Case Study Sallie Mae Fisher
Sallie Mae Fisher is a recently widowed, depressed, 82-year-old-female with congestive heart failure (CHF), atrial fibrillation, and hypertension. She has been hospitalized four times for CHF exacerbation. With limited family support, and a long list of medications, she is having difficulty managing her CHF. During a home health visit, the nurse and nursing student assess Sallie Mae and identify several concerns.
Subjective Information
Subjectively, Sallie states, “My mind just feels so cloudy” and “I’m just not worth a lick”. She complains of loss of appetite, nausea, and difficulty opening a can of soup. She expresses loneliness after the loss of her husband of 59 years, and financial concerns regarding the cost of medication and prescribed …show more content…
She has a throw rug, which a potential fall hazard, newspapers spread across the couch, medications haphazardly spread across the table, and she is still in her robe and pajamas. Although she complains of feeling cloudy, she answers questions appropriately. She is slightly hypotensive and bradycardic with a blood pressure of 90/56 and a heart rate of 58. She has a capillary refill of less than 3 seconds and does not have any pedal edema. She is tachypneic with a respiratory rate of 24, but her breath sounds are clear and equal. Her bowel sounds are hypoactive and she has not had a bowel movement in 3 days. Her skin is dry with poor skin turgor and tenting. She takes many medications, and on examination there appears to be some duplication without explanation, or education. If Sallie Mae is taking all her medications as prescribed, it is possible she is overdosing. With a daughter who works full time, and issues of her own, Sallie Mae has little …show more content…
Sallie does not appear to understand her medications, and she has some duplicate medications listed on her discharge medications and her home medication list. It is possible Sallie has taken too much of her Lasix, and is now dehydrated as evidenced by her weight loss, dry skin, constipation, and skin tenting. Adverse drug events, drug interactions, medication non-adherence, functional status decline, malnourishment, and cognitive impairment are all associated with polypharmacy in the elderly (Maher, Hanlon, & Hajjar,
Subjective Information
Subjectively, Sallie states, “My mind just feels so cloudy” and “I’m just not worth a lick”. She complains of loss of appetite, nausea, and difficulty opening a can of soup. She expresses loneliness after the loss of her husband of 59 years, and financial concerns regarding the cost of medication and prescribed …show more content…
She has a throw rug, which a potential fall hazard, newspapers spread across the couch, medications haphazardly spread across the table, and she is still in her robe and pajamas. Although she complains of feeling cloudy, she answers questions appropriately. She is slightly hypotensive and bradycardic with a blood pressure of 90/56 and a heart rate of 58. She has a capillary refill of less than 3 seconds and does not have any pedal edema. She is tachypneic with a respiratory rate of 24, but her breath sounds are clear and equal. Her bowel sounds are hypoactive and she has not had a bowel movement in 3 days. Her skin is dry with poor skin turgor and tenting. She takes many medications, and on examination there appears to be some duplication without explanation, or education. If Sallie Mae is taking all her medications as prescribed, it is possible she is overdosing. With a daughter who works full time, and issues of her own, Sallie Mae has little …show more content…
Sallie does not appear to understand her medications, and she has some duplicate medications listed on her discharge medications and her home medication list. It is possible Sallie has taken too much of her Lasix, and is now dehydrated as evidenced by her weight loss, dry skin, constipation, and skin tenting. Adverse drug events, drug interactions, medication non-adherence, functional status decline, malnourishment, and cognitive impairment are all associated with polypharmacy in the elderly (Maher, Hanlon, & Hajjar,