Sallie Mae Fisher’s Health History and Discharge Orders Assignment

Sallie Mae Fisher’s Health History and Discharge Orders Assignment

Observe the simulated "Home Visit with Sallie Mae Fisher" video on YouTube

(Sally Mae Home Visit by sage Mohan)

Refer to "Sallie Mae Fisher's Health History and Discharge Orders" for specifics related to the case study used to inform the assignment.

Using "Home Visit with Sallie Mae Fisher" and "Sallie Mae Fisher's Health History and Discharge Orders," complete the following components of this assignment:

Essay Portion

After viewing the home visit, write an essay of 500-750-words in which you do the following:

1. Identify, prioritize, and describe at least four problems. Sallie Mae Fisher’s Health History and Discharge Orders Assignment

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Improper Medication Management

Inadequate Nutrition affecting Body weight

Safety and fall

Depression and Grieving

2. Provide substantiating evidence (assessment data) for each problem identified.

3. Identify and describe at least four medical and/or nursing interventions.

4. Discuss your rationale for the interventions identified.

Prepare this step of the assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Scripted Dialogue Portion

Utilizing the information learned from the home visit, health histories, and discharge orders, write a scripted dialogue in which you provide Sallie Mae with education that describes her problems and the interventions identified to improve her condition. Consider Sallie Mae's physiological, psychosocial, educational, and spiritual needs when developing your dialogue. Sallie Mae Fisher’s Health History and Discharge Orders Assignment

Your dialogue should resemble a script. The following is an example of a few sentences from a scripted dialogue:

Nurse: "Good morning, Salle Mae, my name is ______ and I will be your nurse today. I understand you are experiencing problems with ________."

APA format is not required for this part of the assignment, but solid academic writing is expected.

Refer to "Home Visit With Sallie Mae Fisher Grading Criteria."

Entire Assignment You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center.

Sallie Mae Fisher’s Health History and Discharge Orders

Sallie Mae Fisher Health History

Ms. Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. During the last 6 months, she has been hospitalized four times for exacerbation of her CHF. She was discharged home last Saturday from the hospital after a 3-day stay to treat increased dyspnea, an 8-pound weight gain, and chest pain. Sallie Mae Fisher’s Health History and Discharge Orders Assignment

Ms. Fisher is recently widowed and lives alone. She has a daughter, Thelma Jean, who lives in town but works full time and has family issues of her own. Therefore, family support is limited.

Hospital Discharge Instructions

Mountain Top Home Health to evaluate cardio-pulmonary status, medication management, and home safety.

Medical Equipment Company to deliver oxygen concentrator and instruct patient in use. O2 at 2 liters per nasal prongs PRN. Sallie Mae Fisher’s Health History and Discharge Orders Assignment

Prescriptions given at discharge:

· Digoxin 0.25 mg once a day

· Lasix 80 mg twice a day

· Calan 240 mg once a day

Order written to continue other home meds.

Sallie Mae’s Home Medication List

Zocar 50 mg once a day

Minipres 1 mg once a day

Vasotec 10 mg twice a day

Prilosec 20 mg once a day

Furosemide 40 mg once a day

Effexor 37.5 mg at bedtime

Lanoxin 0.125 mg every other day

Multivitamin once a day

Potassium 40 mEq once a day

Ibuprofen 400 mg q 4 hours as needed for pain

Darvocet N 100 mg q 4 hours as needed for pain

Nitroglycerin ointment, apply 1 inch every day

Home Visit Withwith Sallie Mae Fisher Grading Criteria

REQUIREMENTS:
Essay Portion

1) Identified and prioritized at least four problems from the simulated home visit with Salle Mae.

2) Summarized each problem identified with evidence to substantiate findings (assessment data). Sallie Mae Fisher’s Health History and Discharge Orders Assignment

3) Identified and discussed at least four medical and/or nursing interventions to meet client needs.

4) Provides rational for interventions identified. Discussion of rationale includes support from outside resources (current evidence-based literature).

