Home Visit with Sallie Mae Fisher

Home Visit with Sallie Mae Fisher

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Home Visit with Sallie Mae Fisher

Mae Fisher is an 82-year old lady whose health condition can be assessed based on her physical examination and her health history. She was recently discharged from a hospital after suffering various illnesses like congestive heart failure, atrial fibrillation, and hypertension. She lives alone because she recently lost her husband and her daughter lives in town away from her. This paper identifies four problems that Ms. Mae Fisher is currently experiencing giving a substantive evidence for each problem. The evidence is based on her health history and discharge orders as well as well as from the health assessment done by the nurse during her home visit. The paper also identifies the four medical and nursing interventions that are aimed at improving Mae Fisher’s health condition.

Problems identified from Mae Fisher’s Condition

From Mae Fisher’s health records, prescription, and her physical examination, four problems can be clearly identified. The first problem is fluid volume deficit that is related to various factors in the Mae Fisher’s condition. During the interview, Mae Fisher said that she has a low motivation take a diet that is rich in fluids. The second problem is that she has a high risk for injury related to falls due to her illness. She is unwell and might not do the daily chores because of her weak condition. The only person that could have come to her aid is her daughter who lives in a town away from her. The third problem that Mae Fisher is experiencing is non-compliance to medical prescriptions. The fourth problem that she is experiencing is depression which affects many patients that stay alone. Ms. Fisher’s problems can be confirmed by her responses during the interview, her health history and discharge orders.

Evidence to Support the Diagnosis

Mae Fisher’s fluid volume deficit problem can be verified by various assessment results. She has a poor skin turgor which is a clear evidence of body dehydration. Normally, the skin should immediately return to its earlier state after being pinched. She also has dry mucous membranes, another evidence that confirms the fact that her body is not adequately hydrated. The second diagnosis shows that she has a high risk of injury resulting from falls during her illness. Her rage is carelessly thrown on floor increasing her risk of falling while moving in the house. She also did not show a good body balance while moving in the house. She also commented that her mind is cloudy, increasing her risk falls related to dizziness and vertigo. The third diagnosis of prescription non-compliance is seen from her frequent hospitalization for CHF exacerbation. Her depression is seen from the fact that she is lonely and misses her deceased husband a lot. She is only comforted by the knowledge that she will see her husband again someday to come.

Medical and Nursing Interventions

Ms. Fisher’s problems are severe and should be addressed by appropriate interventions that are aimed at reducing the effects of her illness and improving her health condition. The best nursing intervention for fluid volume deficit is by encouraging the patient to drink plenty of fluids like water and diluted drinks (Popkin, D’Anci, & Rosenberg, 2010). This intervention should be accompanied by monitoring the vital signs, capillary refills, and mucous membranes. The risk for falling is inevitable especially in aging patients like Mae Fisher. The best intervention for this risk is by examining her medications to determine the drugs that increase her risk of falling and reduce or stop their dose where necessary (Degelau et al., 2012). Her environment should also be improved by placing call lights within her reach and showing her how to call for assistance. The problem of non-compliance to medical prescriptions can be intervened by encouraging the patient to the drugs by emphasizing on their importance and highlighting the effects of non-compliance (Maningat, Gordon & Breslow, 2013). The interventions for depression include assessing the patient’s clinical symptoms, interacting with her at a low tone and identify the activities that may interest her to do.

Interventions Rationale

The above interventions can be justified for various reasons based on the patient health conditions. Fluid volume deficit leads to dehydration of the body. Encouraging the patients to take diets rich in fluids tops up the lost water and maintains the fluid balance in patient’s body (Popkin et al., 2010). Sweet drinks can help the patient to replace the lost sugar as salty drinks replace the lost salts in the body. Examining the medication of the client is a key step for restoring strength in patients. Certain medications like diuretics and antidepressants are consequential as they increase the risk of falling. Therefore, their stoppage or reduction their dose can help restore the strength in the patient. Aging people like Mae Fisher also require helpers for companionship and assistance in daily house chores. Educating the patient on the benefits of prescription compliance and the effects of non-compliance makes it easy for her to view taking medication as a personal responsibility. Depression is inevitable especially in the patients who are bereaved and live alone. Interacting with such patient and encouraging her to verbalize her feelings makes significant reduces emotional outburst that causes depression.

References

Degelau, J., Belz, M., Bungum, L., Flavin, P. L., Harper, C., Leys, K., … & Webb, B. (2012). Prevention of falls (acute care). Institute for Clinical Systems Improvement Health Care Protocol. Updated April

Maningat, P., Gordon, B. R., & Breslow, J. L. (2013). How do we improve patient compliance and adherence to long-term statin therapy?. Current atherosclerosis reports, 15(1), 1-8.

Modric, J. (2013). Skin Turgor Test. eHealthStar Retrieved from http://www.ehealthstar.com/test/skin-turgor-test.

Popkin, B. M., D’Anci, K. E., & Rosenberg, I. H. (2010). Water, hydration, and health. Nutrition Reviews, 68(8), 439-458.

Serrano, M. (2012). Depression Nursing Interventions. Retrieved from http://rnspeak.com/psychiatric-mental-health-nursing/depression-nursing-interventions/.