Topic
Patient assessment
Instructions
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 preview
According to Considine & Currey (2015), for the elderly in particular, patient assessment should be conducted using an evidence-based approach so that medical workers can be better equipped to identify signs of decline. This can be accomplished through the use of a general survey which starts once the medical worker walks into the room of the ill individual. Some of the things that can be assessed by simply observing Millie in her home include:
Distress level—Even though Millie does not appear to be in obvious distress, it is evident, from the fact that she is staring blankly outside the window is an indication that all is not well. Millie actually suffers from intermittent incontinence of bowel and bladder. Fred, who is four years older than her, may not be able to handle all responsibilities that fall on him in a timely manner.
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