Patty Mills is a 74-year-old female with a past medical history of coronary artery disease with stent placement, hypertension, and diabetes. Her son brought her to the Emergency Department because she has become increasingly weak and confused and was found by a neighbor wandering her neighborhood unable to locate her home. Patty’s son tells the nurse that his mother takes a “water pill” for her blood pressure 2 or 3 times a day. The label on the medication bottle that she brought to the hospital states, “Furosemide 40mg BID”.  Patty is admitted with fluid volume deficit.

Health Challenges: 

1. One health challenge this patient faces is a risk for falls. She is weak and this puts her at risk for losing balance and falling if she is not monitored. Another health challenge she faces is heart failure because of her diabetes, high blood pressure, and her stent placement. A third health challenge is her level of consciousness. She is confused and has been found wandering so she is at risk for getting lost and losing consciousness (Ackley, 2008).
2. Patty requires an on-going assessment of her high blood pressure and her water pill medication, her blood glucose level for diabetes, and her level of fluids (making sure she does not have hypovolemia). The high blood pressure and blood glucose levels would be something she can do outpatient and monitor those things from home. If they were to flare up and become too high or too low, she would need to go to an inpatient hospital setting. Her level of fluids can be managed from home (inpatient) by tracking her I’s and O’s and weighing herself. Again, if this were to get too low or too high (water retention/edema), she would need to go to an inpatient setting (Honan, 2019).
3. Patty needs education on how to take her own blood pressure so she can monitor it – this can be done by using an at-home machine. She needs education on how to check her blood glucose levels (finger prick), when to do so, where to do it and why we do it. She also needs to learn that the normal level for this is 70-100 mg/dL (Honan, 2019). She would need to get a blood glucose monitor for her own house as well. Lastly, she would need to change her diet and exercise level and nutrients in order to manager her diabetes and fluid deficit levels. This could be taught by giving her a pamphlet or a diagram of how to plan her daily schedule out. Patty could implement the teach-back method in order to show her understanding of what I taught her (Honan, 2019).
4. The patient’s primary (priority) nursing diagnosis is: fluid volume deficit meaning she has a low level of fluids in her body due to hypovolemia. The etiology of this diagnosis is weakness, confusion, and the Furosemide 40mg that she is prescribed. The defining characteristics for this are confusion, weakness, and the need for a hospital visit (Ackley, 2008). This takes priority because the fluid volume deficit is why she came into the hospital in the first place, and it is causing her to become confused and wander around alone, and with her being weak as it is, she needs to be monitored.
5. Some nursing actions that I will take in providing care to my patient would be the following: monitor her fluid intake and output, put a hat in her toilet to help keep track, help her with getting to the bathroom and back safely without falling or losing balance, putting grip socks on her feet, providing her with a healthy-diabetic based diet with proper amounts of fluids, weighing her daily, monitoring her vitals and blood glucose several times a day, and assessing her level of consciousness and muscle strength frequently as well. I would also make sure to do a skin turgor assessment and edema assessment of her skin. Lastly, I would educate the patient and her family the signs and symptoms of hypovolemia and how to prevent it from occurring (Honan, 2019).