NUR 302 Nursing : Hypertension and Cardiac Problems

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.

Answer:

Sallie Mae Fisher is an elderly woman in her 80’s, widowed, and is diagnosed with hypertension and cardiac problems. The home visit showed the following concerns:

1: Patient’s safety at home

2: Patient shows signs of confusion, and her mind feels clouded.

3: Signs of Dehydration

4: Hypoactive bowel movement.

The first problem is evidenced by how the rug was kept on the floor, which had trip hazard. Secondly, the patient kept her door unlocked, which raises a security concern. She also seemed to be a little confused. It seemed that she was still mourning the death of her husband. She showed a lowered interest in taking care of herself. This raises a concern of her safety and well being staying alone and unsupervised. Additionally, the signs of depression can also be an indicator of dementia (Reppermund, 2016).

The second problem has been acknowledged by the patient. The third problem is related to a poor turger and slight tensing of skin and a dry mucous, which suggests signs of dehydration (Hooper et al., 2014). The evidence for the fourth problem is that Sally did not have a bowel movement for 3 days.

The possible nursing interventions that can be applicable for the patient are: 1) Provision for round the clock supervision of the patient. 2) Psychotherapy sessions and medical intervention to. 3) Diet recommendation or consulting dietician 4) Spiritual and Emotional guidance.

The round the clock supervision can ensure safety at home and also to ensure the patient is administered the medicine regularly, and any health emergency being promptly addressed. The psychotherapy sessions can help her to deal with her grieving process. It can also help to reduce chances of prolonged grief and post traumatic stress (O’connor et al., 2015). Dietary specialists can provide suggestions about good and bad diet, and recommend a diet plan to suit the metabolic needs/condition of the patient. For hypoactive bowel movements, the nurse can suggest fluid consumption (1.5 to 2 liters per day) and use of defecation aids. The nurse can also provide laxatives and suppositories. A spiritual counseling can be suggested for the patient, to help her find meaning in her life, and to take care of herself, and find peace of mind (Gog et al., 2014).

Transcript:

Sally- C’mon in the door is open.

 Kate- Hi Sally, its Kate from Mountain High Top. This is Chistina; she is a nursing student at Grand Canyon.

Christina- Hi there.

Sally- Hi Christina.

Kate: The week nurse told me a little about a little about your trouble since the weight gain.

Sally- C’mon in and sit down

Kate- So how are you feeling sally?

Sally- My mind just seems so clouded.

Kate- The nurse tells anyone till Sunday, the day you were released from hospital, today is Thursday. Well, I know it’s easy to get the day together if you are not feeling well.

Sally- I’m not just worth the look. I don’t have any appetite. I have been really sick to my stomach the last few days, that’s all I can do to open a can of soup. You know, I used to be right decent cook, but since Woody died, I don’t even care.

Kate: You must miss him very much. I would love to hear about him, if you feel like talking.

Sally- Woody was my best friend. He was just, such a hard working guy. He worked for the railroad and he was a jokester too. He could make me laugh.

Kate: Now let’s see why you are not feeling so well. Christina can you do the physical for Sally?

Christina: Yes, you bet. Her Blood pressure was 90/56, heart rate was 58, respiratory rate was 24, temperature was 97.8ºC, weight loss of 14 pounds in one week, lungs clear bilaterally, capillary refalls less than 3 seconds, poor skin turgor pressure and tenting, mucous membranes dry, hypoactive bowel movement and no edema in lower extremities.

Kate: Christina let me see her discharge instruction. According to the instructions, you are supposed to have oxygen. 

Sally: Oh forget it. The young doctor had some crazy ideas. I don’t need any oxygen. They said it won’t cost anything but that’s how it doesn’t work all the time.

Kate: Now let me look at your medications.

Sally: These are the three new prescriptions. My daughter got them refilled on Sunday. The nurse who came did not see those.

Kate: When did you start your medications?

Sally: Sunday night right away.

Kate:  OK Sally, me and Christine are going to review our findings. Is that OK with you.

Sally: Yeah, its OK.

References:

Goh, A. M., Eagleton, T., Kelleher, R., Yastrubetskaya, O., Taylor, M., Chiu, E., ... & Lautenschlager, N. T. (2014). Pastoral care in old age psychiatry: Addressing the spiritual needs of inpatients in an acute aged mental health unit. Asia?Pacific Psychiatry, 6(2), 127-134.

Hooper, L., Bunn, D., Jimoh, F. O., & Fairweather-Tait, S. J. (2014). Water-loss dehydration and aging. Mechanisms of ageing and development, 136, 50-58.

O'connor, M., Nickerson, A., Aderka, I. M., & Bryant, R. A. (2015). The temporal relationship between change in symptoms of prolonged grief and posttraumatic stress following old age spousal bereavement. Depression and anxiety, 32(5), 335-340.

Reppermund, S. (2016). Depression in old age—the first step to dementia?. The Lancet Psychiatry, 3(7), 593-595.