Detailed Analysis of Sally Mae Fisher's Home Visit Case Study

This report analyzes a home visit case study of Sally Mae Fisher, an 82-year-old woman with a history of chronic congestive heart failure, atrial fibrillation, and hypertension. The analysis identifies four major problems: fluid volume deficit, risk for imbalanced nutrition, risk for fluid and electrolyte imbalance, and a high risk for falls. Evidence from the patient's assessment, including low blood pressure, poor skin turgor, and dry mucous membranes, supports these diagnoses. The report discusses relevant nursing interventions, such as educating Sally Mae on balanced diet and fluid intake, considering oral hydrating solutions, recommending psychological help for depression, and emphasizing the importance of drug adherence. The interventions are supported by evidence-based literature and address the physiological, psychosocial, and educational needs of the client.

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.

SALLY MAE HOME VISIT 2
Her last diagnosis is risk for falls. This is evidenced by her low blood pressure and
verbalizing that her mind is cloudy, and she also groans as she sits down. She is also an elderly
woman with a heart condition, coupled with her fluid volume deficit and lack of a full time care
taker, she is at high risk for falls.
Interventions
Educate sally Mae on the importance of a balanced diet and fluid intake. According to her
physical assessment, the patient is dehydrated, and at the same time is at risk of electrolyte
imbalance due to her medication. She should be therefore encouraged to drink enough fluids at
set times of the day. Moreover, oral hydrating solutions like Rehydralyte can be considered to
facilitate fluid replacement. In addition, (Oates and Price, 2017) emphasizes on importance of
patient education on importance of hydration.
A balanced diet should also be promoted by including the patient’s daughter and
recommending a diet plan. The patient seems depressed about her husband’s death; therefore, her
mental health is fragile, and seeking psychological help should be recommended. There is a
connection between nutrition and depression, as stated by the Anxiety and depression association
of America (ADAA, 2016). Episodes of depressions can be accompanied by low appetite and
subsequent weight loss as is evident in the patient’s history.
The nurse should also educate Sally on the importance of drug adherence, especially
since she has multiple medications. According to (Cantlay, Glyn and Barton, n.a), Polypharmacy
in the elderly increases the risk for side effects and can cause geriatric syndrome. Therefore, it is
imperative for the patient to understand the significance of drug adherence in reduction of side
effects and help them in creating a way to remember when and how to take the drugs.

SALLY MAE HOME VISIT 3
References
Rushing., J. 2009. Assessing for dehydration in adults. Nursing. 39(4) PP 4-14
Ann, C. and Helene H. 2011. Fluid and Electrolyte Series: Balancing act Na+ Sodium K+
Potassium. Nursing2019. 41(7) PP 44-50
Arampatzis, S., Funk, G., Leichtle, A. B., Fiedler, G., Schwarz, C., Zimmermann, H., Lindner,
G. (2013). Impact of diuretic therapy-associated electrolyte disorders present on
admission to the emergency department: A cross-sectional analysis. BMC
Medicine,11(83).
Oates, L. L., & Price, C. I. (2017). Clinical assessments and care interventions to promote oral
hydration amongst older patients: A narrative systematic review. BMC Nursing,16(4).
ADAA. 2016. Depression. Anxiety and depression association of America. Accessed from
https://adaa.org/sites/default/files/Depression-ADAA_Brochure-2016.pdf
Cantlay, A., Glyn T., and Barton N. (n.a). Polypharmacy in the elderly. InnovaAit. 9(2) Pp 69-77