Elderly patients have many needs that younger patients do not.Being discharged
from the hospital after surgery can present additional issuesbeyond those
associated with physical recovery. In this task, you will assumethe role of a
case management nurse who is responsible for determining the mostappropriate
discharge placement for an elderly patient named Mrs. O’Neill. Thepatient is to
be discharged from the hospital after being diagnosed withpernicious anemia and
hypertension.
You have just accepted the assignment of Mrs. O’Neill’s
case manager. As such, you are responsible for determining the mostappropriate
discharge placement and plan. From the patient’s health record, youare able to
ascertain the following information:
Health Chart:
Mrs.
Sadie O’Neill is a 70-year-old, second-generation Irish Americanwho, until
recently, has been in excellent health all of her life. Shereticently admits
that prior to this hospitalization she has not had a physicalexamination in
over 10 years, is taking no prescription medications, and has neverhad surgery
in her life. She had her children at home and has never beforebeen
hospitalized. In passing, she mentions taking some “vitamins” to“help her
energy” every day, but she is not sure what they are. She wearsglasses for
reading and has hearing loss at 80% in both ears. She does not wearhearing
aids.
Mrs. O’Neill lives with her 65-year-old sister, Carol, who has
never been married. Mrs. O’Neill’s husband of 43 years, Peter, diedtwo years
ago at the age of 70. Mrs. O’Neill and her sister live in atwo-bedroom,
one-story home in Cleveland, the same home Mrs. O’Neill lived inwith her
husband. Mrs. O’Neill has one son, Sean, 44, a lawyer. Sean and his43-year-old
wife, Maureen, both work an average of 40 hours a week and havethree children
(ages 9, 11, and 13). They live in a condominium in downtownCleveland close to
Lake Erie and not far from Mrs. O’Neill. They visit Mrs. O’Neillevery
week.
Carol moved in with her sister, Mrs. O’Neill, to help after the
death of her husband. Carol continues to work as a legal secretary,so she is
out of the home most of the day.
Three months ago, Mrs. O’Neill began to
feel dizzy and weak. She did not mention her symptoms to her sisteror son
because she did not want to worry them, and she thought that thecondition would
just go away if she rested. However, recently she became severelydizzy and,
upon getting out of bed in the morning, lost consciousness. Hersister called
911, and Mrs. O’Neill was brought to the hospital where sheunderwent diagnostic
testing. She was diagnosed with pernicious anemia andhypertension.
Mrs.
O’Neill was prescribed Lopressor 25 mg bid for an average BP of160/100. She was
also given vitamin B12. She will require regular B12 injectionsafter discharge.
Upon discharge, Mrs. O’Neill will return to her home. She hasbeen
referred to a specialist for testing and possible hearing aids.
To
determine the appropriate plan of care, you meet with the patientand then the
family to gain more information. With the patient and family’spermission, you
conduct a safety assessment of the patient’s home.
Patient Interview
Results:
Mrs. O’Neill is relieved that the diagnosis was not more
severe. She does question the hypertension since she does not feelill, just
dizzy sometimes. Mrs. O’Neill insists that she can take care ofherself and can
take her own medications. She continues to deny that she needshearing
aids.
Family Interview Results:
The family insists that
according to earlier family discussions, Mrs. O’Neill will receivedaily
assistance from family members who will take turns seeing to herneeds. Mrs.
O’Neill’s sister Carol assures that she is home by 5:00 p.m. eachevening and
can prepare dinner. She will be sure there is appropriate foodavailable for
Mrs. O’Neill when she is out.
When questioned, the family appeared to
understand Mrs. O’Neill’s need to take medications each day, butthey were
somewhat confused about when the medications should be taken.
The family
refuses any outside nursing assistance since they know that Mrs.O’Neill will
not want anyone “fussing” over her. However, they will try to visitas often as
possible.
The family states that Mrs. O’Neill’s home is not large and has
one story. However, it is cluttered with items she has collectedthroughout her
marriage and also with items Carol brought with her. They admitthat they are
concerned about the safety of Mrs. O’Neill moving through the houseif she is
dizzy. The family states that Mrs. O’Neill is alert and well ableto care for
herself.
Safety Assessment:
ScholarMatic: Explanation & Answer
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