ACE.D triptych

Patrick and Gloria Lake


We meet Patrick Lake, age 64, when he comes into the clinic for a routine outpatient visit. He has an above the knee amputation from a combat service related injury 40 years ago, but has managed well.  He has several chronic conditions and complains of joint pain.  In Scenario 2, Patrick is admitted to the cardiac care unit with heart failure, and Scenario 3 takes place during a home visit three days after discharge. Throughout all three scenarios, learners are expected to communicate appropriately with a patient who has a disability.


Patrick talks about losing his leg while in service and how he has managed in the 40 years since that injury.  He has maintained a very active lifestyle but he now has arthritis and it is limiting his ability to do many things.  He does not want to be a burden to his children. 

Patrick’s wife Gloria expresses her concerns about how Patrick is adjusting to the gradual loss of his independence. Sometimes he does not put his prosthesis on and uses a walker in the house, and she is concerned about him falling.

Scenario 1 Scenario 2 Scenario 3

We meet Patrick when he comes into the clinic for a routine outpatient visit. He expresses concerns about a variety of aches, pains and some dizziness. The nurse will need to complete a focused history and assessment.

Patrick was admitted to the cardiac care unit 2 days ago in heart failure. His condition improved with treatment and he is now on a telemetry unit. The nurse is expected to complete an assessment and start teaching in preparation for his discharge in two days.

Patrick was discharged from the hospital 3 days ago with orders for daily follow-up visits by a home health care nurse. During this second visit, the nurse is expected to complete an assessment of Patrick and the environment and conduct appropriate client and family teaching.

Finish the Story Assignment

Learners have now seen Patrick at three snapshots in time. What do they think his life will be like three months from now?

Author Information

Bette Mariani, PhD, RN, ANEF
Colleen Meakim, MSN, RN, CHSE, ANEF
Suzanne Smeltzer, EdD, RN, FAAN, ANEF
Villanova University College of Nursing
Villanova, PA

(Original Home Health Scenario created by: Mary Pickett, PhD, RN, and Elizabeth Keech, PhD, RN, Villanova, PA: Villanova University College of Nursing)


The Patrick and Gloria Lake unfolding case content was reviewed in 2023.