Nutrition and Fluids
Ms. Fisher needs to be educated on the importance of eating proper meals and the outcomes that may present themselves if she does not stick to a sound diet plan. She needs also be advised about controlling her intake of sodium which has got a direct effect on her body fluid levels. Her diet assessment should also provide directions on the importance of supplementing her meals with fresh fruits and vegetables. The rationale for eating proper meals and not sticking to soups only is aimed at preventing cases of weight loss cases. Her skin losing turgidity translates to her being dehydrated therefore; she needs to be educated about taking in more fluids to address this condition. She needs to stick to a low sodium diet to have checks on fluid retention in her blood. There is also the need to explore the different ways in which she acquires finances for her dietary needs.
Medication non-compliance
Ms. Fisher has got also issues with complying with the medication that she has been prescribed to by the doctor taking care of her. The charge nurse identifies that she is supposed to be having an oxygen supply in her house of which she replies that she does not need any oxygen supplements even though they are given free of charge at the hospital (Grand Canyon University, 2015). Additionally, her willingness to take the pills prescribed to her is also low saying that she thinks she does not need all that medication. It is also evident that her medication has not been well arranged and labeled.
The proper intervention in this case should be based on the fact that by her not using the oxygen that she has been recommended to, places her at a greater risk of increasing the severity of exacerbation of her chronic heart failure (Roger, 2013). As such, she is supposed to be educated about the importance of adhering to the prescribed medication to prevent any cases of her conditions deteriorating in addition to possibilities of medication side effects because of not following the required dosages (Camm et al., 2012). The oxygen supply will be important for her daily needs and also during the times that she moves out for walks. A nurse is also supposed to be visiting her occasionally to assess her condition. Her mediation should also be well labeled and arranged/grouped to prevent any possibilities of using the wrong dosage.
Depression
Ms. Fisher shows signs of depression which include; sadness, loss of appetite, loneliness, social withdrawal, weight loss and defiance. She is sad because of her being widowed; therefore, she is missing her husband a situation which is also the reason why she is lonely. She has lost her appetite; a situation which has compounded to weight loss. This weight loss is related to her not cooking for herself and only taking soup from cans (Grand Canyon University, 2015). Another factor for depression is because of signs of social withdrawal since there are many newspapers on the seat she is sitting on, which may mean that she has got limited time to interact with other people our friends.
The interventions that Ms. Fisher need s to observe in this situation is to be educated on the need to be going for walks around the neighborhood and involving herself in elderly support her groups to have that feeling of belonging. This effort has got the effect of reducing any withdrawal signs. Additionally, there is the need for her to be educated on the importance of cooking and for herself to alleviate the possibilities of her missing out on important nutrition due to loneliness.
Home Safety
It is crucial that these issues be addressed in the shortest possible way to prevent any hazards occurring. Ms. Sallie is supposed to be educated on the environmental hazards that might cause falls, proper ventilation, and the importance of mobility around the house (Truter, 2011). Therefore, the nurse should help Ms. Sallie on how to arrange her furniture, increase lighting and aeration. The rationale for these interventions is entrenched on the fact that there is the need for improved lighting, proper arrangement and placement of the rug in the house to ease mobility and prevent possibilities of falling which could result in injuries or fractures (Truter, 2011). Additionally, Ms. Fisher is supposed to be actively involved in physical exercises like Tai Chi to improve the strength of her legs thus prevents falling from body imbalance (CDC, 2016).. She is also supposed to be mindful of her eyesight and periodically go for checkups to ascertain the strength of her eyes. This is directed at ensuring that they function well. Furthermore, she is also supposed to be educated on the importance of installing handrails in areas where there are staircases in her house for ease of movement (CDC, 2016). Proper aeration is crucial in enhancing her oxygen supply in addition to what her doctor recommended.
Dialogue
Nurse: "Good morning, Salle Mae, my name is Mrs. T and I will be your nurse today. I understand you are experiencing problems with dyspnea, congestive heart failure, atrial fibrillation, and hypertension. Did the doctor explain the symptoms of these illnesses and their management?
Sallie Mae: yes the doctor did explain everything. However, I think the doctor exaggerated the symptoms and medication. I am healthy and this was just a small problem for aged people hence it will which will go away with time and there is no reason for all these medication.
Nurse: Mrs. Mae, please understand the doctor did not intend to make you worry or exaggerate your condition. Therefore, you should continue with the medication and including utilizing the oxygen prescribed. It is also important that you group and label your medication correctly so that you do not get confused on what medication you need to take at a particular time.
Sallie Mae: I will do that.
Nurse: I understand you feel lonely, have lost weight and feel sick to the stomach. I see that you are taking coca cola drink and you have just had soup from a can?
Sallie Mae: I tend to lose appetite when I feel lonely. I lost the morale to cook hence I take canned food or I order fast food such as pizza and French fries.
Nurse: Given your condition is it advisable that you take healthy meal preferably vegetable, fruits and less fat and sodium. Thus, you need to start cooking your own meals and avoid fast foods since they will complicate your condition. Additionally, you need to be physically active. You need to go for walks around the neighborhood as much as possible during the day, visit friends and go to church. These activities will help to be active and feel rejuvenated hence getting the rid of loneliness and pray for your husband. I will also urge you to join a support group for elderly where you can participate in sports and health education initiatives which will educate you on how to take care of yourself while at home. These programs will also educate you on dangerous symptoms and signs to check for during old age. I will finally, advise you to arrange your house properly; this carpet can trip you and hence injuring yourself.
Sallie Mae: Thank you for this information
Nurse: You’re welcome. Goodbye, and see you next week.
References
CDC. (2016). Preventing Falls Among Older Adults | CDC Features. Retrieved from http://www.cdc.gov/Features/OlderAmericans/
Roger, V. L. (2013). Epidemiology of heart failure. Circulation research,113(6), 646-659.
Grand Canyon University. (2015). Grand Canyon University | Digital Resource. Retrieved from http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs410v_vp01Alt.php
Camm, A. J., Lip, G. Y., De Caterina, R., Savelieva, I., Atar, D., Hohnloser, S. H., & Ceconi, C. (2012). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. European heart journal, ehs253.
Truter, I. (2011). Falls prevention in the elderly. SA Pharmaceutical Journal,78(9), 12-17.
