Sallie Mae Fisher, Case Study Example

Four problems affecting Sallie Mae Fisher according to priority are dyspnea due to congestive heart failure. The second is edema due to heart failure. Thirdly, is pain and fourth is safety living alone. The evidence-based reasons for dyspnea, edema and chest pain are associated with the congestive heart failure medical condition. Therefore, any profound evidence relates to the pathophysiology of heart failure, which is manifested in the history that ultimately gives rise to the three symptoms identified.

Congestive heat failure occurs when the heart functions abnormally. It could be detectable or undetectable. Importantly, the heart fails to pump blood at a rate required to metabolize tissues. When it does supply blood to tissues at the required rate the diastolic filling pressure becomes elevated. Significant symptoms are weight loss, dyspnea upon exertion or rest, acute pulmonary edema, chest pain, pressure or palpitations, fatigue and weakness, anorexia, orthopnea with weak rapid thready pulse among many other irregularities. These were manifestations expressed by Sallie Mae Fisher, which show evidence of dyspnea in the congestive heart failure condition (Goljan, 2014).

Dyspnea

Experts explaining the pathophysiology of dyspnea in congestive heart failure confirmed that there is a dislocation/ non-alignment between efferent motor activity and the brain respiratory center.  Afferent signals emerging from airways mechanical receptors located in the lungs and chest wall structures act as chemoreceptors in the blood. Therefore, dyspnea has very little relationship to intrinsic respiratory function. The physiology is closely associated with interruption of information, which was not resolved or perceived from a disjointed perspective within the respiratory system (Goljan, 2014)

Edema

There are two phases to edema formation in patients with congestive heart failure as Sallie Mae Fisher. Alteration in capillary hemodynamic occurs. This process facilitates movement of fluid from vascular into interstitial space. In some patients edema is localized while others it is generalized as in Mrs. Sallie Mae’s situation. She has gained 8 pounds in a few weeks. While the history did not show palpable swelling in any part of the body the excessive weight gain is indicative of tissue edema and the body retaining fluid (Faris, Flather, & Purcell, 2012).

Chest Pain

Studies are still uncertain about the pathophysiology of chest pain in patients with congestive cardiac failure. The closest they have come to understanding chest pain occurrence in CHF is by measuring myocardial perfusion at rest and when walking. These measurements are compared to biochemical indicators using the same two variables rest and walking. However, evidenced-based research shows where patients with chest pain spend longer days in hospital as  Sallie Mae Fisher. This is to manage the condition since the incidence of death among these patients is much higher (Goldman, 2011).

Safety

Patients with chronic congestive cardiac failure and at Mrs. Fisher’s age should never live alone. She often gets dyspnea and has to administer oxygen to herself. Besides, these patients tend to be fatigued. When she needs the oxygen to be administered it might not be possible for her to reach the machine and tubes. She can collapse and die due to lack of oxygen (Feltner,  Jones & Cené, 2014).

Four medical and/or nursing interventions that are applicable to Mrs. Sallie Mae Fisher are medication to improve heart function, positioning which relieves dyspnea and emotional support. As a nursing intervention this is very important. Studies show where congestive heart failure patients die earlier when they feel dependent on another or useless in themselves. Mrs. Fisher’s husband died, which is a serious loss for her. Now she lives alone. Even though her daughter cares it appears that there is very little she can do to be of much support to her mother. It then becomes a situation of grief, loneliness and loss of hope. Perhaps, moving to an assisted living facility where there are other people and caregivers she could do better. The fourth intervention is introducing a therapeutic diet that could control weight gain and relief water retention in the body. Weight gain increases difficulty in movement (Faris et.al, 2014).

Scripted Dialogue

Nurse: Good day Mrs. Fisher. How are you today?

Mrs. Fisher: What can I say? I feel horrible, but am taking life one day at a time because I had a wonderful life as a young person. My situation seems to be getting worse. Maybe my end is near.

Nurse: Very sorry to hear of your discomfort. However what exactly is your concern at this moment.

Mrs. Fisher: Well if I begin speaking it will take the entire day. They are so many, but the worse is  breathless. Even though I am taking the oxygen it does not seem to help anymore. Besides, I feel so heavy and uncomfortable. These are the two main ones now.

Nurse: Mrs. Fisher I am sure your doctor must have told you that at your age the body organs do not function as well as younger people. Despite this there are many ways in which one can cope with these discomforts. Concerning the breathlessness let me see how many liters of the oxygen take (nurse examines the machine and asks Mrs. Fisher to start the administration). See you are expected to take 2 liters per nasal prongs PRN. Here you are taking just one. Let me adjust it for you and take the recommended dose yo see what happens (Mrs. Fisher inhales oxygen). How do you feel now?

Mrs. Fisher: This is much better. Why the nurse who comes everyday did not tell me this.

Nurse: Maybe she adjusted it and you mistakenly changed it. Watch carefully and see where it has to go and mark the place careful. When your nurse comes in you can have her verify that it is correct.

Mrs. Fisher: Thank you.

Nurse: With respect to your feeling of heaviness in your condition the heart is not working at its maximum. Your heart is like a pump in the body that pours blood to all organs and cells. When it does not work at its maximum back up of fluid occurs. This means that there would be accumulation of fluid in the body. This would make you feel heavy.  Heart function is essential in helping your body get rid of the excess fluid naturally. For example, you  must use less salt. Doctor has prescribed medication, which you must take to help your heart function better in pushing the water out of your body. Remember to take them as prescribed to facilitate the process.

Mrs. Fisher: Thank you for the information, but sometimes I feel so depressed alone in here. I never lived alone.

Nurse: I understand how you feel. Do you have other relatives who can live with you? Or what about moving to a facility where there are other women your age with whom you can communicate and persons to help. You could even have your pastor visit you at times to give you communion and pray with you. It helps

Mrs. Fisher: That sounds great. How do I do that because my relatives are as old as I am and have their own troubles?

Nurse: I will speak to your primary care, cardiologist, and social worker with whom you can make the arrangement. Your daughter could make a valuable input too. Is there anything else I can do for you today?

Mrs. Fisher: No I just want to rest and sleep.

Nurse: O.K it was very pleasant meeting with you.

Mrs. Fisher: Thank you and have a blessed day

Nurse: Bye

References

Faris, R. Flather, M., & Purcell, H. (2012). Diuretics for heart failure. The Cochrane database of systematic reviews 2:

Feltner, C. Jones, C., & Cené, C. (2014). Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis. Annals of internal medicine 160 (11): 774–84

Goldman, Lee (2011). Goldman’s Cecil Medicine: Heart Failure (24th ed.). Philadelphia: Elsevier Saunders

Goljan, E. (2014). Rapid Review Pathology (4 ed.). Philadelphia, PA: Saunders/Elsevier