SALLIE MAE FISHER 6
SallieMae Fisher Case Study
Mrs. is an 82-year-old woman who lives alone. She hashad a history of extensive cardiac, includes hypertension, arterialfibrillation as well as congestive heart failure. After beingdischarged from the hospital, she has been under special home care.It is evident that from the last home visit, that her health has beendeteriorating.
Anumber of problems can be identified. One of the most criticalproblems is poor diet. She is not getting enough nutrients from herfood, which, has resulted in her health worsening even further.Additionally, Mrs. Fisher may be suffering from dehydration – andby extension, fluid deficit. She also lives alone and as such, incase of any accidents she would not get anyone to help her. Moreover,the electrolytes and fluids in her body are imbalanced.
Theissues that have been identified above have supporting assessmentdata. She could get hurt at home. Right at the beginning, it took hera relatively long time to open the door. Also, she almost tripped onthe floor rug while she was walking to the couch. In addition, shementioned that her mind has been hazy. Mrs. Fisher said that she hasnot been able to eat well and has no appetite. This supports thediagnosis on her having a poor diet and nutrition as well asdehydration. She also complains of being sick to the extent that shecannot open and eat a can of soup that has worsened her diet andfluid deficiency. This shortfall could have been caused by poorfeeding patterns and less motivation to eat. Her lack of motivationto feed may have been as a result of her living in solitary. She iswidowed and she talks about missing her late husband. Her physicalshows that she has lost over 11 pounds since being released from thehospital. Her skin also shows coarse turgor characterized by tenting.The nurse found out that Mrs. Fisher’s mucus membranes were dry.Other than that, she has a very low blood pressure (90/56).
Morethan anything, Mrs. Fisher will need regular consultation and homecare visits with nurses and doctors she is comfortable with. Thereshould be at least two checkups a week. If an older medicalpractitioner is available, then they should encourage her to take themedication and oxygen tank. She was skeptical about having oxygenaround the house and pointed out that she did not believe much ofwhat the young physicians were telling her. In addition, she willneed counseling to help her deal with the recent loss of her betterhalf. Her daughter will also have to be informed about the situationand be involved in the process of planning for her mother’s care.
Mrs.Fisher also needs an overall lifestyle change that will allow hermore physical activity and better nutrition. Her low blood pressureis of great concern. She will need (ACE) angiotensin convertingenzyme inhibitors which will increase blood flow by widening herblood vessels (Albert, 2012). In addition, her blood pressure levelsand weight should be checked regularly. Her drug intake will need tobe monitored and some drugs, such as ibuprofen, Digoxin and lasixshould be discontinued.
Mrs.Fisher needs to be kept under observation, especially since she hasbeen feeling unwell for the past few weeks. Mae should be visited byolder caregivers who she has established a rapport with (Baptiste,Mark, Groff-Paris & Taylor, 2014).Moreover, Sallie should be encouraged to take her medication andpractice what her nurses recommend. Ibuprofen needs to bediscontinued because it may increase sodium retention which isdangerous for a patient with Congestive Heart Failure (Hanson,Aalfs & Plonczynski, 2013).Patients taking Lanoxin and Potassium need close observation.Administration of Digoxin should be stopped because lanoxin servesthe same purpose as the former. Also, Furosemide and Lasix should notbe taken together as they accomplish the same objectives.
Nurse:Good Morning, Mrs. Fisher, my name is nurse Lucy and I will betaking care of you today.
Sallie:Good morning Lucy. Please, call me Sallie.
Nurse:I understand that you have been unwell as a result of your congestiveheart failure. How are you doing today?
Sallie:I haven’t been myself for a while. I feel tired, dizzy and stressedout. It’s been really hard since my Woody died.
Nurse:Sounds like he was a good man. It`s normal to feel sad and lonelyafter losing a loved one.
Sallie:It`s better when my daughter visits. But when I’m alone, I feel badagain.
Nurse:There are support groups that meet once a week. I can makearrangements for you to attend one every Saturday.
Sallie:Thank you Lucy. I’ve been feeling weak, but I hope I can make it tothe meetings.
Nurse:You need to do more activities. The senior center here is free andhas all the necessary equipment’s and very experienced staff.
Sallie:Can I talk to my daughter about it first?
Nurse:Yes, you can. You could come and see me when she visits over theweekend and I will take you both through the routines I haverecommended for you. I will also print out your care plan so that youcan refer to it whenever you want.
Sallie:Thank you Lucy. That will be great because I sometimes forget things.
Nurse:You’re welcome Sallie. Call me at any time in case you have anyquestions or if you need any help.
Nurse:See you on Saturday.
Albert,N. M. (2012). FluidManagement Strategies in Heart Failure. CriticalCare Nurse.32 (2),
Baptiste,D.L., Mark, H., Groff-Paris, L., & Taylor, L.A. (2014). Anurse-guided patient-centered
heartfailure education program. Journalof Nursing Education and Practice.4(3), 49-57
Hanson,C., Aalfs, K., & Plonczynski, D.J. (2013). Advanced PracticeNurse-managed Heart
FailureClinic Benefits Patient’s Quality of Life and Limits Readmissions.Nursingand Health.1(3), 47-51