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.
These are the problems in order of priority.
1. Poor medication management
2. Depressed and does not have family support
3. At risk for falls at home due to carpet. Lives alone. Safety component.
4. Nutrition watch
Home Visit with Mrs. Fisher 1
Nurse A.M.: Hello, Sallie Mae. I am nurse A.M. and I will be taking care of you.
Sallie Mae: Good morning A.M. I am experiencing some problems juggling my care and I’m hoping you can help me.
Nurse A.M.: Of course. I want to make sure you are comfortable with your care. I’ve already placed a call to your concentrator oxygen supplier and they’ll deliver it on Thursday, the 10th at 2:00 P.M. And the great thing about the company is that someone from the company will sit with you and teach you how and when to use the tank. You should let them know if you have any questions. So, I’m going to help you with medications. I read in your chart that you are taking multiple medications. Do you have a pill box or is someone helping you with the medications?
Sallie Mae: Sometimes, when my daughter is here, she helps me with the medications. But, she is here rarely. I usually take the medications as I remember them.
Nurse A.M.: Sallie, that is extremely dangerous as adverse drug interactions can occur. We are going to create a pill case with all of your medications. I’m going to go through what day and time to take the medication. We can set recurrent alarms on your phone if that is helpful.
Sallie Mae: Yes, that would be great.
Nurse A.M.: Usually when Lasix and Digoxin are prescribed together, weakness or muscle cramps should be reported to the physician. Have you let the doctor know?
Sallie Mae: I am not experiencing muscle cramps, only fatigue.
Nurse A.M.: Okay, I will make a note of it. I’ve also noticed that the medications you’re taking include Lasix and Furosemide. This is the same drug and could explain your fatigue. I am going to inquire with your physician if this is an error.
Sallie Mae: I really do not know much about the drugs. My late husband took care of all the medical supplies and medication.
Nurse A.M.: I understand. Now that you are taking a lot of medications, it is important to eat a nutritious meal. For instance, some side-effects of Calan include fatigue, nausea, constipation, and light-headedness. I also recommend taking a short walk, so your body is in motion, and you’ll be more confident and determined to get through this.
Sallie Mae: I will have a healthy meal service delivering food three times a week.
Nurse A.M.: That is a good start. Are you predominantly alone? I see that you are taking Effexor for depression.
Sallie Mae: Yes, I am. My daughter visits rarely and we have some family issues. I feel alone in my treatment plan.
Nurse A.M.: Sallie, I want you to be optimistic about your treatment plan. I think that’s a good start. Do you have any friends or acquaintances living in the area? I can reach out to them, so you have someone to talk to when you feel lonely.
Sallie Mae: I do have a friend from church that lives in the area. She is a little too social, but I enjoy talking to her.
Nurse A.M.: Do you want to give her a dial at the end of our conversation?
Sallie Mae: Sounds like a plan. Thank you.
Nurse A.M.: You mentioned she was a friend from church. I always try to create a comprehensive plan for my patients that address their physical, social, spiritual, and educational needs. Do you still have faith?
Sallie Mae: Sometimes. I am just exhausted or depressed to steer towards faith at the moment.
Nurse A.M.: I understand. You’ve recently lost your husband and your health has certainly made it challenging for you to believe in a higher power and practice regularly, but I know you will be optimistic and be able to build sense of community by regularly attending church. Say a small prayer every night before bed.
Sallie Mae: I do feel at peace during Mass.
Nurse A.M.: Well, that’s a good start. I can certainly ask your church’s deacon to do a prayer with you sometime this week.
Sallie Mae: That would be good. I like the deacon.
Nurse A.M.: Would you mind if I move this carpet away from the door? I noticed you were at risk for a fall. Moving the carpet would make both you and me feel better about avoiding an injury.
Sallie Mae: Thank you for noticing. I did not even think twice about it.
Nurse A.M.: I’m going to get started on the medication times list. Do you have any questions for me or any concerns you want to address?
Sallie Mae: I am okay. Thank you for talking with me and informing me.