Community Home Visit with Sallie Mae Fisher Order Instructions: THIS ASSIGNMENT HAS 2 PARTS:
1- ESSAY PORTION (750 WORDS)
2- SCRIPTED DIALOGUE PORTION (ABOUT 900 WORDS)
Collaborative Learning Community: Home Visit with Sallie Mae Fisher
Details: This is a CLC assignment.
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:
1. Identify, prioritize, and describe at least four problems.
2. Provide substantiating evidence (assessment data) for each problem identified.
3. Identify and describe at least four medical and/or nursing interventions.
4. 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.
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 the 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 ______ 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
You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center. Only Word documents can be submitted to Turnitin.
NRS410V.R.SallieMaeFishersHealthHistoryandDischargeOrders_Student_02-11-13.docx NRS410V.R.HomeVisitWithSallieMaeFisherGradingCriteria_Student_02-11-13.docx
Please Note: Assignment will not be submitted to the faculty member until the “Submit” button under “Final Submission” is clicked.
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 are 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
• An order was 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
REQUIREMENTS:
Essay Portion
1) Identified and prioritized at least four problems from the simulated home visit with Salle Mae.
2) Summarized each problem identified with evidence to substantiate findings (assessment data).
3) Identified and discussed at least four medical and/or nursing interventions to meet client needs.
4) Provides rational for interventions identified. Discussion of rationale includes support from outside resources (current evidence-based literature).
Scripted Dialogue Portion
1) Utilizes information learned from the home visit, health history, and discharge orders presented in the simulation to develop a patient dialog.
2) Dialog addresses the physiological, psychosocial, educational, and spiritual needs of the client.
Format/Style
1) Essay Portion
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.
Information is paraphrased and not copied/pasted from other sources, including dictionaries, textbooks, e-books, and electronic links.
2) Scripted Dialogue Portion
APA format is not required for this part of the assignment, but solid academic writing is expected.
Total______pts / 100 x 200=_______% of grade Possible
10
20
40
80
10
20
10
Actual
______
______
______
______
______
______
______
Community Home Visit with Sallie Mae Fisher Sample Answer
Collaborative Learning Community: Home Visit with Sallie Mae Fisher
Identify, Prioritize, and Describe At Least Four Problems
Ms. Fisher has chronic congestive heart failure (CHF) history. She has been experiencing CHF exacerbation. She has a history of hypertension and atrial fibrillation. From the review of the system, the patient has the following problems (Albert, 2012);
- a) Decreased cardiac output: this is attributable to the fact that the patient heart has reduced capacity to meet her body`s metabolic requirements. The decrease in blood flow that supplies the heart results into a reduced cardiac output, which the causes the insufficient blood fail to circulate to all the other body parts. This causes an altered heart rate, weakness, and paleness. This problem is clinically manifested by irregular pulse rhythm, tachycardia, and generalized body weakness.
- b) Fluid and electrolyte imbalance: the patient has not been taking a lot of fluids. The imbalances are related to low fluid intake and use of diuretics.
- c) Dyspnea episodes had been indicated in the discharge report, but the patient declined the proposed intervention of using oxygen supplement.
- d) A risk for imbalanced nutrition: associated with poor dietary intake.
Provide Substantiating Evidence (Assessment Data) For Each Problem Identified
The decreased cardiac output is indicated by the blood pressure of 90/56. The insufficient blood circulation to the other parts of the body is the main cause of tachycardia. The fluid and electrolyte imbalance is indicated by the patient’s skin condition. The patient skin is tenting and coarse. This is an indicator that the patient’s body is not well hydrated. When pinched, a hydrated skin goes back to the original state immediately. The assessment also indicated that the mucous membranes are dry. The hypoactive bowel movement bowel movement sounds, low blood pressure and her complaints that her mind is cloudy are the indicator for fluid and electrolyte imbalance (Hughes, 2013).
The episodes of dyspnea are evident by the fact that the patient discharge report had requested for oxygen gas supplementation but the patient declined the treatment. This indicates that the condition is still persistent as it was not managed. The patient risk for imbalanced nutrition is indicated by the fact that the patient has lost 14 pounds within a span of one week. This indicates that the patient has not been able to cook or she has no caregiver to help her with her daily routine activities such as hygiene or feeding. She says that she has no appetite and is still undergoing grief due to the loss of her husband (Apostolo et al. 2012)
Identify and describe At Least Four Medical and/or Nursing Interventions and Their Rationales
| Nursing diagnosis | Nursing intervention | Rationale |
| Decreased cardiac output | Abnormal heart lungs and sounds will be assessed
Assess patient consciousness and mental status
Assess skin temperature as well as the peripheral pulses |
This facilitates the detection of the renal failure associated with fluid and electrolytes imbalance
This can be caused by toxicity due to an accumulation of waste products caused by impaired blood circulation. This is manifested by the patient condition of legarthy, altered consciousness and “cloudy mind’ Reduced perfusion of oxygen to the secondary tissue could lead to decreased temperature and diminished peripheral pulses |
| Fluid and electrolyte imbalance | Monitor diagnostic tests and laboratory findings
Implement strategies to manage fluid and electrolyte imbalances
Administer cardiac glycoside agents as indicated, the nurse should monitor toxicity
Assess risk for skin integrity complication such as bed sores |
Important as they provide clues on patients response to medication and statues of the disease.
