Home Visit Study of a Patient with CHF

Home Visit Study The patient, Mrs. Fisher, stays alone after she recently lost her husband. She has been hospitalized on several occasions following exacerbation of CHF symptoms with the most recent hospitalization being because of increased dyspnea. Other than CHF, she suffers from hypertension and atrial fibrillation. This paper presents a home assessment of the patient to identify her problems and possible interventions.

Identified Problems and Assessment Data During the home visit, it is evident that Mrs. Fisher has multiple problems including polypharmacy, dehydration, fall risk and depression. Polypharmacy is as a result of multiple drug use that is not essential for use. In the case, it is coupled up little knowledge of the prescribed medications. The patient has multiple medications with other drugs being duplicated. The patient does not have anyone to remind her to take medications which contribute to non-compliance.

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Dehydration or decreased fluid volume is caused by excessive fluid loss and reduced fluid intake. The patient is at an increased risk of dehydration due to the excessive dosage of a loop diuretic. Also, common symptoms caused by dehydration including dry mucous membranes, weakness, lack of appetite, nausea, low blood pressure, lack of concentration were evident in the patient.

Increased fall risk is common among the elderly and patients with physical injury and multiple chronic conditions. Geriatric patients are at an increased risk of falls due to age-related functional decline, muscle wasting, and general body weakness (Gulanick, 2013). In Mrs. Fishers’ case, it is worsened by her polypharmacy, home environment, weakness, and dyspnea.

Last is depression, a mental disorder causing stress and anxiety. The patient is lonely, chronically ill and has recently lost her husband. She has no one to help her or talk to.

Interventions Necessary interventions need to be put in place to improve patient outcomes and improve her quality of life. With proper interventions, exacerbations and adverse health events will be prevented hence reducing re-hospitalization cases. This requires a multidisciplinary approach to ensure that the patient stays in an improved home environment, address polypharmacy, increase fluid intake and have someone to constantly take care of her.

To address her polypharmacy, her medications have to be checked and reviewed based on the benefits and risks associated with its use (Maher, Hanlon, & Hajjar, 2014). A physician and a pharmacist will decide on the medications to be continued or discontinued. After that, she will be left will only the necessary medications. Also, a simple drug schedule should be formulated based on her needs and daily routine to encourage drug adherence (Mann et al., 2018)

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The second intervention is to address dehydration. This can be achieved by reducing the patient’s diuretic medications. Also, dieting can be utilized to ensure the patient takes a lot of fluids. In extreme cases, intravenous supplemental fluid can be administered. By managing dehydration, exacerbations of CHF symptoms will be reduced (Gulanick, 2013).

Fall risk can be reduced by reducing polypharmacy which is a major risk factor in patients with chronic comorbidities (Gulanick, 2013). Her home environment can also be modified to ensure that passageways are well lit, non-slippery and have rails for support. Last is depression which can be addressed by providing her with the constant company to talk to and help her with activities of daily living. Second, assigning a caretaker is a necessary intervention to help her with activities of daily living. Anti-depressive drugs could also be prescribed.

Rationale The first intervention was to address polypharmacy and increase compliance by removing the unnecessary medications from the patient’s prescription. It is obvious that the patient is using many unnecessary medications hence the logic of discarding medications that are not beneficial to her health (Maher et al., 2014). In the same way, increasing fluid intake and reduce her diuretics will eventually address the issue of dehydration. This will help reduce the potential adverse events in her health (Ambrose, Cruz, & Paul, 2015).

Assigning a caregiver is also logic as the patient urgently needs someone to help her do the house chores as well as create a better drug adherence approach. Having company is great as the patient will have someone to talk to hence help minimize anxiety and depression (Kobayashi & Steptoe, 2018). Lastly, home modification is important to prevent falls. Due to her age and frailty, her walk ways require to be made non-slippery and with support rails.

Scripted Dialog

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Nurse: Good morning Sallie Mae, I am Nurse Elle, and I will be assessing your health today.

Sallie Mae: Good morning.

Nurse: So, How do you feel? Have your symptoms stabilized since you got discharged.

Sallie Mae: I am much better now. The chest pains have subsided, and I am feeling much stronger.

Nurse: Tell me about your current medications. Have you taken any today?

Sallie Mae: Yes, I took my morning drugs but forgot the midmorning ones. The drugs are too many, and the doctor keeps on adding more every time I get hospitalized. Taking too many drugs is boring and has no fun.

Nurse: Would you appreciate if your medications are reduced?

Sallie Mae: Yes, please.

Nurse: These are truly a lot. I will look into it.

Sallie Mae: Why now? Why was I taking them all for? Was it in vain?

Nurse: No. These are the recommended medications for your heart disease, hypertension, pain, and arterial fibrillation. Some of them serve the same purpose while some of them may not be beneficial to your health hence the need to discontinue them.

Sallie Mae: Okay. That’s fine.

Nurse: Welcome. So you stay alone. Does it ever get lonely?

Sallie Mae: Yeah, It is quite boring as my daughter visits once in a while. I don’t want to be a burden to her.

Nurse: I will find someone to keep you company and help you around the house.

Sallie Mae: Thank you. God bless you.

Nurse: Thank you too. You will get better soon. The Lord is with you.

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Ambrose, A. F., Cruz, L., & Paul, G. (2015). Falls and fractures: a systematic approach to screening and prevention. Maturitas, 82(1), 85-93.

Gulanick, M. A. (2013). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.).

Philadelphia, PA: Elsevier Health Sciences.

Kobayashi, L. C., & Steptoe, A. (2018). Social isolation, loneliness, and health behaviors at older ages: longitudinal cohort study. Annals of Behavioral Medicine, 52(7), 582-593. doi: 10.1093/abm/kax033.

Maher, R. L., Hanlon, J. T., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety, 13(1), 10.1517/14740338.2013.827660. http://doi.org/10.1517/14740338.2013.827660 Mann, E., Zepeda, O., Soones, T., Federman, A., Leff, B., Siu, A., & Boockvar, K. (2018).

Adverse drug events and medication problems in hospital at home patients. Home Health Care Services Quarterly, 37(3), 177-186. doi: 10.1080/01621424.2018.1454372.