Jan Marsha Marie V.

Domiquel

BSN-N21

Case Analysis Statement

Mrs Velez. is an 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.

Questions:

1. What services would be appropriate for the geriatric team to provide Mrs. Velez?

A Comprehensive Geriatric Assessment (CGA) is necessary for Mrs. Velez to

restore her functional status. Comprehensive geratric assessment (CGA) is a process
which is used to manage frail or vulnerable older people. It is interdisciplinary that it
takes account of inputs not only from doctors but also nurses and allied health
professionals. It is multidimensional since it takes account not just of medical
diagnoses but also functional impairments and the environmental and social issues
which affect patient wellbeing.

 As her nurse, I would conduct a comprehensive geriatric assessment

on her, concentrating on the CGA's section on fall risk as evidenced on
the case of Mrs. Velez status which is ambulatory.
 The team can also examine the patient’s medical history in order to
determine previous illnesses that may affect the client’s health
condition. It is also necessary to assess the patient’s ability to live
independently. Furthermore, the team will provide Mrs. velez with a
care manager to discuss topics, issues, make home visits, and suggest
needed services.
 The geriatric team can also provide home care services such as;
personal care, home modifications, household maintenance, health
care, and day programs.
2. How would you approach prioritizing care for Mrs. Velez? List down at least 5
prioritized care.

When caring for multiple patients at once, nurses frequently need to prioritize
their regular nursing care tasks. Setting priorities for the many care requirements that
have been assessed and managing the ensuing competing expectations present
problems for nurses' moral and professional principles. Moreover, the nurse can also
use Maslow’s Hierarchy of Needs when prioritizing care.

The prioritized care needed for Mrs. Velez are the following:

1. Mrs. Velez has a chronic conditions as evidenced of 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.
2. 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 physician may provide diuretics, since
diuretics are the first-line drug in the treatment of CHF. ACE inhibitors reduce
mortality in patients with CHF and should be administered with diuretics to
patients with CHF and abnormal or normal LV ejection fraction. Nursing
interventions includes monitoring of signs of respiratory distress and altered
cardiac output, administering prescribed medication, preventing infection,
and promoting adequate nutrition by maintaining a high-calorie, low sodium
diet as prescribed.
3. Pleural effusion was also present on the condition of Mrs. velez. Pleural
effusion, sometimes referred to as “water on the lungs,” is the build-up of
excess fluid between the layers of the pleura outside the lungs. To provide
care to the client the nurse will assess the patient using the pain rating scale
for intensity, as well as characteristics and location of pain. Moreover to
educate the patient on deep breathing exercises and relaxation techniques.
Administer prescribed medications and assess patient’s response at least 30
minutes after drug administration. In addition, assist the patient to change
positions as tolerated and encourage her to lie on the affected side if
possible.
4. Since Mrs. Velez is using a cane to help her walk, she is at risk for falls. That is
why the nurse should provide nursing care as much as possible. These
includes; Encourage the patient to don shoes or slippers with nonskid soles
when walking. Beds should be at the lowest possible position. Consider
physical and occupational therapy sessions to assist with gait techniques.
Improving home supports and teach client how to ambulate independently
and with assistance if necessary.
 5. Fatigue is often thought of as the state of feeling very tired, weary or sleepy
resulting from various sources such as insufficient sleep, prolonged mental or
physical work, or extended periods of stress or anxiety. Boring or repetitive
tasks can intensify feelings of fatigue. The nurse will assess the patient’s
description of fatigue and determine possible causes of fatigue to identify
related factors and recognize potential causes to enable the building of a
collaborative plan of care. Implement the use of assistive devices. Teach
energu conservation methods for Mrs. Velez and educate the family of Mrs.
velez regarding task and time organization methods appropriate for the said
client.

References:

Welsh, T.J., Gordon, A.L., et al. (2014) Comprehensive geriatric assessment – a

guide for the non-specialist. National Library of Medicine.
https://pubmed.ncbi.nlm.nih.gov/24118661/

https://www.ccohs.ca/oshanswers/psychosocial/fatigue.html#:~:text=Fatigue%20is%
20often%20thought%20of,can%20intensify%20feelings%20of%20fatigue.