Ann Smith who is 66 years old and has had multiple sclerosis since she was 18. She sees half a dozen physicians, takes 21 prescribed medications, and is typically in and out of the hospital twice a year.
Here is the short version of what happened:
Feb. 11 – Smith’s personal care attendant (PCA) drives her to a hospital because Smith is having troubletalking and hearing. She is admitted for IV rehydration.
Feb. 15 – Smith is discharged to a nursing home where she shares a bedroom with another woman. She is now weaker than when she was at home and needs help standing, dressing, and taking care of other daily activities.
March 3 – Smith returns to the hospital. At the nursing home, she tried to call 411 to get a phone number but dialed 911 by mistake. She seems flustered and disoriented as she talks to the police, so she’s returned to the hospital for a mental health evaluation.
March 6 – Smith is readmitted to the nursing home where she continues her rehabilitation. She is moved by the kindness of the staff and loves the food, but is anxious to get back to her own home.
March 21 – Smith develops a urinary tract infection and becomes agitated, which her doctor attributes to too many changes of place and medications, so she is admitted to a hospital again.
March 26 – She is discharged to the nursing home again, but develops cellulitis in one hand. The infection spreads up her arm.
March 28 – Smith is readmitted to the hospital for treatment of cellulitis. She is overwhelmed again, her anxiety flares, and she’s transferred to the mental health unit.
April 6 – She is again discharged to a nursing home, and the nurses begin to doubt whether she can live independently at home, with some help.
But Smith wants to go home but there are several issues. She has been in and out of this nursing home and several hospitals for the last 2 months. She was admitted to the hospital from home because she was severely dehydrated; simply put, she wasn’t getting enough to drink. Now, after three separate hospital stays, repeated recoveries, and $56,171 in bills, Smith is cleared to go home, but before she can go, her nurses want to make sure seemingly small problems that triggered her long, expensive medical journey won’t happen again.
Smith’s 93-year-old mother, her only living relative, after a long struggle with her conscience, finally called and told the nurses why Smith wasn’t getting enough to drink: She was letting her PCAs work hours that were convenient for them, but not for her. Smith usually wakes up around 6 a.m., but her PCA was not arriving until 10 a.m. Moreover, another PCA, the one who comes on weekends, wasn’t arriving at Smith’shome until 4 p.m. So from 6 am to 10 am during the week–and 6 am to 4 pm on weekends–she had no one to help her get to the bathroom or to get something to eat or drink; she also experienced multiple falls during these periods. However, Smith relates well to the PCAs and relies on them for emotional support.
What questions would the nurse like to know?
How do you interpret what you have noticed?
How should the nurse respond (list interventions)?
How should the nurse evaluate the patient’s responses to the interventions?