Scripted Dialogue Portion

1. Utilizes information learned from the home visit, health history, and discharge orders presented in the simulation to develop a patient dialog.

6) Dialog addresses physiological, psychosocial, educational, and spiritual needs of the client.

Format/Style

1) Essay Portion

Prepare this step of the assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

Information is paraphrased and not copied/pasted from other sources, including dictionaries, textbooks, e-books, and electronic links. Sallie Mae Fisher’s Health History and Discharge Orders Assignment

2) Scripted Dialogue Portion

APA format is not required for this part of the assignment, but solid academic writing is expected.

Total______pts / 100 x 200=_______% of grade

Possible

10

20

40

80

10

20

Total: 200 10 ______10

Actual

______

______

______

______

______

______

______

Improper Medication Management

Seniors and other individuals are dealing with many different health conditions are forced to self -administer different types of medication on a daily basis for their ailments. Often, this is burdensome to them. "Forty percent of older adults take five or more prescription medications a day. Additionally, the number of older adults in the United States is increasing at a rapid rate. In 2007, people ≥ 65 years of age comprised 12.6% of the U.S. population. The U.S. Census Bureau estimates that number will increase to 20% by 2030" (ADA.2009). Medication compliance in the elderly is an ongoing issue. In Ms. Fishers case, she needs an intervention for her polypharmacy to maintain compliance. Teaching Ms. Sallie Mae Fisher’s Health History and Discharge Orders Assignment. Fisher to use a pill organizer and arranging them weekly will help improve her compliance related to memory problems. Simple clear instructions, side effects and reasons why she is taking the medications is an important teaching method at her home visits.  Improving patient knowledge of their disease and medication regimen has been proven to increase compliance. (ADA.2009). Due to the out- of- pocket cost for oxygen therapy and the lack of knowledge of the importance, Sallie Mae was unable to fill prescription. There is a higher increment in the cost of prescription drugs in comparison to other sector of health care (Steinman, Sands, Covinsky, 2001). This population spends an average of 3% or more of their income on prescribed medication, with higher percentage when over the counter medication is factor in. Sallie Mae Fisher’s Health History and Discharge Orders Assignment

Inadequate Nutrition affecting Body weight

Nutrition is very important for successful aging and malnutrition with dehydration could lead to serious health problems such as infections, confusions and weight loss and the patient Ms. Sallie Mae Fisher has signs and symptoms of dehydration which are dry mucosa membranes, coarse skin turgor, constipation In Ms. Sallie Mae Fisher’s case, there are a combination of factors leading to her inadequate nutrition and some of which are

Lack of care as she is elderly and alone not forgetting her mental state and illness, she needs help with meal preparation and encouragement in feeding. Sallie Mae Fisher’s Health History and Discharge Orders Assignment

Fatigue from the effects of CHF, hypotension leading to inadequate tissue perfusion will make her feel sick and not able to tend to her activities of daily living

Lack of exercises and fresh air with lack of sensory and mental stimulation leads to loss of appetite.

No water within her reach and a combination of hypertensive drugs as well as furosemide will affect her hydration as well as her mental status.

Depression and loneliness from loss of her husband will further compound her dehydration.

Safety and fall

Providing education to Sallie Mae and her daughter Thelma Jean, on safety and fall hazard precautions, and to understand the importance of how older adults greater than the age of 70 are already let alone with an increased risk of falls. Even more so for those elderly persons on blood pressure medications like Sallie Mae, in which she is on several blood pressure and other medications, that are linked to even higher risks for serious falls/injuries. These polypharmacy patients tend to have increased emergency room visits with fractures, dislocation of joints, and brain bleeds. Sallie Mae Fisher’s Health History and Discharge Orders Assignment. Sallie Mae is on several medications for blood pressure, arrhythmias, heart failure, depression, water retention, and pain. She will also be on oxygen, in which the equipment will be a safety and fall hazard as well. Assessing her living area/space for trip hazards such as rugs, electrical cords, and any other objects in which can cause tripping and falling, ensure she has adequate lighting. She has a daughter, but she works full-time and has family issues of her own in which limits Sallie Mae’s family support. Therefore, education to both the patient and the daughter is important on being careful with all the medications Sallie Mae is on. Also, initiate a plan and/or develop a system for her to call for help in the event she has a fall, especially since she lives alone. Important also to have a blood pressure machine at home and instruct on how to monitor blood pressures often, normal blood pressure range, and what to do if too high or too low, especially since on several blood pressure medications. (Kernisan, L., 2019) Sallie Mae Fisher’s Health History and Discharge Orders Assignment

