Community Health Nursing Case Study

Mr. Evans is a new patient to this nurse. This is the first home visit and upon presentation the patient has tachycardia and presumably newly diagnosed Atrial fibrillation, for which he takes Digoxin. According to records last Digoxin level was two months ago. Respiration are increased and adventitious breath sounds are noted. Patient states that this is his baseline. Patient has COPD and takes Proventil PRN and Theo-Dur twice a day. Patient reports he had a hospitalization for “congestion in his heart” and is currently on Lasix 40 BID. Patent denies any acute distress, home health aid reports recent weight loss, loose stools and complaint of nausea. This nurse in the field would interview the patient and his wife after the clinical assessment. I would ask about any anorexia, loose stools, nausea and or vomiting. Patient does take a stool softener daily. After assessing attend skin turgor and sign if dehydration, this nurse would investigate when the patient takes his medication, and if he has been missing any doses of meds. This nurse would ask when his next cardiology follow up is and when he is due for any labs including a BMP since 40 mg of Lasix twice a day is a higher dose, and for a current digoxin level. This nurse would ask how the patient is sleeping and how often he is using his rescue inhaler for shortness of breath and wheezing. This nurse would ask when his next follow up with oncology is and how long he has had the port, when the last time it was accessed. “he unique features of CVADs require specific strategies for reducing CVADRI rates: the devices are designed for long-term use, are manipulated at various healthcare facilities (in some cases, they must be serviced, even if there are signs of infection, and it is difficult to visualize the devices during manipulation), and are mechanically complicated, which can increase the risk of infection. In addition, cancer patients are typically immunocompromised and are therefore more susceptible to infection in general.”(O'Grady NP, Alexander M, Burns LA) This nurse would question the patients wife, if she notices anything that is new or not her husbands baseline. This nurse being the first time meeting the patient would also do a baseline mini mental assessment to understand how orientated both he patient and his wife are to the current health issues. Comparing the role of the community health nurse and acute care nurses in this situations. The acute care nurse has all the tools needed readily accessible to run the labs and diagnostics needed to present all the information the doctor to review. In the acute care setting you can rely on the other staff present including doctors, other nurses, respiratory techs etc to help and assist in developing interventions for this patient. In the community setting the nurse is autonomous in her assessment and interventions. Making clinical judgments based on his or her own level of expertise and experiences. You have to rely on the patient’s and or caregivers information. All testing would have to be done on a outpatient setting or if the patient was unstable transferred to an acute care setting for evaluation. In community health nursing the nurse has a better advantage to see how the patient is adapting and taking care of themselves or how others are taking care of the patient in the home. The acute care nurse does not get the advantage of adapting interventions to the patients home routine.

References

Kearney-Nunnery, R. (2012). Advancing your career: Concepts of professional nursing (5th ed.). Philadelphia, PA: F. A. Davis.

O'Grady NP, Alexander M, Burns LA, et al. Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:1087–1099. http://www.medscape.com/viewarticle/806418