Home Visit with Sallie Mae Fisher
observe the simulated "Home Visit With Sallie Mae Fisher" video (http://lc(dot)gcumedia(dot)com/zwebassets/courseMaterialPages/nrs410v_vp01Alt.php). 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: Identify, prioritize, and describe at least four problems. Provide substantiating evidence (assessment data) for each problem identified. Identify and describe at least four medical and/or nursing interventions. 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.
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.
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.
- 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
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Home Visit with Sallie Mae Fisher
The four problems that Ms. Fisher has are as follows. First, she has a history of chronic congestive heart failure (CHF). In the past six months, Ms. Fisher has been hospitalized 4 times for exacerbation of her CHF. Secondly, Ms. Fisher has a history of hypertension considering that her blood pressure is 90/56. Third, she has a history of atrial fibrillation. Fourth, Ms. Fisher had dyspnea and she had been discharged from hospital the previous Saturday following a 3-day stay to treat this condition.
Interventions for CHF: She needs to observe lifestyle changes like regular exercise, reducing salt intake and losing weight. It is noteworthy that in the past 1 week, Ms. Fisher was able to lose a total 14 pounds. The appropriate medications include angiotensin-converting enzyme (ACE) inhibitors. This medication basically widens blood vessels thereby making it easier on the patient’s heart to pump blood (Copeland et al., 2010). The appropriate Angiotensin-converting enzyme inhibitors for the patient include Enlapril/vasotec; Fosinpril/monopril; Lisinopril/zestril; Captopril/capoten; and Benazepril/lotensin. Digoxin/lanoxin will help the heart of the patient to pump more blood simply through increasing the strength of its contractions. Beta-blockers will help in slowing the heart rate and they include Carvedilol/coreg; Atenolol/tenormin; Propanolol/inderal; Acebutolol/sectral; and Bisoprolol/zebeta (Copeland et al., 2010). Other medical interventions include: oxygen therapy; ABC’s or airway, breathing and circulation; constant cardiac/pulse oximetry monitoring; pain relief with the use of Morphine and bed rest. Nursing interventions include monitoring crucial signs/neuro status and oxygenation. Monitoring daily weight is vital – it of note that a weight increase of 2.2 kilogram over a period of one day is seen as significant. Moreover, it is necessary to evaluate digoxin levels if she is taking digoxin, and also evaluate levels of electrolyte such as potassium, sodium and creatinine (Copeland et al., 2010).
Interventions for hypertension: since the patient has high blood pressure (BP) or hypertension – her blood pressure is 90/56 as stated in the video &ndash...