Nursing Essay Example: Home Visit with Sallie Mae Fisher

Sallie Mae Fisher is an 82-year-old lady whose health condition is somewhat interesting. She is suffering from a mix of various ailments such as congestive heart failure, hypertension, and atrial fibrillation. She had been admitted to a hospital for three days because of dyspnea, chest pains and an 8-pound increase in her weight. After her health conditions were stabilized, she was discharged and is recuperating at home. She currently lives alone after her husband passed on recently. Furthermore, her only daughter, Thelma Jean lives and works in town which is a long commute to her mother's place. Other than that, Thelma is also dealing with her own family issues, and as such, she cannot live with her mother. Sallie Mae Fisher has limited family support and requires nursing interventions. The purpose of this paper is to identify problem areas that Ms. Fisher is facing with substantive evidence for each. It also identifies particular nursing and medical interventions that can change and improve Ms. Fisher's health.

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Mea Fisher Conditions and the Problems Identified

Looking at Sally Mae Fisher's prescriptions, health records as well as her physical examination, it is clear that there exist problems with her conditions. This paper will bring out four of these problems. The first problem is a deficit in the volume of fluid that was related to particular factors. The reasons for the low fluid volume was that Ms. Fischer had a reduced motivation to taking water or other beverages that would help her fluid levels, she also did not like taking meals or diets that were rich in fluids, and she was also depressed which also affected her greatly. The other reason was that she was susceptible to the risk of falling easily which was related to the illnesses. This meant that she could easily get injured if she applied herself physically due to her weakness. As such, she had to abandon her daily chores, and she needs someone to help her especially considering that she lives alone at the moment.

She is also facing the risk of having an acute electrolyte imbalance which is also related to the first problem of fluid deficit and use of diuretics. It means that her pH levels are not balanced. It is a common problem that affects older people and has the ability to cause morbidity and mortality. Diuretics are substances that are able to increase salt and water amount expelled from the body. Ms. Fischer's use of this drug did not help her fluid volume considering she did not take a sufficient amount of water or fluids, to begin with. The last problem was that she faced the risk of having an imbalance in her nutrition that can be related to her inadequacy in her dietary intake.

Substantiating Evidence for the Problems above

The first problem was recognized by looking at her blood pressure that was 90/56. This can well support the first diagnosis as it is an indication of low fluid volume or fluid volume deficit. Another indication of the problem can be evidenced in that her skin is coarse and she has tenting when pinched. Indeed, when skin is pinched, it should normally go to its normal state after a few seconds. However, this was not the case for Ms. Fischer which indicates low fluids in the body. Her mucous membrane that should be wet and moist is dry because she does not take a sufficient amount of water.

Considering the second problem, it was observed that Ms. Fischer almost tripped to the floor and did not have good balance as she approached the door. She also complained of having a cloudy mind, and her blood pressure was low. All these evidenced and led to the diagnosis that she was weak and could well injure herself quite easily. For the third issue, hypoactive bowel sounds, cloudy mind, and low blood pressure were an indication of electrolyte imbalance. All these were characteristic of Ms. Fischer and led to the third diagnosis. For the last problem, Ms. Fischer is getting weak because she does not take food that is helpful to her needs. She verbalized that she likes taking a can of soup which has affected her greatly and she also has lost appetite. Her husband's death seems to cause a huge impact on her mental attitude and has affected what she eats.

Nursing Interventions and Their Rationale

A major intervention for Ms. Fischer's case is that there should be fewer physicians and specialist taking care of her. Having many nurses and doctors attending to a patient means that there is a high chance of duplication of medication (Accetta, 2016). This is clear in that Ms. Fischer is taking the Lasix medication wrongly and is unaware that she is repeating the medication as she was given some while being discharged and at home. It could well explain why she has a low heart rate.

Another intervention is that the nurses should give proper advice and explanation about the importance of equipment and medication provided (Sidani & Braden, 2013). Sally Mae Fischer states that she turned back the oxygen provided to her during discharge because she thought she did not need it and did not want to be charged extra. Because of the lack of oxygen, she has been fatigued and has been feeling restless. The nurse should explain the benefits of supplemented oxygen such as how it can reduce fatigue, restlessness, and shortness of breath. She could coordinate with the company to have it brought back and explained its usage to Sally.

The nurse should also come up with a diet and timetable for patients with dietary issues and ensure that they follow them to the very end. Considering Ms. Fischer was getting weak and did not have any dietary plans, the nurse should help her come up with a diet with consultation with nutritionists that is helpful in making her strong. It could also cater for her fluid intake which will well help increase her fluid volume that is deficient. At times, it is not a must for medication to bring relief to patients (Lewis et al., 2019).

