Sallie Mae Fishers Health History And Discharge Orders

Sallie Mae Fishers Health History And Discharge Orderssallie Mae Fis

Sallie Mae Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. She has been hospitalized four times in the past six months for CHF exacerbations and was recently discharged after a hospital stay for increased dyspnea, weight gain, and chest pain. She lives alone, recently widowed, with limited family support from her daughter, Thelma Jean. Discharge instructions included home health evaluation and delivery of oxygen concentrator with instruction, though she refused oxygen therapy due to cost concerns. Her medication list includes digoxin, Lasix, Calan, and other home medications, with observed discrepancies such as potential medication overlap and dosage issues, which pose risks of toxicity and electrolyte imbalance.

Paper For Above instruction

The case of Sallie Mae Fisher presents a complex interplay of chronic illness management, medication adherence, environmental safety, and psychosocial factors impacting her health outcomes. Addressing her multifaceted needs requires a comprehensive nursing approach, integrating assessment, diagnosis, planning, intervention, and evaluation to optimize her quality of life and reduce hospitalization risk.

Introduction

Sallie Mae Fisher’s health status reflects the challenges faced by elderly patients with chronic cardiovascular conditions. Her recent hospitalization due to CHF exacerbation highlights the importance of effective disease management, medication compliance, environmental safety assessments, and psychosocial support to prevent readmission and promote independence.

Assessment

Assessment begins with gathering subjective and objective data. Subjectively, Ms. Fisher reports feeling tired, with reduced appetite and an overall sense of being run down, potentially influenced by grief and social isolation. She also exhibits reluctance to use prescribed oxygen therapy, citing financial concerns, which compromises her respiratory management. Objectively, her vital signs include hypotension (BP 90/56 mm Hg), bradycardia (HR 58 bpm), and tachypnea (R 24), suggesting hemodynamic instability. Her weight has decreased by 14 pounds since discharge, indicating possible worsening of CHF with ongoing fluid imbalance or inadequate intake. She appears frail, with poor home safety conditions, such as clutter and inappropriate footwear, elevating her fall risk. Her medication list reveals potential for overuse and toxicity, especially with overlapping doses of digoxin, and mismanagement of diuretics that could precipitate electrolyte disturbances.

Diagnosis

Based on the assessment, the primary nursing diagnoses include:

  • Impaired physical mobility related to weakness and environmental hazards.
  • Risk for falls related to hypotension, hypoxia, medication effects, and environmental hazards.
  • Deficient knowledge regarding medication management and use of oxygen therapy.
  • Potential electrolyte imbalance related to diuretic overdose and medication interactions.
  • Impaired health maintenance related to grief, social isolation, and medication non-compliance.

Planning

Goals should focus on safety, medication adherence, symptom management, and psychosocial support. Specific, measurable objectives include:

  • Eliminate environmental hazards to prevent falls within two weeks.
  • Ensure medication regimen is correctly managed, with no duplicate or inappropriate dosing, within one week.
  • Enhance patient education regarding medication use and oxygen therapy within the same timeframe.
  • Improve nutrition and hydration to support weight stabilization and overall health.
  • Provide emotional support and connect Ms. Fisher with community resources for grief counseling and social engagement.

Implementation

Interventions include conducting a home safety assessment, removing clutter, securing loose rugs, and advising proper footwear and assistive devices such as a cane or walker to enhance stability. The nurse should collaborate with pharmacists to reconcile medications, avoiding duplications and inappropriate doses, and arrange for blood tests to monitor digoxin levels and electrolytes. Education on the importance of medication adherence, signs of toxicity, and oxygen therapy benefits should be reinforced. Additionally, the nurse can coordinate with social services to address emotional needs and provide resources for grief support. Addressing her nutritional status and encouraging small, frequent meals will aid in weight stabilization and energy recovery.

Evaluation

Regular follow-up is essential to assess whether safety measures are effective, medication adherence has improved, and her health status stabilizes. Monitoring weight trends, vital signs, and lab results provides data on CHF management effectiveness. Adjustments to her care plan should be made accordingly, with continuous support to foster independence and prevent rehospitalization.

Conclusion

Managing the health of elderly patients like Sallie Mae Fisher requires a holistic approach that encompasses physical safety, medication management, psychosocial support, and patient education. Addressing her environmental hazards, medication issues, and emotional well-being can significantly reduce hospitalization risk, improve quality of life, and promote safe aging in place.

References

  • Ackley, B., & Ladwig, G. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care (9th ed.). Mosby Elsevier.
  • About Health. (2014). What is polypharmacy? Retrieved from https://www.abouthealth.com
  • Drugs.com. (2015). Digoxin dosing and toxicity. Retrieved from https://www.drugs.com
  • Potter, P., Perry, A., Stockert, P., & Hall, A. (2011). Basic nursing (7th ed.). Mosby Elsevier.
  • U.S. National Library of Medicine. (2015). Digitalis toxicity. Retrieved from https://medlineplus.gov
  • RXList. (2015). Lasix. Retrieved from https://www.rxlist.com
  • American Heart Association. (2016). Heart failure: Diagnosis and management. Circulation, 134(25), e312-e354.
  • Harrison's Principles of Internal Medicine. (2018). Chapter on Cardiovascular Disease. McGraw-Hill Education.
  • Chung, M. K., et al. (2019). Therapeutic strategies for atrial fibrillation in elderly patients. Heart Rhythm Journal, 16(5), 679-686.
  • National Institute on Aging. (2020). Managing chronic health conditions in older adults. https://www.nia.nih.gov

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