NR 305 General Skin Nutrition Discussion

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NR 305 General  Skin Nutrition Discussion

NR 305 General  Skin Nutrition Discussion

 

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Your home health agency has received an order from a local hospital to evaluate and treat an elderly woman being discharged from its medical surgical unit.

Millie Gardner, an 83-year-old female patient, is being discharged home today to the care of her husband Fred (87 years old) following a 9-day hospitalization for pneumonia, dehydration, and failure to thrive. She has a history of hypertension (HTN), Type II Diabetes, and cerebral vascular accident (CVA) with left-sided weakness. Patient is alert and oriented but does have periods of forgetfulness during the overnight hours. Patient has intermittent incontinence of bowel and bladder and requires assistance with all activities of daily living (ADLs).

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Medications:

  • Lopressor
  • Lisinopril
  • Plavix
  • Metformin
  • Novolin R per sliding scale *NEW*
  • Multivitamin
  • Colace
  • Zithromax *NEW*

Upon arrival you are greeted by Champ, the couple’s rambunctious miniature Doberman pinscher dog. Millie is in her wheelchair staring blankly out the window, and Fred is busy in the kitchen preparing the couple’s lunch.

  • Based on the scenario above, please use the general survey process to describe the areas that you would be observing immediately upon entry to the home.
  • What, if any, concerns related to Millie’s skin and nutritional status do you have?
  • What nursing interventions will you include in the plan of care to address these concerns?
  • What teaching strategies will you use to educate Millie and Fred on the new medications?
  • Using the SBAR, please include the information that you will communicate to the physician’s office at the completion of the visit.General Survey/Skin/Nutrition study. Regardless of your specialty or practice setting, each of your patient encounters should begin with a brief study of the overall characteristics of the individual, which is referred to as the general survey (Jarvis, 2016). It is this brief overview that provides you with the first impression of your patient and enables you to quickly gauge his or her level of distress thus allowing you to prioritize your care delivery more efficiently. The general survey begins the minute you walk into the room and includes not only the patient but his or her surroundings as well. So what kinds of things can we assess simply by observing our patients?
    • Distress level—Are they breathing, is it labored, are they grimacing or displaying other outward signs of distress?
    • Physical appearance—Are they clean, dressed appropriately for the weather, displaying any obvious injuries?
    • Behavior—Is it appropriate for the situation and for their age?
    • Age—Do they look their stated age?
    • Nutritional status—Thin, obese, cachexic
    • Skin—Scars, discolorations, jaundice, ashen, obvious open areas, signs of abuse
    • Mobility—ROM, gait, assistive devices
    • Environment—Safety hazards, equipment, odors, and so on.

    With consistent use of this sequential and evidenced-based approach to patient assessment during each patient encounter, nurses are better equipped to recognize early signs of decline (Considine & Currey, 2015).

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