Depression and Grieving

Change and loss are painful and are part of human’s existence and as individuals age, these become a common issue and could be loss of a loved one, work, independence or health and as such people are destined to grieve at one point. It is really vital to bear in mind that grieving is a normal and expected response to changes and there is a difference between grief and depression and important to properly understand it in the elderly and if both are being experienced in the elderly as seem to be the case in Ms. Sallie Mae, it needs to be addresses in treatment which can only be given after proper diagnosis. Sallie Mae Fisher’s Health History and Discharge Orders Assignment. Depression in the elderly affects roughly 7 million adults above 65 and in Caucasian male above 85 it is the leading cause of suicides in the nation (CDC, 2018), hence depression diagnosis as in Ms. Sallie can be hindered by multiple medications that create mask or create other symptoms, or it coincided with the diagnosis of heart failure, bereavement or grief. Sallie Mae Fisher’s Health History and Discharge Orders Assignment

Interventions and Rationale

Addressing Sallie Mae’s problems may be as simple as making adjustments to her home environment. An example of this would be removing the trip hazards and putting into place foot wear that is nonslip. Her medications need to be evaluated by her physician so that the extra medications can be changed. Her confusion/ cloudy mind may be a direct result of her being overmedicated. According to Marcum, Handler, Wright & Hanlon, 2010 the patient should receive additional education regarding her medications. Sallie Mae Fisher’s Health History and Discharge Orders Assignment. This should include the administration, the side effects and the importance of taking as directed on time. Counseling should be recommended for additional support through this time of grief. The insurance regarding the use of the O2 condenser needs to be further evaluated and possibly a social worker consult should be set up. For monitoring of her food and fluid status she needs to be given and educated on documenting her input and output for 7 days to review for the doctor.

Conclusion

Sally has lost 14 pounds in a week, is feeling cloudy, low blood pressure, has not been compliant with her medications, she is not using her oxygen per discharge instructions, is feeling depressed from the loss of her husband, and does not have much family support since her daughter has a busy life. It is important as a nurse to advocate for Sally since she doesn’t have much resources with her family and friends. As we saw they are several issues identified in her home and in her health when visited Sally. Sallie Mae Fisher’s Health History and Discharge Orders Assignment. Her safety and her health are the main concern for Sally. As well as having good communication with Sally letting her know what the plans and goals would be. The nurse should build a trusting, caring and professional relationship with Sally. This way she becomes encourage to care for her own care and still give her some independence. As the nurse continues to do home heath visits she will continue to evaluate the effectiveness of Sally quality of care.

References

American Diabetes Association. Promoting Medication Adherence in Older Adults (2009).

Retrieved from http://spectrum.diabetesjournals.org/content/22/2/80

Kernisan, L. (2019). Better Health While Aging: Blood Pressure Medications Are a Risk for

Falls in Seniors. Retrieved from https://betterhealthwhileaging.net/falls-blood-pressure-

medications-elderly/

Michael A Steinman, MD, Laura P Sands, PhD, and Kenneth E Covinsky, MD,2001. Self- restriction of Medications Due to Cost in Seniors without Prescription Coverage. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495305/

Marcum, Z. A., Handler, S. M., Wright, R., & Hanlon, J. T. (2010). Interventions to

Improve Suboptimal Prescribing in Nursing Homes: A Narrative Review. The American Journal of Geriatric Pharmacotherapy, 8(3), 183–200. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925103/

WISQARS (Web-based injury statistics Query& Reporting System)

Sallie Mae Fisher’s Health History and Discharge Orders Assignment