500 words, sample is attached

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Health Medical

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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 findings" and "Sallie Mae Fisher's Health History and Discharge Orders," complete the following components of this assignment:

After viewing the home visit findings, 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.
Identify and describe at least four medical and/or nursing interventions.
Discuss your rationale for the interventions identified.

Prepare this step of the assignment according to the APA guidelines.

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:
- Digoxin 0.25 mg once a day
- Lasix 80 mg twice a day
- Calan 240 mg once a day
Order written to continue other home meds.
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 findings

area rug on the floor- fall hazard
Door unlocked, she doesn’t answer it, just tells person to “come in” without looking to see who is there- safety hazard
Dehydrated- tenting present, dry mucous membranes, BP 90/56
No appetite- eating canned soup- lost 14 pounds in 1 week
Not using prescribed O2- resp rate 24,
No BM for 3 days, likely due to dehydration
Lonely, widowed and her daughter is “busy

Unformatted Attachment Preview

Running head: ASSIGNMENT TITLE HERE 1 Sallie Mae Paper Purple Group Grand Canyon University: Pathophysiology and Nursing Management of Clients’ Health March 05, 2017 ASSIGNMENT TITLE HERE 2 Sallie Mae Fisher has been recently hospitalized for congestive heart failure exacerbation. Sallie Mae still continues to be at declining health. Instead of fluid overload, she is experiencing fluid volume deficit. She has lost 14lbs in the last week. The home health RN reported poor skin turgor, tenting of the skin, and hypoactive bowel sounds. She reports that she feels sick to her stomach and feels lonely ever since her husband passed away this year. The nurse noticed Sallie Mae almost slipped on a loose rug in the hallway and had an unsteady gait during ambulation. Her respiratory rate is 24 and she does not have the home oxygen that was supposed to be utilized after discharge. Her daughter works a full time job and has been late in getting her medication refilled. Sallie Mae is dehydrated, not consuming enough calories, and is not able to manage her medications well. Sallie Mae is at an increased risk for falls from her polypharmacy and hypotension. Sallie Mae has a history of atrial fibrillation, hypertension, and congestive heart failure and is taking Calan, Digoxin, Lasix, Nitroglycerin, vasotec, and minipress. All of these medications can decrease blood pressure and increases her risk for falling. According to Sirkin & Rosner (2009), “diuretics account for 16% of preventable drug-related admissions to hospital, which includes falls.” The article further explores target blood pressure for the elderly patient. Sallie May has a blood pressure of 90/56 and a heart rate of 58. According to Sirkin & Rosner (2009), researchers suggest that BP be lowered at a slow rate and lowering BP under 140 in patients older than 74 years old may be unsafe. They also mention patients with heart failure may need their BP lower than this. Sallie Mae has had a weight loss of over 14lbs in one week. She has imbalanced nutrition and needs to get help immediately. She has poor skin turgor, tenting, and dry mucous membranes. She may need to go to the hospital and get IV fluids. The patient said she cannot ASSIGNMENT TITLE HERE 3 even open up a can of food. She is not safe to live by herself if she cannot eat or drink enough to stay healthy. The RN should provide food and fluids for the patient and see if she can eat or drink. The lack of eating and drinking could be related to her recent loss of her spouse. The lack of consuming food and fluids and taking several blood pressure medications is a dangerous combination for Sallie Mae. Her Lasix and other Blood pressure medications should not be given if her Blood pressure is only 90/56. According to Gulanik (2011), the RN should assess and document intake and output. Sallie Mae should be assessed for altered mental status because dehydration can cause confusion. Monitoring her vital signs is important because dehydrated patients can have decreased blood pressure and increased heart rate. APA dictates that you should avoid having only one subsection heading and subsection within a section. In other words, use at least two subheadings under a main heading, or do not use any at all. When you are ready to write, and after having read these instructions completely, you can delete these directions and start typing. The formatting should stay the same. However, one item that you will have to change is the page header, which is placed at the top of each page along with the page number. The words included in the page header should be reflective of the title of your paper, so that if the pages are intermixed with other papers they will be identifiable. When using Word 2003, double click on the words in the page header. This should enable you to edit the words. You should not have to edit the page numbers. ASSIGNMENT TITLE HERE 4 References Gulanick, Myers. (2011). Nursing Care Plans, 7th Edition. [Pageburstl]. Retrieved from https://pageburstls.elsevier.com/#/books/978-0-323-06537-5/ Sirkin, A., & Rosner, N. (2009). Hypertensive management in the elderly patient at risk for falls. Journal Of The American Academy Of Nurse Practitioners, 21(7), 402-408. doi:10.1111/j.1745-7599.2009.00418.x
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Explanation & Answer

Attached.

Running head: SALLIE MAE PAPER

1

Sallie Mae Paper
Name
Institution

SALLIE MAE PAPER
The recent hospitalization of Sallie Mae Fisher relates to a congestive heart collapse
exacerbation. Sallie Mae's current health state continues to decline. She is undergoing fluid
volume deficit as a substitute of fluid overload. The past week has seen her burn 14lbs.
According to the RN report, she had the following symptoms:
1.Hypoactive bowel noise
2. Deprived skin turgor
3. Tenting of the membrane
Recent releases she has given out point out that she is experiencing stomach upsets. She
is also reported to undergo solitude after the recent demise of her husband this year. Sallie Mae's
nurse noticed that she has a tremulous way of walking during ambulation. She nearly tripped on
an unfastened rug in the hallway. She lacks the home oxygen that they should administer to her
after discharge. This is needed for her consumption. Her respiratory pace is 24. Her medication,
bill has been overdue for payment by her daughter who is working in a full-time job. Sallie Mae
faces many health challenges. These include.
1.Mismanagement of her medication
2.Dehydration
3. Low levels of calories
Sallie Mae faces an actual danger of the declines of her hypotension and polypharmacy.
She has an account of experiencing congestive heart failure, atrial fibrillation, and hypertension.
She is consuming minipress, lasix, digoxin, calan, and nitroglycerin. All of these medications
amplify the...