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Social History: Mrs. Wells never worked outside the home. She cared for her husband, who had multiple medical problems until he died 10 years ago. She raised three children, one daughter and two sons. One son lives in town and is "looking out" for Mom. The other two children are out of state and have very little contact. She has few interests. She is primarily sedentary. She has never exercised on a regular basis. She has never smoked but has always had two "high balls" each night before supper. Review: Reports polyuria and nocturia x 2-3 each night. She has been more forgetful as of late, but attributes that to normal aging. Reports weight gain of 40 lbs. over the past 2 years. Decreased visual acuity to the point where she has difficulty reading the newspaper. Incontinence of urine 5-6 times per week. This occurs when she has the urge to urinate but cannot make it to the toilet before wetting herself. Activities of Daily Living ADLS ; : Intact patient is able to feed, dress, and bathe self; ambulating without assistance; she does have occasional incontinence ; . Instrumental Activities of Daily Living IADLs ; : Stopped driving due to poor vision. "She can cook when she wants to." Family takes her shopping once a week. Advanced Directives: Has a living will. Eldest son husband of person with her ; is her health care power of attorney. Environment: Patient reports that she lives in a three-story Victorian home. She primarily lives on the first and second floors. There is a half-bath on the first floor and all the bedrooms are on the second floor. The floors are hardwood covered with rugs of various sizes. The bathroom has a clawfoot tub with a shower curtain. There is no lighting on the stairway and dim lighting in the hallways. The daughter-in-law states that the house is cluttered with magazines and various "knickknacks." Physical Examination: Weight: 280 lbs. Sitting BP: 160 80 Pulse: 62 Standing BP: 142 70 Pulse: 60 Gen: Obese white female in no apparent distress, responds appropriately to questions. Skin: Warm, laceration on her forehead, ecchymosis over the right hip. HEENT: Poor vision, cannot read newsprint, she can count fingers; poor hearing- you have to speak loudly for her to hear and she still misses things at times. Chest: Clear to auscultation, no rales, rhonchi, or wheezes. Height: 5' 6 and cardura.

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