Sallie Mae home visit
These hospitalizations are one of the problems and evidence that Mrs. Fisher’s cardiac condition is worsening. Her CHF and A-fib are causing fluid retention and increased cardiac pre-load, decreased cardiac output, compromised coronary circulation, which is resulting in angina, dyspnea, and weakness (Copstead, 2013; GCU, 2013a). Numerous cardiac medications demonstrate an attempt to treat these signs and symptoms (GCU, 2013b) but Mrs. Fisher may neither truly understand her disease process, nor comprehend the potential side effects of her medications (GCU, 2013a). For these reasons, more nursing care, specifically, increased home health visits will be beneficial. Mrs. Fisher’s poor health and decreased knowledge means that she will need a nurse to visit at least twice weekly, in order to obtain vital signs and provide a physical assessment so there is adequate time to treat any new health problems. During these visits, comprehensive health education may also occur. In review of Mrs. Fisher’s interview, including her health history and discharge instructions, there is concern that further assessment of her medications is needed. The PCP needs to be contacted and updated on dose increases. Her Digoxin has been increased to 0.25 mg once a day from 0.125 every other day. The patient’s Lasix has been increased to 80 mg twice a day from 40 mg once a day. In addition, she has been prescribed Calan (verapamil) but also has multiple home medications for her heart and BP pressure. She has a nursing diagnosis of knowledge deficit, related to unfamiliarity with her disease process and lifestyle implications of disease process. A nurse should then assess Mrs. Fisher’s learning styles; teach her the pathophysiologic process of her disease, and benefits of taking her medications. Furthermore, a nurse should teach her the importance of assessing a radial pulse before taking Digoxin and following PCP instructions about when not to take it (i.e. HR 60/min or less).