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Pathophysiology and Nursing Management

Pathophysiologyand Nursing Management


Pathophysiologyand Nursing Management

  1. Identify, prioritize, and describe at least four problems.

Theproblems in the video &quotHomeVisit with Sallie Mae Fisher and the Discharge Orders are thefollowing

  1. Lack of patient’s care such as family care and guidance and counseling and society care.

  2. Non-adherence to the prescriptions and other instructions which are assigned by the medical faculty.

  3. Family problem issues and limited care for the old people in the society.

  4. Other problems include the management and control of the diseases such as Congestive Heart Failure (CHF), atrial fibrillation, hypertension and the dyspnea diseases.

  1. Provide substantiating evidence (assessment data) for each problem identified.

      1. Lack of care

Fromthe video and her health history, it is clear that SallieMae is recently widowed and lives alone. She has a daughter, ThelmaJean, who lives in town but works full time and has family issues ofher own. Therefore, family support is limited.In addition, the patient is in a solitary home with nothing to do butread a lot of magazines. As a result, she is lonely and has no othermeans of suppressing boredom, for instance, entertainment. There isno TV in the room to at least suppress her emotions after the loss ofher husband. Thus, there is lack of critical care to see her throughthe medication. She always remembers her late husband as a person whojoked around her and never left cigarettes and says that she misseshim so much and one day she knows she will reincarnate with him. Thisshows she lacked guidance and counseling after the death of herhusband on how to cope without him.

B.Non-adherence to the doctor’s instructions and prescriptions

Thereare lots of medication and also failure to take doctors instructions.Medical Equipment Company had been contracted todeliver oxygen concentrator and instruct patient on its use that isO2 at 2 liters per nasal prongs PRN to Ms Fisher andinstruct her on its use but was not done as expected and this putsher life at risk.In addition, the patient has been issued with lots of medicines asshown in the video, in fact, more than ten bottles which she mustaccurately take its prescription (Marquis &amp Huston,2009). Thisis actually cumbersome and hectic considering her old age. Themedical industry has not come up with better administration of drugswhich can be taken at ease and patients end up taking drugs in bulk.For instance, Sallie Mae has to take the following drugs

  • Prescriptions given at discharge:

    • Digoxin 0.25 mg once a day

    • Lasix 80 mg twice a day

    • Calan 240 mg once a day

SallieMae’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 mEq 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

C.Family problem issues and limited care for the old people in thesociety.

MsFischer lives alone and takes care of herself though she has onedaughter who works full time and has her own family issues. Perhapsthis indicates why she stays alone with a maid despite her old age.The society has not been able to cater for the protection of oldpeople and as a result their health deteriorates. As witnessed in thevideo, the patient nearly felt on the floor as a result of a piece ofcloth carelessly thrown on the floor.

      1. Other problems include the management and control of the diseases

Thereare diseases which are a burden and expensive to treat and maintainsuch as the following congestive heart failure, atrial fibrillation,hypertension and dyspnea. Allthese diseases are expensive and cumbersome to manage and it is morestressful for Ms Fisher since she stays alone in addition to thenumerous quantities of medicines she is been prescribed to take twiceor once a day.

  1. Identify and describe at least four medical and/or nursing interventions and rationales for the interventions.

Thefirst intervention which is required to be incorporated is that nurses need to ensure they develop and get involved fully inprograms which enables easier transition of patients and thepatient caretaking beginning from the hospitals to patients home andfocusing mainly on disease management. The rationale behind this isthat it ensures the patient adheres to the instructions from thehealth facilities on disease management and takes all the medicinesprescribed (Marquis&amp Huston, 2009).

Inaddition, they should ensure they are consistent with both hospitaland home-based education or guidance and counseling relating to thedisease affecting the patient especially on weight monitoring andintake of diet and fluids in the case of Sallie Mae. The rationalebehind this is to ensure, the patient don’t take meals or getemotions which increases the development and vulnerability of thediseases she has suffered from before (Tomey, 2009).

Medicinemanagement and home safety should be evaluated as this is a challengein the Sallie Mae’s environment. In this case measures should beset up and adhered appropriately by the responsible persons. Forinstance, the floor is not safe as evidenced by a towel which isthrown carelessly and she can be felled by it hence increasing herhealth problems. The rationale behind this is to ensure that theright prescriptions are taken and the environment within should notfacilitate the occurrence of other disease but facilitate therecuperation of the patient (Tomey,2009).

Lastly,concerning the cost of medicines, the medical health departmentshould ensure free administration of medicines to elderly and aidthem to ensure they recuperate because majority are old, widows andpoor and don’t have means to sustain their health. In this waytheir social welfare is improved.


(Thescene starts by the doctor entering the room alongside withChristina, the maid and knocks on the door. Salle Mae comes in toopen and was about to be felt by the towel on the floor).

Doctor: Goodmorning (greets her), Salle Mae, my name is Joyce and I will be yourdoctor today. I understand you are experiencing problems withcongestive heart failure, atrial fibrillation, hypertension anddyspnea.

Ms.Fisher:Youare highly welcome doctor (sits).

Doctor:Howare feeling now (sits)?

SalleMae:Iam not feeling quite okay but I still find a lot of difficultieswhile breathing and this world makes me really get tired. Thismedicines I have been given are a lot and it is very hectic takingthem.

Doctor:Youdon’t have to worry about everything Salle Mae, your God is withyou and you will recover soon. Have you taken any medicine as of now?

SalleMae:Yes,I have done, as I was assisted by Christina.

Christina:Actually she is been full dose and has never skipped any.

Doctor:Thankyou Christina.(Refers to hospital prescription) I can read here that last Sundayyou were admitted due to dyspnea and were discharged. How areprogressing now with the dyspnea? Do you feel any difficulty inbreathing?

SalleMae:Actually,this medicine I am taking has assisted me and I don’t feel muchdifficulty as such since I can take a work a walk outside the garden.

Doctor:That is nice, and I am very happy to hear that. What I want you to dois to continue with the medicine and you are done, Christina willnotify me through the phone as I will give her my contacts so she cannotify incase of any complication.

SalleMae:Okdoctor. I miss my husband when he died and I always think about him.I can’t believe he died but I know one day we shall rejoin again.

Doctor:Thatis sweet(holds her shoulder gently), Salle Marie, actually we alllove people who took a bigger roles in our lives and God who gave usthose blessings will surely not leave us sad but assures us alsoabout his great joy in our lives. Thank you Salle Marie for your timeand I wish you quick recovery.

SalleMae:Thankyou too doctor for your kind visit to check my condition. God blessyou.


GrandCanyon University. HomeVisit with Sallie Mae Fisher.http://lc.gcumedia.com/zwebassets/courseMaterialPages/nrs410v_vp01Alt.php

Marquis,B. L., &amp Huston, C. J. (2009). Leadershiproles and management functions in nursing: theory and application(6th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams &ampWilkins.

Tomey,A. (2009). Guideto nursing management and leadership(8th ed.). St. Louis, Mo.: Mosby Elsevier.