Advanced Applications of Home-Based Primary Care-Virtual Workshop-Case Study Introduction to Minerva

Case Study Introduction to Minerva

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Minerva Barbas, an 86-year-old woman with a complex medical history, had a recent post-hospitalization visit following a discharge after treatment for exacerbated congestive heart failure (CHF) and cellulitis in her legs. Minerva's medical background includes recurrent CHF-related leg edema, moderate Alzheimer’s disease with behavioral disturbances, a previous cerebrovascular accident resulting in mild dysphagia, coronary artery disease (CAD), hypertension, chronic kidney disease stage 3, macular degeneration, generalized osteoarthritis, hypothyroidism, gastroesophageal reflux disease (GERD), breast cancer (status post-mastectomy), and recurrent urinary tract infections (UTIs).<br /><br />Her dementia diagnosis occurred six years ago and has worsened over the past six to nine months. Minerva exhibits increased forgetfulness, repetitive questioning, post-meal agitation, heightened verbal and physical aggression, and became particularly agitated during personal care. Notably, she threw a glass of orange juice on the floor in a recent incident.<br /><br />Minerva’s son, who holds her Health Power of Attorney, provided information via telephone, while her daughter, the primary caregiver who lives with her, reported these behavioral changes. The family is seeking help to manage Minerva’s CHF symptoms to prevent further emergency room visits, improve her mobility and reduce the caregiving burden, improve her mood and behaviors, and reduce the frequency of UTIs.<br /><br />Minerva's current medications include Donepezil, Memantine, Isosorbide, Furosemide, Potassium Chloride, Magnesium Chloride, Metoprolol, Hydrocodone/APAP, Acetaminophen, Levothyroxine, Omeprazole, Ocuvite, and a multivitamin. She has no known drug allergies.<br /><br />Screenings indicate Minerva has a high burden of care, a moderate risk of opioid addiction, and a high risk of functional decline. Her physical examination revealed blood pressure of 136/62, pulse of 65 (irregular), and a sacral-coccygeal stage 4 pressure ulcer among other findings.<br /><br />The family’s short-term goals focus on managing CHF and related symptoms, while long-term goals aim at enhancing her overall quality of life and reducing the caregiver’s burden. The care team needs to address issues such as improving mood and mentation, mobility support, and optimizing medication management.

Keywords

Minerva Barbas

congestive heart failure

cellulitis

Alzheimer’s disease

coronary artery disease

chronic kidney disease

behavioral disturbances

caregiver burden

medication management

quality of life