This helps reduce risks associated with decreased cardiac output Digitalis is associated with the positive inotropic effect on the myocardium. It also strengthens contractility which improves cardia output Patient skin is at risk of developing skin complication. The patient should remain hydrated reposition every two hours to prevent bed sores |
| Episodes of dyspnea | Oxygen saturation and ABGs should be monitored
A patient should be given oxygen as indicated by oxygen saturation and ABGs report
A patient is encouraged to make adequate rest |
This provides insights into hearts ability to circulate and perfuse the distal tissues with oxygenated blood
This will provide the patient with enough gas for gaseous exchange. This will help alleviate hypoxia and activity intolerance This facilitates reduction of cardiac overload, which reduces myocardial oxygen consumption. |
| Imbalanced nutrition | Assess patient ability to carry out daily living activities such as cooking, taking medication right dosage and appropriate time, shopping from the groceries, cleaning the house and self-hygiene | This will help check if the patient has the capacity to take care of herself, or there is a need to have a caregiver with her. This will also help identify if there is medication adherence. |
Part B: SCRIPTED DIALOGUE PORTION
A: Health care: quality of life
Nurse: Good morning Salle Mae, I am Myre from Mt view Hospital. I am your nurse today. I comprehend that you have not been feeling fatigued and shortness of breath. In general, how would you describe your health?
Patient: In comparison to my health status a week ago, I would say my health fairly good. But I am extremely weak and cannot do anything without loss of breath.
Nurse: I will read a list of activities that you would normally do on any typical day. After I read each of them, please state if your current health limit’s them a little or more?’
(Patient intercepts)
Patient: Nurse, lately I have not been doing any activity other than resting on this couch.
Nurse: Why is so? Is that because of your health status?
Patient: Yes, I can barely manage to get myself a glass of water. Cooking has also become an issue and I am relying on frozen foods.
Nurse: Okay, Salle, how do you feel? How things have things been with you since you were discharged from the hospital?
Patient: I feel helpless. I have not known peace for the last two weeks especially because I am depending on other people for help. I am overburdening them. They would so much better if I was not alive.
Nurse: What are some of the things do enjoy doing? How often do you get to do them nowadays? What do you do on the weekends?
Patient: I love golfing. Normally, I would spend the weekends with my friend Penny playing golf. However, since the regular hospitalization incidences, I am unable to join her and all I do during the weekend is sleep.
Nurse: I have noticed that you have been to the hospital a lot lately. How does this make you feel? Would you like to tell me what else has been going on with your health?
Patient: This has made me lose energy. I am unable to understand why life has been this tough. (She is acute distress). My energy levels are low and I seem to be very forgetful lately.
Nurse: Salle, how has the heart failure affected you and how it kept you from living life the way you have always wanted?
Patient: I am no longer able to do things the way I have always wanted because I have to sit and rest a lot during the day. I lose breath even when walking for short distances like from the bed room to the toilet. The shortness of breath has makes it difficult to sleep at night. I feel tired and fatigued throughout the day.
Nurse: Salle, I would like to make you understand your symptoms. You have a health condition which makes your heart fail to function properly. This makes it difficult to propel enough blood to the other body organs of the body. This explains why you have been experiencing shortness of breath, activity intolerance and fatigue.
Patient: Is this why I have all these medications. They are just too many and sometimes I forget to take some.
Nurse: Salle, the medications will help reduce your signs and symptoms. You must adhere to medication. To ensure that you take medication all the time, you can put an alarm for a reminder.
Patient: My mind is cloudy, what can I do to have a peaceful life?
Nurse: Salle, you need to have adequate rest. You must also adhere to medication. Try as much as possible to maintain an active lifestyle such as taking a walk around the neighborhood. Importantly avoid prescribed medication alcohol or cigarettes.
Salle, do you feel sad living alone?
Patient: Ever since Eddy left me (her eyes tears), I feel depressed.
Nurse: You really loved your husband, tell me more about him
Patient: He is the best thing that has ever happened to me. He was the funniest person ever and kept very happy. He was hardworking and my best friend.
Nurse: Are there members of the family or community who regularly check on you? Whom can you call for help when you are not feeling okay?
Patient: My daughter and best friend Penny. She lives a few blocks down the street. Penny is always checking on me and would prepare dinner for me when she visits.
Nurse: What about social workers and case managers? Do you mind if I contacted them to discuss ways they can help you?
Patient: I do not really think that I am that needy, but it is okay, may be they too have additional instructions of benefit to me
Nurse: that is okay, I will reach a social worker; she could be having ample solutions to that will help you manage your health condition and obtain the appropriate social support.
Patient: Thank you so much.
Nurse: Meanwhile Salle, I would encourage you to remain active in church and prayer groups. This will help you have an improved sense of belonging. I will also enroll you to a cardiac rehabilitation program at a health facility that targets the elderly population diagnosed with CHF; it is a community where you meet with other people experiencing the same condition.
I will see in five days. I want you to take the medication as requested, eat nutritious food to help the body retain its energy. Try to remain active to avoid other complications associated with congestive heart failure.
Patient: Alright nurse; thanks for checking on me.
Community Home Visit with Sallie Mae Fisher References
Albert, N. (2012). Fluid Management Strategies in Heart Failure. Critical Care Nurse, 32(2), 20-32. doi:10.4037/ccn2012877
Apostolo, A., Giusti, G., Gargiulo, P., Bussotti, M., and Agostoni, P. (2012) Lungs in Heart Failure. Pulmonary Medicine Volume 2012, Article ID 952741, doi:10.1155/2012/952741
Hughes, R. (2013). Treatments to achieve fluid balance in heart failure. Br J Cardiac Nursing, 8(11), 537-540. doi:10.12968/bjca.2013.8.11.537