Sally Mae Fischer indicates that she may be going through a bout of depression although she does not state that expressly. She states that she has never been the same since her husband died and had affected her daily activities such as cooking which she says she does not care anymore. The nurse could offer counseling if she has been trained or let a counselor give Ms. Fischer a home visit to deal with the pain of losing a loved one (Ersek, 2002). This is especially critical considering that Ms. Fischer lives alone and does not have anyone to help her. The nurse could also tell Ms. Fischer's daughter about this and ask her to visit her mother more regularly as it would have an effect on her mental wellness and emotional growth.

Scripted Dialogue

Nurse: Good morning Ms. Fischer, my name is ______, and I will be your nurse today.

Ms. Fischer: Good Morning to you too. It is a pleasure meeting you. Please come in.

Nurse: Thank you, Ms. Fischer. I understand you are experiencing.....

Ms. Fischer: Please call me Sally dear, Ms. Fischer is too formal, and this is an informal meeting.

(Both chuckle)

Nurse: Alright Sally, that means we are friends which I like very much. You can also call me ****** rather than nurse to even it out.

Ms. Fischer: You got it dear. Oh, sorry *****

(Both laugh out loud)

Nurse: Let us get on with what has brought me in today

Ms. Fischer: Please lets

Nurse: I understand you are experiencing problems and I have come to discuss these with you plus talk about solutions and recommendations that I would like to have for you.

Ms. Fischer: I think that would be splendid.

Nurse: I will first go through what I have as the problems that you are experiencing from past interactions and I will also like to hear if there are more issues that have arisen since then.

Ms. Fischer: If it is for my own betterment, you know I am well on board.

Nurse: Marvelous. So let us begin with particular symptoms that you are having. I understand that you feel as though your mind is cloudy, you are also experiencing a fluid deficit in your body, you have lost appetite, and you are very tired and fatigued.

Ms. Fischer: I think you got that right.

Nurse: Well there is more. I also understand that you are not eating well and are very weak. This has caused you to be very weak and has affected your handling of the daily chores.

(Ms. Fischer nods in agreement)

Nurse: From your physical assessment, I can see that your blood pressure was 90 over 56, the heart rate was 58, and respiratory rate was 24. Also, to add on to that, the temperature was 97.8. You have lost 14 pounds in the last one week since your admission to the hospital a week ago.

Ms. Fischer: You seem to have me well figured out.

Nurse: (Smiling) well, you know we have to be on top of things so that you can have the best care possible.

Ms. Fischer: I appreciate that very much. So, is there more?

Nurse: Your skin is coarse, and the mucous membranes are dry, the bowel sounds are hypoactive as well, and I do not know if you have had a bowel movement since the last visit.

Ms. Fischer: Well, I did, but it was only one time since then.

Nurse: I understand. It is very important that you are taking care of yourself even as we come in day to day to check up on you. (Pauses for effect). For instance, you should take more liquids especially water as it has an effect on your health. You have a fluid deficit which can lead to electrolyte imbalance and other factors. Please ensure that you take water more regularly as it is good for your health.

Ms. Fischer: Yes ma'am

Nurse: I can see that you had been provided with the supplement oxygen. I hope they brought it back and are using it. It is very important for your health.

Ms. Fischer: Yes they did (points to the corner where the oxygen machine is standing). It has really helped me as I do not have shortness of breath anymore and my fatigue levels have also improved.

Nurse: I am happy about that. Please keep using it. It might cost a few extra bucks, but it is very helpful.

Ms. Fischer: Yes indeed it has.

Nurse: Awesome! Can I see your medication please because I understand that you had been taking a particular drug twice unknowingly? Please bring them all here so that we can see whether to have additional drugs or take out some of the drugs that may be unnecessary at the moment.

Ms. Fischer: Imagine I was, but the last nurse corrected that anomaly and my cloudiness has gone down. I wish my husband was here, he would probably have gotten that issue from the start. That man was very thorough you know (speaks from the other room and appears with a handful of drugs)

Nurse: Thank you for speaking about him. How are you coping here alone? You know living alone can be tough plus the last nurse indicated that you did not feel like cooking anymore.

Ms. Fischer: It has been tough but I am coping. My daughter occasionally comes to see me although it would be nice to have someone more often.

Nurse: I understand Sally, I know how lonely it is and it can have an effect in your health. I hope you have started eating well again especially considering it is for your own benefit.

Ms. Fischer: Yes and by the way, I am feeling better and have been able to do some house chores.

Nurse: That is nice. (Takes the drugs and counterchecks each one)

Nurse: The drugs are all alright. Keep taking them as prescribed dear.

Ms. Fischer: You got it.

Nurse: I am happy with your progress. I will come soon, and we can discuss more. I want also for us to draw a meal plan and have a lengthy discussion. I know we can be good friends and I am looking forward to our future interactions.

Ms. Fischer: Thank you so much. I would love that a lot.

Nurse: I beg to go now (stands up). It was a real pleasure meeting you Sallie. Have a lovely afternoon.

References

Accetta, R. C. (2016, May). Polypharmacy: Strategies for Reducing the Consequences of Multiple Medi...