Concerning Patient Problems

On physical examination, the patient is hypotensive with poor skin turgor and dry mucous membranes.  With the new prescription for furosemide, the patient is no longer edematous. However, it appears that she is not hydrating enough to make up for the fluid loss. Dehydration disproportionally affects the elderly population and since Ms. Sallie is on diuretics with an increased dosage, she is even more at risk.  This can further cause hyponatremia, increased confusion while also decreasing medication absorption in the body.  This risk for dehydration also increases the likelihood that the patient will need readmission to the hospital (Frangeskou, Lopez-Valcarcel & Serra- Majem, 2015). 

The patient does not have her prescribed oxygen.  Miss Sallie declined the company who was charged with bringing her an oxygen tank.  Ms. Sallie was discharged with instructions to utilize this oxygen as needed.  On physical assessment during the home visit, Ms. Sallie is tachypneic.  Her oxygen saturation is not noted.  Oxygen therapy is a common need in patients with congestive heart failure.  Because CHF is caused by a weakened heart, oxygenized blood no longer effectively reaches the tissues.  This causes a lack of oxygen throughout the body including to the heart muscle itself.  With supplemental oxygen therapy, the body is given extra oxygen to circulate throughout the body. Hypoxia can cause brain and heart damage.  This may be the cause of Miss Sallie’s fatigue and confusion as her brain is not being properly oxygenized without the supplemental oxygen (WebMD, 2018).  

The patient is at risk for falls.  As Ms. Sallie moves to open the door, she trips over lose carpets on the floor.  That in addition to her clouded sensorium and confusion exacerbate her risk for falls at home. Elderly are already at a higher risk for falls due to decreased bone density, decreased strength and polypharmacy.  Hazards at home such as loose rugs as seen in the video are also a common risk factor.  The potential for injury after fall is great, especially in the elderly population. 20% of falls cause serious injury including fractures or traumatic brain injuries.  Hip fractures are a common post fall injury that often hinder the patients’ abilities to perform activities of daily living unassisted.  Increased falls and can increase the possibility of hospital readmission, as well as the need to find long term care options (CDC, 2017).

The patient does not appear to have a clear grasp on her medication administration.  Ms. Sallie does not verbalize the indication for the medication and seems concerned about the cost of her prescriptions.  As she complains of increased confusion, and clouded sensorium, it is worrisome whether she is appropriately taking her prescribed medications.  On her discharge paperwork, the medication is only listed with the dosage.  It is important to indicate what the medication is for, when it should be taken and how, as well as any side effects to watch for.  Since Sally lives at home, she does not have someone to administer her medication and therefore is primarily responsible for them herself.  With multiple prescriptions it is important that she is knowledgeable about the indications for her medications to decrease harmful side effects and increase the likelihood that she is taking them correctly (Tangalos & Zarowitz, 2006).  

References

Center for Disease Control. (2017).  Home and recreational safety.  Retrieved from: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

Frangeskou, M., Lopez-Valcarcel, B. & Serra- Majem, L. (2015).  Dehydration in the elderly: A review focused on economic burden.  Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26054498

Tangalos, E. & Zarowitz, B. (2006).  Medication management in the elderly.  Retrieved from: https://mayoclinic.pure.elsevier.com/en/publications/medication-management-in-the-elderly

WebMD. (2018). What is oxygen therapy for heart failure?  Retrieved from: https://www.webmd.com/heart-disease/heart-failure/what-is-oxygen-therapy-for-heart-failure#