Anthony Tsindos is a 72-year-old retired plasterer who had been admitted to hospital five-days ago with an exacerbation of heart failure and ischaemic-type chest pain.

History of Presenting Condition:

Mr Tsindos was brought to the emergency department of this hospital by his son Harry and wife Mrs Tsindos. Harry stated that he had been visiting his parents throughout the week and had noticed that his father had become increasingly breathless and his father's exercise tolerance had been worsening to the point that he is currently unable to ambulate more than 10 steps without needing to sit down. Harry also reported that his father appeared to be neglecting his personal hygiene. Mrs Tsindos (translated via Harry) stated that Mr Tsindos had been sleeping in an armchair for the past three nights and had very swollen feet. Mr Tsindos also stated that he has experienced a "heavy weight" on his chest when trying to walk when short of breath.

Past medical history:

Mr Tsindos was diagnosed with mild systolic heart failure 18 months ago (NYHA II symptoms) secondary to systolic hypertension. An echocardiogram at this time revealed a left ventricular ejection fraction of 30% and no valvular abnormalities. Mr Tsindos has had two previous admissions to hospital with CCF over the past four months.

Other medical history includes:

• Hypertension (diagnosed 15 years ago)
• Elevated serum cholesterol
• Ex-tobacco smoker (30 cigarettes per day for 40 years)
• No known allergies.

Social History:

Mr Tsindos lives with his wife in their inner-suburban home. Mr Tsindos' primary carer is his wife who is in reasonable health. Mr and Mrs Tsindos primary language is Greek; Mr Tsindos speaks limited English whilst Mrs Tsindos speaks very basic English.

Harry reports that Mr Tsindos has become increasingly frustrated and "sad" over the past few months as he has not been able to maintain his prized vegetable and flower garden as he would like. He also has been unable to meet with his friends at the Greek club every week which he has done for since migrating to Australia in 1962. Mr Tsindos has mentioned to Harry on several occasions that he is "tired of getting sick all of the time".

Harry lives approximately 10 minute drive from his parents and visits at least every second day.

Harry is married and has four children aged between 8 and 16 years of age.

An entry by the Social Work team in Mr Tsindos' patient notes indicate that Harry, whilst happy to continue to help his father stay at home, is finding the responsibility of managing his parents, particularly his father increasingly stressful. Harry indicated to Social Work that due to his parents' limited English, he is concerned that his father is not understanding and may not be carrying out the self-care management strategies that the Heart Failure Team have provided to he and his father to date.

Diet and Nutrition:

Mr Tsindos, when feeling well, enjoys his wife's traditional Greek cooking, but when he feels sick, his appetite is "not so good". Harry reports that his mother is always concerned that her husband does not drink enough and she is always at him to drink more.