Home health nursing interventions for elderly patient with congestive heart failure

¶ … Interventions

Home health visits can be a useful method of identifying potential and actual health issues. Visiting the patient's home may provide the opportunity to identify issues which may not be readily apparent at a medical office. The home health visit is meant to assist in the promotion of the patient's health maintenance; limit further disability, and increase baseline health.

The visiting nurse will gain the ability to build a caring, professional, trusting, patient focused relationship. The home health nurse will be able to assist the patient by identifying, procuring and providing education for interventional items. The nurse will also know how to facilitate the communication of identified patient needs, in the home, to interdisciplinary members of the health care team (Liebel, Powers, Friedman, & Watson, 2012, p. 80).

Problem #1

The patient has been prescribed oxygen for home use by her physician. The patient states the she has not arranged oxygen in her home because it will cost her more money. The nursing intervention is to find out the total associated cost and arrange oxygen delivery and then provide education regarding safety and use. The use of oxygen will improve the patient's respiratory function and improve her quality of life (Criner, 2013, p. 48).

Background

Ms. Fisher is an 82-year-old female with a history of chronic congestive heart failure (CHF), atrial fibrillation, and hypertension. During the last 6 months, she has been hospitalized four times for exacerbation of her CHF. She was discharged home last Saturday from the hospital after a 3-day stay to treat increased dyspnea, an 8-pound weight gain, and chest pain. Ms. Fisher is recently widowed and lives alone. She has a daughter, Thelma Jean, who lives in town but works full time and has family issues of her own. Therefore, family support is limited. Hospital Discharge Instructions

Mountain Top Home Health to evaluate cardio-pulmonary status, medication management, and home safety.

Medical Equipment Company to deliver oxygen concentrator and instruct patient in use. O2 at 2 liters per nasal prongs PRN.

Prescriptions given at discharge: Digoxin 0.25 mg once a day, Lasix 80 mg twice a day, Calan 240 mg once a day

Order written to continue other home meds. Sallie Mae's Home Medication List

Zocar 50 mg once a day

Minipres 1 mg once a day

Vasotec 10 mg twice a day

Prilosec 20 mg once a day

Furosemide 40 mg once a day

Effexor 37.5 mg at bedtime

Lanoxin 0.125 mg every other day

Multivitamin once a day

Potassium 40 mg once a day

Ibuprofen 400 mg q 4 hours as needed for pain

Darvocet N. 100 mg q 4 hours as needed for pain

Nitroglycerin ointment, apply 1 inch every day

Identify and prioritize 4 problems and 4 interventions

Problem 1 -- Ms. Fisher experiences chronic congestive heart failure. This disease decreases cardiac output, minimizing the amount of blood pumping through the heart. Since the oxygen is not adequately circulated in the blood nor is the carbon dioxide, as the blood returns to the heart from the body and lungs, it can cause fluid (mostly water) to escape from capillary blood vessels. Some of the symptoms typically experienced with CCHF are shortness of breath, swelling, and weakness. That is why Ms. Fisher has experienced episodes of tripping and cloudy mind.

Problem 2 -- Hypertension or elevated blood pressure in the arteries can cause several problems in a human body. Not only does it cause strain to the heart, it can lead to hypertensive heart disease and slowly destroys the heart by enlarging it. It also demonstrates ability to cause kidney problems as the kidneys become burdened with the added strain. Because Ms. Fisher has hypertension, her already fragile heart is getting worked beyond capacity, exacerbating her CCHF.

Problem 3 -- Atrial Fibrillation is an unequal and frequently speedy heart rate that usually causes poor blood movement to the body. Since the heart's two upper chambers called the atria beat wildly and unevenly -- out of synchronization with the two lower chambers or the ventricles, it causes the poor blood flow