ACE.V triptych

Butch Sampson


Butch Sampson, age 68, was exposed to Agent Orange during his service in Vietnam. Chronically homeless, Butch has Type 2 diabetes resulting in the removal of two toes. During the first two simulations, Butch is in a Veterans Administration hospital for surgical debridement of his great toe. The nursing focus is on assessment of his foot, medication administration, diet teaching, and planning for his needs after discharge. He is discharged to a temporary housing facility, but during a visit by the home health nurse in Simulation 3, we find that Butch is in danger of being evicted because he has been smoking in his apartment, a violation of the rules.


Butch has come to the VA clinic because of an infected toe. We learn that he is homeless, fiercely independent, and very suspicious of others.
Scenario 1 Scenario 2 Scenario 3

Butch was admitted to the VA hospital with cellulitis of the right great toe and had a surgical debridement. His diabetes is out of control and he is a smoker. The nurse will assess his wound, administer his IV antibiotic, and begin some teaching.

Butch is being discharged from the VA hospital to a transitional housing facility. He is somewhat resistant because of all the rules he must follow. The nurse will review all discharge instructions, provide additional teaching as needed, and complete the medication reconciliation form.

When the nurses make a home health visit to assess and redress Butch's foot, perform a safety assessment of the home environment, check his blood sugar, and determine if he is following his diet and taking his medications, they discover that Butch is in danger of being evicted because he was caught smoking in his apartment, a violation of the rules.

Finish the Story Assignment

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

Author Information

Janet K. Willhaus, PhD, RN
Boise State University 
Boise, ID


The Butch Sampson unfolding case content was reviewed in 2018.