Home visit with Sallie Mae Essay

Posted: January 18th, 2023

Home visit with Sallie Mae Essay

Provide substantiating evidence (assessment data) for each problem identified. The problems we identified are fall risk, depression, non compliance with meds and unintentional weight loss

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. Home visit with Sallie Mae Essay

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:

o    Digoxin 0.25 mg once a day

o    Lasix 80 mg twice a day

o    Calan 240 mg once a day

• Order 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 Essay

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Based on the assessment of Mae Fisher’s prescription, health records, and physical examination, the most probable problems that she is likely to experience include unintentional weight loss, non-compliance with medication, a high risk of experiencing falls and depression.

Sae Fisher is 82 years old and has been diagnosed with hypertension.  For this reason, she takes Lasix, Vasotec, and prazosin to reduce blood pressure which potentially increases the incidences of lightheadedness and vertigo. Anti-hypertensives have generally been evidenced to cause lightheadedness and fainting among patients upon sudden sitting or standing which increases the risk of experiencing falls (Koch, Wakefield & Wakefield, 2015). Similarly, the diagnosis of atrial fibrillation, congestive heart failure, and hypertension can potentially lead to a stroke which causes numbness, paralysis and weakness of the lower arms resulting in a fall.

Due to the chronic nature of the illnesses that Mae Fisher is suffering from, she requires complex regimes of medications and multiple drug therapy. It is for this reason that she has been prescribed more than five medications. As stated by Wallace et al., (2015), the increasing cost of the drugs used to manage chronic illnesses, drug interactions, high probability of forgetfulness due to age, different dosing and frequencies and limited family support increase the likelihood of non-adherence. Home visit with Sallie Mae Essay

It has clearly been explained that Ms. Fisher is widowed and that she lives alone. Her only family who is her daughter lives in town but has a busy work schedule. This means that Ms. Fisher is often lonely. Loneliness is a common risk factor for depression amongst seniors. Loneliness can result from retirement, lack of mobility, debilitating chronic illnesses, lack of close family support or even neglect resulting in high rates of social isolation (Wallace et al., 2015).

Based on Ms. Fisher’s age and a diagnosis of Congestive heart failure, it means that she cannot perform strenuous activities of daily life including regularly cooking for herself. Despite that, it is notable that she has been prescribed multivitamins which means that she has a reduced appetite. As supported by Koch, Wakefield & Wakefield (2015), the lack of appetite and inability to regularly prepare food for oneself can contribute to Ms. Fisher eating less or starvation increasing the risk of unintentional weight loss.

References

Koch, G., Wakefield, B. J., & Wakefield, D. S. (2015). Barriers and facilitators to managing multiple chronic conditions: a systematic literature review. Western Journal of nursing research, 37(4), 498-516.

Wallace, E., Salisbury, C., Guthrie, B., Lewis, C., Fahey, T., & Smith, S. M. (2015). Managing patients with multimorbidity in primary care. BMJ, 350, h176.