While in the course, Caring for the Community as a Client, I performed a family visit. This assignment allowed me to enter a family's home and assess them as a whole, not just within the healthcare setting. This let me see potential issues that needed to be addressed. The following section from my journal describes my experience with my family. The journal uses the nursing process to develop care plans for the individuals within my family. The follwing insert contains the assessment tools I used and the nursing diagnoses I felt were priority for my family members. Click on the following link to view the whole journal.
The two assessment tools I decided to use were the Beck’s Depression Inventory because the elderly are at an increased risk for depression and suicide, and a Fall Risk Assessment considering they have two staircases. One of the staircases is hardwood flooring making it extremely slippery. M.G. even stated that many people had fallen down the stairs. I performed both of these on M.G. and T.G. The other assessment tool I used was the Windshield Survey which was used to assess the environment and community. I did not recognize any risks after completing the survey.
After completing the fall assessment I discovered that M.G. has a low risk of falling even though she is prescribed two of the medications the can pose a risk for falls. T.G. on the other hand was a fairly high risk. He stated he had fallen within the last twelve months while outside in the garden. He was not injured, just sore and a little bruised. He also stated that he recently may have suffered a mild stroke. He has minor weakness on one side and he did present with a mild aphasia. He seemed to have some difficulty getting his word out.
The Beck Depression Inventory showed that both M.G. and T.G. has mild depression, which is a score less than 15. M.G.’s score was a 4, she did not score any higher than a zero or a one on any questions. The areas she scored a one on were feeling more discouraged about the future than she used to, crying more than she used to, having less energy than she used to, and is fatigued more easily than she used to. She stated that the reason she cries more is because of the change she has seen in her husband since he had his mild stroke. T.G’s score was a 7, he did not score any higher than a zero or one on any questions. The areas where T.G. scored a one included feeling sad more of the time, feeling more discouraged about the future than he used to, does not enjoy things as much as he used to, cries more than he used to, has less interest in other people or things than before, has less energy than before, and can’t concentrate as well as he used to. When asked, T.G. explained that most of his negative feelings he is experiencing started when he was diagnosed with diabetes and grew even worse since he had his mild stroke.
The diagnosis I formed for T.G. was risk for injury related to a high risk of falling as evidenced by weakness on one side, diabetes, a past fall within the past twelve months, two sets of stairs, and fear of falling again. I educated him about the importance of proper foot wear that would help prevent falls, sitting down if he feels dizzy, staying hydrated, and not getting overheated in his workshop or garden and watching for signs of hypoglycemia (cold, clammy skin, shakiness, dizziness, and hunger). I also recommended changes he could make in his home environment to help prevent falls. In the bedroom I stated he should install a nightlight, remove throw rugs, keep the area clear of clutter, keep the bedding tucked in so he did not trip, and add extra lighting to the room. In the bathroom I suggested installing grab bars next to the shower and toilet, adding a nightlight, and having non slip mats so the rug stays in place. In the kitchen I recommended moving the items they used most often to lower cabinets, use a step stool to reach high items, and make sure the floor is safe from hazards. For the stairways I recommended him to make sure the walkway remained clear, installing handrails on both sides, and adding slip resistant pads or carpet to the hardwood stairway. I also told him that remaining active was important in helping increase his strength and balance, and I provided an educational sheet on proper ways to get up in the unfortunate event of another fall. Even though M.G. was a low risk for falling I still educated her about preventing falls. I felt like it was just as equally important for her to know this information to prevent her own falls and hopefully they can help each other remember to take precautions.
I also took some time to provide some education for diabetics. I praised T.G. for managing his diabetes as well as he has. I provided a little extra information about watching his sugar when exercising, proper foot care for a diabetic, signs of hypoglycemia, his Metformin, and the sick day rules for diabetics. I used informational sheets that were easily readable to help me in my education.
The diagnosis I formed for M.G. was readiness for enhanced knowledge related to high blood pressure and high cholesterol as evidenced by expressed interest in learning and asking questions about the topic. To help M.G. learn more I looked up and printed off a few educational sheets from http://www.americanheart.org/presenter.jhtml?identifier=3004356.The educational sheets I gave here included information about blood pressure medication, what cholesterol levels mean, why she should limit sodium intake, and how to lower blood pressure. The medication sheet provided tips on how to remember to take the medications, what types of medications there are, and side effects. The cholesterol level sheet told her what her total cholesterol, high-density lipoprotein, and triglyceride levels should be. The sodium sheet included why sodium is bad, how much sodium the average person needs, sources of sodium, and foods she should avoid. Lastly, the sheet on how to reduce high blood pressure included information on losing weight, limiting salt, and ways to be more active. All of the educational tools had extra resources to learn more and provided warning signs for heart attack and stroke. I allowed M.G. to keep all of the informational sheets and ask any questions she had.
