TASK 43 You are a ward nurse in the cardiac unit of Greenville Public Hospital. Your patient, Ms. Martin, is due to be discharged tomorrow.
Patient : Ms. Margaret Helen Martin Address : 23 Third Avenue, Greenville
Age : 81 years old (DOB: 25 July 1935) Admission date : 15 July 2017
Social/ family background: Never married, no children
Lives in own house in Greenville Financially independent
Three siblings (all unwell) and five nieces/nephews living in greater Greenville area
Contact with family intermittent No longer drives
Has ‘meals on wheels’ (meal delivery service for elderly)
Mon-Fri (lunch and dinner), orders frozen meals for weekends
Diagnosis : Coronary artery disease (CAD) angina
Treatment : Angioplasty (Repeat-first 2008) Discharge date : 16 July 2017, pending cardiologist’s report Medical information : Coeliac disease Angioplasty 2008
Anxious about health-tends to focus on health problems Coronary artery disease → aspirin, clopidogrel (Plavix) Hypertension→ Metoprolol (Betaloc), ramipril (Tritace) Hypercholesterolemia (8.3) → atorvastatin (Lipitor) Overweight (BMI 29.5) Sedentary (orders groceries over phone to be delivered, neighbour walks dog)
Family history of coronary heart disease (mother, 2 of 3 brothers) Hearing loss-wears hearing aid
Nursing management and progress during hospital stay:
Routine post-operative recovery Tolerating light diet and fluids
Bruising at catheter insertion site, no signs of infection/bleeding noted post- procedure
Pt anxious about return home, not sure whether she will cope
Discharge plan Dietary
Low-calorie, high-protein, low-cholesterol, gluten-free diet (supervised by dietitian, referred by Dr)
Frequent small meals or snacks Drink plenty of fluids
Physiotherapy: Daily light exercise(e.g., 15-minute walk, exercise plan monitored by physiotherapist) No heavy lifting for 12 weeks
Other: Monitor wound site for bruising or infection Monitor adherence to medication regime Arrange regular family visits to monitor progress
Anticipated needs of Pt: Need home visits from community Health / district nurse – monitor adherence to post-operative medication, exercise, dietary regime Regular monitoring by Dr, Dietitian, physiotherapist Danger of social isolation (infrequent family support)
Writing Task: Using the information in the case notes write a letter to the Nurse-in-Charge of the District Nursing Service outlining Ms. Martin’s situation and anticipated needs following her return home tomorrow. Address the letter to Nurse-in-Charge, District Nursing Service, Greenville Community Health Care Centre, 88 Highton Road, Greenville.
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