Identifying and Prioritizing the Problem
One of the problems that can be distinguished in this case study is the risk of injury. Considering the women’s age (the risk of injury increases with age) and her current medical condition, she can accidentally fall and seriously hurt herself. The problem is of high priority for several reasons: injury is the leading cause of death among elderly; people with injuries remain twice as long in hospitals; costs for medical services are higher in the case of an injury (Yelon & Luchette, 2013, p. 221).
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Substantiating Evidence for Problem Identified
As Sallie says in the video, she has a weak appetite and eats very little. The woman moves very slowly and looks tired. Also, she has lost 14 pounds in one week, and her blood pressure is 90 over 56, which is very low. All of that indicates fatigue that can lead to dizziness and accidental falls, which, in its turn, can cause injury.
The nursing intervention should consist of both external and internal components (Lord, Sherrington, Menz, & Close, 2007, p. 306). As for external ones, all possible home hazards should be eliminated. Internal components refer to health education. Sallie should be taught about the risks of injuries and the ways to prevent those. She should be motivated to move more, do special gymnastics and eat regularly. She also needs a lot of fresh air. To make her feel better psychologically, the nurse should talk with her about her husband.
Rationale for the Interventions Identified
As Lord et al. (2007) state, removing all possible home hazards is the first thing to do. That is essential but still not enough to keep the patient safe. Sallie needs to move, and she should do that outdoors, to both train her muscles and breathe fresh air. Also, her psychological and spiritual needs should be addressed, so she can feel better inside.
The Dialogue with Sallie Mae Fisher
Nurse: Hello, Sallie, my name is ______, and I am your nurse. Your health history tells me that you have such conditions as ______.
Sallie: Good morning. Yes, that is right. I have just returned from the hospital where I have been taken because of _____.
Nurse: Do you feel better now?
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Sallie: A little bit.
Nurse: I am worried that considering your age and medical condition, you can feel bad and tired, and there is a risk of injury in such a case. I want to help you to prevent it. Would you mind?
Sallie: Sure, I would not. I do feel a little tired and dizzy sometimes. What should I do?
Nurse: Firstly, you should remove all home hazards, like sharp objects, for example.
Sallie: Okay, I will do that.
Nurse: Then you will need to walk outdoors every day for _____ minutes. You need a lot of fresh air. Do you like to walk? Did you walk a lot with your husband?
Sallie: Yes, we usually took a walk after the dinner.
Nurse: We should refresh your memory then. Would you like to walk with me and tell about your husband a little more?
Sallie: I will be glad to.
Nurse: You will also need to eat regularly since otherwise your fatigue will only increase.
Sallie: I will try.
Nurse: Finally, I will teach you how to do certain exercises. That will help you to train your muscles and joints a little bit.
Sallie: Would you help me with that?
Nurse: Sure, I will teach you how to do your gymnastics and help with everything you need.
Lord, S., Sherrington, C., Menz, H., & Close, J. (2007). Falls in Older People: Risk Factors and Strategies for Prevention. Cambridge, UK: Cambridge University Press.
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Yelon, J. A., & Luchette, F. A. (2013). Geriatric Trauma and Critical Care. New York, NY: Springer Science & Business Media.