HOME VISIT WITH SALLIE MAE FISHER

CLC Yellow Group: Home Visit with Sallie Mae Fisher

Sarah Jade Anacion, Idalmis Espinosa, Karan Kortlander, Daisy Kuriakose

Grand Canyon University: NRS-410V

August 27, 2017

Introduction

The authors of this paper will isolate complications based on the nurse’s interview with Sallie Mae Fisher. Upon reviewing the objective and subjective aspects of the interview we will offer assessment information that supports the problem, along with interventions and rationales to help the patient achieve the best possible outcome.

Using a series of five phases we will begin the nursing process: Assessment, Diagnosis, Planning, Implementation, and Evaluation. In the assessment we will include the subjective and objective data. Based on this information we make our nursing diagnosis and identify what the priority problems our patient is dealing with. Once a diagnosis is made we develop a plan based on priorities with set goals and outcomes. We implement this by activating the plan. This can be done by the nurse, physician or a combined effort of both. The final step is evaluating if we have achieved the goals that were set forth. If the patient’s outcome did not meet the goal, we must reevaluate and readjust our goals to suit the patient’s current needs. Critical thinking is used by the nurse throughout this entire process.

Upon viewing the video provided of the home visit with the nurse and nursing student, the following was observed: Sallie Mae Fisher lost her husband last year; she appears to still be grieving. She has a history of congestive heart failure (CHF), atrial fibrillation (AF) and hypertension. Ms. Fisher was recently hospitalized with chest pain, SOB and a several pound weight gain,( most probably due to her CHF and water retention). She was discharged from the hospital last Saturday. When the nurses came from Mountain Home Health to evaluate Sallie Mae, she revealed that she has not been hungry, and she feels run down and tired. She mentioned that she really has not taken care of herself since her husband’s passing. She appears to be non-compliant she refused delivery of the home oxygen she was prescribed to be on 2L per nasal cannula PRN. She said “she did not need it and was worried about the cost”. Her daughter Thelma Jean is identified as her contact and support system. Thelma however works full time and has a family so her availability to her mother appears limited; she was not able to pick up her mother’s prescriptions until a few days after she was discharged. Sallie’s vital signs that were taken during the home visit were: BP 90/56, HR 58 and R24. She was prescribed medications upon discharge; however it appears she is continuing to take her old prescriptions as well. This could cause possible interactions and runs a risk of over medicating the patient (About Health, 2014).

Her diuretic was prescribed Lasix 80 mg BID, however she was already taking 40 mg per day. She should be on a total of 160 mg per day and she is taking 200 mg per day. This could contribute to weakness and nausea (RXList, 2015).This also could cause and imbalance in her electrolyte levels causing arrhythmias. Sallie weighed 136 lbs upon discharge and her current weight is 122 lbs, which constitutes a 14 pound weight loss which is alarming. Her physician should be notified immediately.

Ms. Fisher was prescribed Digoxin 0.25mg once daily for her ( AF ) upon discharge, at home she was already taking Lanoxin 0.125mg every other day. These are also the same medication. This medication is not to be taken if HR is less than 60 BPM. Sallie’s HR was 58 BPM. Ms. Fisher’s weight is 55kg based on that she can take 3.4-5.1mcg/kg which is 0.25mg per day (Drugs.com). The safe dose for this drug is being exceeded, which could lead to toxicity. She should have her Digoxin levels tested with a blood test (U.S. National Library of Medicine, 2015). This could further contribute to her fatigue.

Using both subjective and objective information that was gathered from the home visit with Sallie Mae Fisher, The Yellow Group identifies the following issues that need to be addressed along with interventions and rationales.

First problem, intervention and rationale

Ms. Fisher is a fall risk. Given her low BP, HR, medications, lack of appetite, as well as low energy level, There is a loose scatter rug in the Living room and she is wearing improper shoes, newspapers are laying all over the sofa and floor which poses a hazard of tripping and falling. The nurses need to go through her entire home and identify potential risk factors. Clutter needs to be removed and proper lighting needs to be in place (Ackley & Ladwig, 2011). Having client wear non-slip shoes instead of slippers would help prevent falling. Wearing appropriate footwear in the house would prevent her from slipping. Evaluate failure to use assistive aids such as a cane or walker, due to her weakness this would help her navigate through her house(Potter, Perry, Stockert, & Hall, 2011).

Second problem, intervention and rationale

Third problem, intervention and rationale

Fourth problem, intervention and rationale

Conclusion

References

Ackley, B., & Ladwig, G. (2011). Nursing diagnosis handbook: An evidence-based guide to

planning care (9th ed.). St. Louis: Mosby, Elsevier.

About Health. (2014). What is polypharmacy? Retrieved from

http://longevity.about.com/od/agingproblems/f/polypharmacy.htm

Potter, P., Perry, A., Stockert, P., & Hall, A. (2011). Basic nursing (7th ed.). St. Louis, Missouri:

Mosby, Elsevier.

RxList. (2015). Lasix. Retrieved from