NRS 410 CLC Assignment: CHF Exacerbation and Increased Dyspnea

CHF Exacerbation and Increased Dyspnea: As a group, observe the simulated “Home Visit With Sallie Mae Fisher” video (.gcumedia.com/zwebassets/courseMaterialPages/nrs410v_vp01Alt.php” title=”http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs410v_vp01Alt.php”>http://lc.gcumedia.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. NRS 410 CLC Assignment: CHF Exacerbation and Increased Dyspnea. 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.
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 XX 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 – NRS 410 CLC Assignment: CHF Exacerbation and Increased Dyspnea

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. NRS 410 CLC Assignment: CHF Exacerbation and Increased Dyspnea. 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. 0, at 2 liters per nasal prongs PRN.
Prescriptions given at discharge: o Digoxin 0.25 mg once a day o 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

NRS 410 Week 4 Assignment: Home Visit With Sallie Mae Fisher SAMPLE

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. NRS 410 CLC Assignment: CHF Exacerbation and Increased Dyspnea. 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). NRS 410 CLC Assignment: CHF Exacerbation and Increased Dyspnea. 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. NRS 410 CLC Assignment: CHF Exacerbation and Increased Dyspnea. 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

NRS 410 Week 4 Assignment: Home Visit With Sallie Mae Fisher 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

http://www.rxlist.com/lasix-drug/indications-dosage.htm

U.S. National Library of Medicine. (2015). Digitalis toxicity. Retrieved from

https://www.nlm.nih.gov/medlineplus/ency/article/000165.htm

NRS 410 CLC Assignment: CHF Exacerbation and Increased Dyspnea