Answer

Assignment 3

Introduction: Case study ONE

Identify the case and outline the purpose and structure of the report.

The report focuses on case study ONE about a 70-year-old man named Mr. Wilson who was brought to the emergency department (ED) at 10:15 AM. The purpose of the report is to identify the crucial health problems facing Mr. Wilson in order to set nursing goals and interventions that will ensure the client receives quality care and excellent discharge. The report starts with an assessment of the client’s profile followed by an identification of the client’s key health problems and the treatment outcomes. Finally, several interventions and a discharge strategy shall be proposed followed by a conclusion.

Assessment (100 words)

I would use a physiological and psychological assessment tool to create a profile for my client. The Katz Index of Independence can be a good assessment tool to determine the ability of Mr. Wilson to function effectively on his own when conducting his daily activities. Using the Index, I would be able to determine whether Mr. Wilson should continue living alone, or he should placed in an assisted living program (Ávila, et al, 2014). I would also use the Geriatric Depression Scale to measure the levels of depression Mr. Wilson is suffering from in order to recommend the best psychiatric treatment or counseling program.

Client’s Health Problems (350 words)

Mr. Wilson suffers from heart disease, ventricular fraction and depression. The hypertensive heart disease takes priority in Mr. Wilson’s case as he has been previously diagnosed with a left ventricular ejection fraction (LVEF) of 30, which is lower than the normal of 50 as well as being treated for hypertension in the past. Mr. Wilson may also be suffering from mild ventricular fractions given that he has been previous treated for heart attacks.teh pitting edema in his legs is also an indicator that he  might have had mild heart attacks that led to a shortness of breath and breathing difficulties. I would prioritize Mr. Wilson’s depression as the third priority; nevertheless, it is an important health problem as the depression might be contributing to the heart problems because of the stress he is feeling. The three health problems lead to the symptoms affecting the client and should be addressed with immediate urgency in order to treat the client, which would improve the quality of his life.

A closer look at the three heath problems reveals that the heart disease might be caused by the fact that the client has been treated for heart attacks in the past. The previous heart attacks might have damaged his heart permanently, especially by making the left ventricular muscles weak as evidenced by the low ventricular fraction (Collins, et al, 2014). Mr. Wilson’s age also places him at significant risk of heart disease and the heart attacks might have weakened his heart muscles further. The client might also be suffering from varicose veins caused by the inability of his veins to pump adequate blood to his veins thereby resulting in the pitting edema. The varicose veins might be directly related to the client’s heart condition and his low left ventricular ejection fraction (LVEF), which could result in the inability of the veins to pump adequate blood to all parts of his body. The depression affecting Mr. Wilson is directly related to his wife’s death, which caused the client to withdraw from the community and live in solitude. The client might respond positively to counseling or a group home (Whalley, Thompson & Taylor, 2014).

Goals (150 words)

The first goal for  treating the heart disease prioritized as the most urgent health problem facing my client is to stabilize his present condition in order to restore normal heart functioning. The second goal or desired outcome for my client is to control his symptoms over the long term by ensuring that the heart disease does not pose further danger to the client. The client’s present heart condition could cause irreparable damage to his heart if corrective measures are not applied immediately (Iung & Vahanian, 2014). The client is experiencing trouble breathing, which reduces the supply of oxygen to his lungs, heart and blood. Prolonged lack of sufficient oxygen in the client’s body deprives him tissues of adequate blood and oxygen and might lead to muscle atrophy.  The symptoms of his heart disease must be controlled immediately in order to ensure that he does not suffer from such symptoms again as they could be fatal.

Interventions (350 words)

To achieve the first goal of stabilizing the client’s current condition, one intervention that can be applied includes treating the patient with Diuretics also known as “water pills” in order to reduce the amount of fluids in his body. The patient could also be treated with ACE inhibitors to widen or dilate his blood vessels and aid in normal blood circulation. The two interventions can be very effective over the short term as the ED personnel strive to stabilize Mr. Wilson’s condition before recommending further treatment. The diuretics could help reduce the amount of fluids in the client’s body given that he has been taking significant amounts of water over the last few days, while on a paracetamol prescription, which could have led to an accumulation of excess fluids in his body (Iung & Vahanian, 2014). The ACE inhibitors could play a vital role in widening or dilating his blood vessels in order to ensure that there is adequate flow of blood to his legs, which would treat the pitting edema identified by the ED nurse upon admission.

To treat the patient’s symptoms over the long term, the client should be treated with a left ventricular assist device (LVAD), which is a type of mechanical heart that is inserted into a person’s chest. The LVAD could resolve the client’s issue with a low left ventricular ejection fraction (LVEF), which might solve his heart issues permanently. The insertion of the LVAD would require a surgical procedure and the client would have to be tested in order to determine if he fits the requirements for the surgery. Another less invasive intervention can be a minimally invasive valve valvuloplasty, which serves the same function as the LVAD. Another long-term intervention suitable for the client would be a regular exercise regimen that is tailored to the client’s current physical condition (Iung & Vahanian, 2014). Regular exercise coupled with medication could ensure that the client never experiences ventricular fraction, which would allow him to have a better quality life. The client should also attend regular check-up clinics where his heart rate and overall physical condition are monitored in order to prevent any sudden heart attacks.

Discharge (350 words)

One of the key issues that the client might face after discharge include receiving proper care after being discharged, avoiding medication errors, proper reconciliation of medications, training caregivers on the client’s requirements. As a discharge planner, I would ensure that the client receives proper care after being discharged by preparing his family and caregivers to meet most of his needs after leaving the hospital. The client’s needs that should be addressed include personal care in terms of bathing, eating and sleeping; household care such as cooking, and cleaning; health care, which includes medication; and emotional care (Egbe, Uppu, Stroustrup, Lee, Ho & Srivastava, 2014). The client’s future caregiver should also be trained on the client’s medication to ensure that he always takes his medication on time and sticks to the exercise schedule planned at the hospital. I would also ensure that the client’s pre-hospitalization, hospitalization and post-hospitalization medications are reconciled to ensure that the client is on the right medication after being discharged from the hospital. To avoid medication errors, I would entrust the client’s medication schedule with his caregiver given that the client is quite old and might forget to take his medications or even take the wrong medication at the wrong time.

Given that Mr. Wilson does not have any family, it would be best to release him to a care facility so that he can receive proper care. As the discharge planner, I would present the client with the best options for a care facility and help him choose one that fits his needs. After identifying a care facility, I would help the client organize to pay for some of his post-hospitalization treatment, because Medicare does not cover all treatment costs after the client leaves the hospital (Lappegård, et al, 2014). This process might be quite challenging given that the client has no family and might have to be admitted to a care facility that caters to the homeless. However, the discharge process might go easier if I identify that the client has private insurance that can cover the costs of his treatment and post-hospitalization care. Such a scenario would make it easier to get the client admitted to an excellent care facility for the elderly.

Conclusion (100 words)

In summary, the report covers a brief diagnosis of Mr. Wilson’s health issues and recommends several interventions to treat the most crucial issues. The recommended interventions are companied by a post-hospitalization plan in order to ensure that the client receives quality care after discharge. The report also addresses Mr. Wilson’s major challenge as a widower with no family and proposes an appropriate solution for his situation. The report serves as a guide on how to treat patients from the time of admission to the emergency department up to their discharge and post-hospital care. The report applies to other similar cases.

question has been answered

Get This Answer