Sallie S Problems and Nursing Interventions

Home Visit With Sallie Mae Fisher Good morning, Sallie Mae, my name is Alexis Jorgenson and I will be your nurse today. I understand you are not feeling well today? Sallie: Hello Nurse, I am feeling a little better than last time but still finding it hard to cope. I understand you are having problems with chronic congestive heart failure. Sallie: This disease is giving me a lot of problems that range from frequent hospitalizations to excessive medications.

I just feel sick when I think about the medication and usually feel like avoiding them. That's sad to hear. I am here to help identify why you are not feeling very well today. Sallie: Thank you, I really appreciate your help and hope that I'll be feeling much better very soon. Nurse: Your medical history shows that you have been hospitalized four times in the past 6 months for exacerbation of congestive heart failure (CHF). Sallie: Yes, this condition is really taking its toll on me.

I mean being in hospital is the worst thing on earth. Nurse: You were recently discharged after suffering dyspnea, chest pain, and an 8-pound weight gain. Based on your last physical assessment, you have lost 14 pounds since your last hospital admission, which is really great and shows you are slowly improving. I am also happy to inform you that you have significantly improved in relation to dyspnea and have no chest pains. Sallie: That's good to hear.

If there is anything I could do to be completely healed, I would do it immediately. No one wants to get and stay sick, not even you, right? Nurse: Absolutely. According to the findings of the physical assessment, I have identified four problems that are affecting your health and well-being. Sallie: Oh no! I don't want to hear I have more problems because that leads to hospitalization and more medications, which is really sickening.

Nurse: I totally understand but the identification of these problems and development of effective suitable clinical and/or nursing interventions help in improving your health and well-being. Sallie: Okay, go ahead. Nurse: First, I have identified that you are struggling prolonged periods of sadness or probable depression because of the loss of your husband. This is also reflected in the fact that your mind seems clouded and loss of appetite (though this may also be brought by your current medications), and limited family support. Sallie: I really loved him.

If he was here today, I would probably be feeling much better. Nurse: Secondly, you are probably suffering from dehydration as evident in the dry mucous membranes. In most cases, dry mucous membranes are usually signs of dehydration and can generate various health problems such as frequent bloody noses. Have you had such incidents? Sallie: Not really. Nurse: The third problem is hypotension or low blood pressure since your blood pressure is below 90/60, which is below the normal rate for an adult.

Even though low blood pressure is not usually diagnosed, it's a major issue in your present condition given symptoms of nausea, dizziness or fatigue (Haiken, n.d.). Sallie: Yes, I've been experiencing extreme fatigue and feel dizzy sometimes. Nurse: The final problem is probable constipation since you haven't had any bowel movements in three days. While the current situation may not be a cause of significant alarm, the less frequent bowel movement is seemingly abnormal (Orenstein & Bass, 2011).

In your case, the constipation could be caused by lack of exercise, medications, and poor eating habits due to loss of appetite. Sallie: I have no appetite because of the more medications that keep increasing after sometime. Nurse: I will provide four recommendations (clinical and/or nursing interventions) to address each of these identified problems. Is that okay with you? Sallie: Yes. As much as I don't want to be subjected to further medications and/or hospitalization, its okay if that will help me become better.

Nurse: Wow! Thanks for being positive about this. That will really help in improving your health and well-being. Sallie: I understand that I have to remain positive about this no matter the difficulties in the treatment process. Nurse: That's awesome. First, I would recommend a grief treatment program to help you in coping with the loss of your husband and the limited family support. This program is crucial since prolonged grief has considerable impacts on your daily life.

The program will be based on psychotherapy, which will help you learn to cope with emotions and identify grief.