out to the mall with Jon and the grandkids. I’m not one for shopping much, but I needed a new ink cartridge for my printer and the computer store is the one place I like to look around in. Too bad we parked clear on the other end of the mall so the kids could go by their favorite stores for Grandpa to buy them a little something. Jon got real mad at me when I asked if I could sit and rest for a while, so I just kept walking. I guess my new shoes were a little tight; I didn’t feel anything but when I got home there was some blood on my sock, and then I saw a sore on my big toe. It must not be too bad since it’s not hurting except when I try to put my shoes on. I showed the sore to Jon and Judy the other day and Judy said she would call the doctor to see what she should put on it. Jon gets so irritated when I need extra help; I hope I can just continue to soak my foot in hot water to clean it out. Judy was a nursing assistant out at the old folk’s home for many years; I’m hoping she will be able to help me with this. I like the idea of the home nurses coming out here as long as my VA benefits pay for it. That way they can see that I’m doing just fine living here on my own. I was searching on the Internet for the best way to treat this sore; there are so many sites that talk about foot sores if you’re a diabetic. Some of those pictures are pretty scary; I can’t sleep at night thinking about what could happen if this doesn’t heal. Of course I haven’t slept through the night for years. Even the couple of beers I have at night when I’m on the computer don’t seem to be helping anymore. Judy sometimes gives the kids Benadryl to help them sleep so I’ve been taking a couple when I go to bed; they seem to help me sleep a little better. As a matter of fact, I need to wrap this up now. I promised Jack, my grandson in college, that I’d Skype him in a few minutes. He just started the agronomy program at the university. I love to hear about what he’s learning and give him encouragement to come back to the farm.

1. What are Red’s strengths?

2. What are your concerns for this patient?

3. What is the cause of your concern?

4. What information do you need?

5. What are you going to do about it?

6. What is Red experiencing?