Castallia L.

Lascuña
N-24
Case Situation Analysis
Mrs. Velez. is a 75-year-old female who was recently discharged home from a long-term care facility
after completing a course of rehabilitation following a 5-day hospitalization for congestive heart failure and
management of pleural effusion related to metastatic lung carcinoma secondary to breast cancer. She was
discharged with medications for management of her chronic conditions and in-home oxygen for her chronic
shortness of breath.
Her functional status is ambulatory with a cane for short distances; she is able to complete her activities
of daily living, although she fatigues easily. She relies on her daughter for grocery shopping, making doctor
appointments, paying bills and banking.
Guide Questions:
1. What services would be appropriate for the geriatric team to provide Mrs. Velez?
-The term "comprehensive geriatric assessment" (CGA) refers to a multidisciplinary diagnostic and
treatment procedure that assesses an older adult's medical, psychological, and functional capacities in
order to build a coordinated strategy to maximize overall health as people age. The foundation of CGA
is the idea that a systematic assessment of frail older people by a group of medical experts may reveal
a range of curable health issues and provide healthier outcomes.
a) Mrs. Velez is accessible with a cane for short distances; therefore, I would do a thorough
geriatric assessment on her with an emphasis on the CGA's fall risk assessment section. The
primary cause of many of the difficulties of the elderly's health state is accidental falls and
drops. Due to their advanced age, elderly patients frequently have fallen as a result of poor
health, which is a hazardous scenario. The provided Fall Risk Assessment Program is a
thorough procedure that includes a precise evaluation of the patients' medical and
pharmaceutical histories. A thorough physical examination is provided as part of the program,
which evaluates the elderly's balance, walking, vision, and hearing abilities in an effort to lower
their risk of falling.
b) The geriatric team can also give Mrs. Velez a geriatric care manager who will speak with her
about challenging subjects and intricate problems, visit her at home and recommend necessary
services, attend to her emotional needs, and create short- and long-term plans. Identifying care
requirements at home, choosing caregivers, and coordinating medical treatments. In addition
to relieving caregiver stress, consider alternative living arrangements.
2. How would you approach prioritizing care for Mrs. Velez? List down at least 5 prioritized
care.
- Setting nursing priorities is an essential aspect of a nurse's profession. Nursing care should be
prioritized so that physiological needs come first, then safety needs, then needs for love and
belonging, and so on. When prioritizing care, a nurse should consider Maslow's Hierarchy of
Needs. Maslow's Hierarchy of Needs offers a structure for prioritizing nursing tasks. There may be
a number of possible nursing interventions that are required, but the nurse must be able to pick out
the most important ones and rank them in order of priority. Maslow's pyramid can help nurses
remember which nursing tasks are most important, starting at the bottom.
a) It is important for Ms. Valdez's health to have a clear and efficient airway because she suffers
from chronic shortness of breath. Maintaining or improving pulmonary ventilation and
oxygenation, fostering comfort and ease of breathing, enhancing ability to engage in physical
activity, and preventing risks associated with oxygenation problems like skin and tissue
breakdown, syncope, acid-base imbalances, feelings of hopelessness and social isolation are
all examples of appropriate management for patients with oxygenation difficulties.
b) The risk factors are those of an underlying disease since pleural effusions are symptoms of
another disorder. Pleural effusion is a significant condition that can result in a number of
complications that might worsen breathing issues and create a situation where life is in danger,
necessitating rapid and sophisticated airway and oxygenation therapy. To provide care. the
nurse can perform the following:
• Utilize the pain rating scale to evaluate the patient's pain features and location as well as
its intensity.
• Prescription medication should be given, and the patient's response should be evaluated at
least after 30 minutes.
• Teach the patient how to relax and do deep breathing exercises.
 • As tolerated, assist the patient in shifting positions, and if at all possible, encourage her to
lie on the injured side.
c) The first medical care of congestive heart failure depends on the condition's severity, the
intensity of its symptoms, its origin, the existence of concomitant illnesses, and any triggering
factors. The control of medications is crucial for HF patients. Treatment of any precipitating
factors, control of fluid and sodium retention, raising myocardial contractility, lowering cardiac
workload, and lowering pulmonary and systemic venous congestion are the general
management tenets. In an effort to decrease volume and thus decrease preload, the doctor may
also recommend fluid and sodium restriction. Nursing interventions will include delivering
prescription medicine, preventing infections, keeping up a high-calorie, low-sodium diet as
directed, monitoring for respiratory distress and altered cardiac output, and promoting enough
nutrition.
d) Both with acute and chronic diseases, fatigue is a subjective issue. It is a self-recognized
condition in which a person feels excessively worn out over time, has a decreased capacity for
physical activity, and is unable to perform effectively. The distinction between exhaustion and
tiredness must be made, though. Temporary in nature, weariness has a wide range of
physiological and psychological causes. To provide nursing care, the nurse should:
• Assess the patient's account of their level of exhaustion (including its intensity,
fluctuations in intensity over time, and aggravating or mitigating variables),
• To identify relevant elements and establish potential reasons to enable the development
of a collaborative care plan, ascertain potential causes of weariness.
• Implement the usage of assistive devices for daily activities since doing so can reduce
energy use and risk of harm.
• Help the patient create a routine for their daily activities and rest. Stress the value of
taking frequent breaks from activity since a schedule that alternates between periods
of action and rest can help the patient complete desired tasks without increasing levels
of exhaustion.
e) Mrs. Valdez has a higher chance of falling because she uses a cane to help her walk. To provide
nursing care, the nurse should:
• Encourage the patient to wear footwear with nonskid soles when walking since nonskid
shoes give patients with reduced foot and toe lift stability.
• Make sure to position the beds as low as feasible. If necessary, position the patient's
bed as close to the floor as you can. The possibility of falls and severe injuries is
decreased by keeping the beds closer to the ground. The mattress being on the floor
lowers the danger of falling in several hospital settings.
• To help with gait skills and to provide the patient with assistive equipment for transfer
and ambulation, think about scheduling physical and occupational therapy sessions.
Start a review of your home's safety as needed. All healthcare professionals who assist
patients with transfers from bed to chair should wear gait belts to increase safety.
Canes, walkers, and wheelchairs are examples of assistive devices that can help the
patient walk more steadily and with better balance. Raised toilet seats make it easier to
get on and off the toilet safely.
• Enhance the home's resources. Numerous nonprofit groups in the community offer
financial support to help older people create safe surroundings in their homes.
• Teach the client how to move about safely at home, including how to use security
features like handrails in the bathroom. This will gradually reduce the danger of falls
while ambulating and minimize anxiety at home.