Sally Mae Home Visit

Running Head: SALLY MAE HOME VISIT 1
Home visit at Sally Mae Fisher’s
The four major problems that Salle Mae has include fluid volume deficit, risk for
imbalanced nutrition, risk for fluid and electrolyte imbalance and a high risk for falls. The Fluid
volume deficit is evident from her blood pressure of 90/56, the evident poor skin turgor with
only a little tenting and a mucous membrane that are dry as seen in her examination. As
explained by Rushing (2009) the outlined clinical signs are features of fluid volume deficit and
dehydration. This may be related to her lack of motivation to take fluids or symptoms of
depression that she exhibits.
Her second problem is risk for imbalanced nutrition, which may be related to limited
family support and intake of less than recommended dietary requirements. This is evidenced by
her rapid weight loss. Ms. Mae also underwent a 14 pounds weight loss in only one week, and
hasn’t had a bowel movement in three days. She also stated that she barely has any appetite and
had only taken a can of soup. She stated that since the death of her husband, she does not car
much about food.
Her third diagnosis is risk for fluid and electrolyte imbalance, related to inadequate intake
of fluids. The patient’s assessment revealed hypoactive bowel sounds. According to (Ann and
Helene, 2011), electrolyte imbalance causes hypoactive or absent bowel sounds. In addition,
Sally Mae takes diuretics which are associated with volume depletion and electrolyte imbalances
such as hypokalemia, hyponatremia, azotemia among others. This is collaborated by (Arampatzis
et al, 2013) whose study revealed that patients who were under all classes of diuretics suffered
electrolyte disorders.