Question

Your home health agency has received an order from a local hospital to evaluate and treat an elderly woman being discharged from its medical surgical unit.

Millie Gardner, an 83-year-old female patient, is being discharged home today to the care of her husband Fred (87 years old) following a 9-day hospitalization for pneumonia, dehydration, and failure to thrive. She has a history of hypertension (HTN), Type II Diabetes, and cerebral vascular accident (CVA) with left-sided weakness. Patient is alert and oriented but does have periods of forgetfulness during the overnight hours. Patient has intermittent incontinence of bowel and bladder and requires assistance with all activities of daily living (ADLs).

Medications:

Lopressor

Lisinopril

Plavix

Metformin

Novolin R per sliding scale *NEW*

Multivitamin

Colace

Zithromax *NEW*

Upon arrival you are greeted by Champ, the couple's rambunctious miniature Doberman pinscher dog. Millie is in her wheelchair staring blankly out the window, and Fred is busy in the kitchen preparing the couple's lunch.

Based on the scenario above, please use the general survey process to describe the areas that you would be observing immediately upon entry to the home.

What, if any, concerns related to Millie's skin and nutritional status do you have?

What nursing interventions will you include in the plan of care to address these concerns?

What teaching strategies will you use to educate Millie and Fred on the new medications?

Using the SBAR, please include the information that you will communicate to the physician's office at the completion of the visit.

Answer 1

Concern related to Millie's skin need to check her skin integrity and bedsore( decubitus ulcer).. because she was hospitalized for 9days and she can not move from bed with out any one support, having intermittent incontinence of bowel and bladder..this is our nurses responsibility to check Patient skin when they hospitalized with those conditions..check skin discoloration,sore, and breakdown..

Elderly people have malnutrition, we need to meet Patient metabolic requirement, make diet schedule as per health condition and patient weight.advice her husband about skin care .meet Patient nutritional requirement..advice to prevent aspiration and feeding technique..physical and respiratory therapy is important for avoiding complication..

Lopressor and lisinopril for hypertension it should be taken only after meal and explain about the side effects..and when to meet the doctor..

Plavix is prevent blood clot because the patient having only limited movement they may have DVT..

Novolin R is a diabetic medicine should be taken as per patient sugar level

Metformin also diabetic medication it should be taken for correct timing before food..

Multivitamins to strengthen the bone and meet the nutritional requirements..

Colace is for prevent constipation.it should be taken during bedtime..if there is any diarrhoea it should be stopped immediately.

Zithromicin is a Azhithromycin drug for avoiding bacterial infection..this is for Patient pneumonia.

Take medication as per doctor advice..inform doctor if there is any abnormality found..

SBAR communication tool useful for different health care settings to improve patient safety..

S _ situation

Mrs Millie Gardner 83year old female patient in home under her husband Fred..patient was hospitalized for 9days with pneumonia, dehydration and failure to thrive..

Background:

She has a history of hypertension (HTN), type IIdiabetes and CVA with left-sided weakness..her vital signs should be included

Assessment:

Patient is alert and oriented, have forgetfulness during the overnight hours..having intermittent incontinence of bowel and bladder..make assessment with patient body skin,eyes, and other parts and include that also..

Recommendations:

Health education given regarding nutrition and hygiene, medication instructions and therapy follow up etc..