End-Stage Congestive Heart Failure in the Nursing Home Setting

Mrs. D is an 89-year-old African American woman who has moved into the nursing home directly from her home. Her husband became ill and could no longer care for her. She has a history of heart failure and was seeing her cardiologist for weekly weights, but she stopped because she could no longer tolerate the outings. She has had multiple falls at home; most recently, she sustained a left wrist fracture. Her past medical history includes allergic rhinitis, arthritis, esophageal reflux, hyperlipidemia, hypertension, chronic kidney disease, a herniated cervical disc, osteoporosis, and situational depression.