As a group, observe the simulated “Home Visit With Sallie Mae Fisher” video (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.
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:
o Digoxin 0.25 mg once a day
o Lasix 80 mg twice a day
o 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 With Sallie Mae Fisher Grading Criteria
Expert Solution Preview
In the “Home Visit With Sallie Mae Fisher” video, Sallie Mae Fisher, an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension, is observed during a home visit. Ms. Fisher has been hospitalized four times in the last 6 months for exacerbation of her CHF and was recently discharged home after a 3-day stay.
After viewing the home visit, it is evident that there are several problems that need to be identified, prioritized, and described. Based on the information provided, here are four problems that are evident:
1. Exacerbation of CHF: Ms. Fisher has been hospitalized multiple times in the last few months due to exacerbation of her CHF. As a result, her symptoms, such as increased dyspnea and weight gain, need to be addressed and managed effectively.
2. Living alone with limited family support: Ms. Fisher is recently widowed and lives alone. Her daughter, Thelma Jean, who lives in town, has her own family issues and cannot provide consistent support. This lack of support can impact Ms. Fisher’s ability to manage her health condition effectively.
3. Inadequate medication management: Ms. Fisher is prescribed multiple medications for her various health conditions. However, there is a possibility of medication errors and non-adherence due to the complexity of her medication regimen.
4. Home safety concerns: Ms. Fisher’s living environment needs to be evaluated to ensure that it is safe and conducive to her health condition. This includes assessing for potential fall hazards, medication storage, and accessibility.
To substantiate these identified problems, the following assessment data can be considered:
1. Objective data: Physical assessment findings such as increased dyspnea, weight gain (8-pound), and chest pain can be documented. Vital signs, including blood pressure, heart rate, and oxygen saturation levels, should also be recorded.
2. Subjective data: Ms. Fisher’s self-reported symptoms, experiences, and concerns should be elicited. This may include asking questions about her level of fatigue, exercise tolerance, and pain levels. Additionally, any difficulties she encounters while managing her medications or adhering to her treatment plan can be explored.
3. Medication reconciliation: Reviewing Ms. Fisher’s medication list, including medications prescribed both in the hospital and at home, is crucial. This will help identify any discrepancies, potential drug interactions, or duplicated therapy that could contribute to her health problems.
4. Home environmental assessment: A home visit or assessment can be conducted to determine the safety, accessibility, and suitability of Ms. Fisher’s living environment. This includes evaluating factors such as the presence of assistive devices, proper lighting, and absence of fall hazards.
Overall, the identified problems and assessment data provide a comprehensive understanding of Ms. Fisher’s health status and the challenges she faces at home. By addressing these problems and utilizing the assessment data, healthcare professionals can develop an appropriate care plan that focuses on improving Ms. Fisher’s health outcomes and ensuring her well-being.
