Sallie Mae Fischer problems identified (we need to identify and prioritize 4)

1) Polypharmacy- Sallie Mae was given new medications at discharge, one of the new medications is Lasix (furosemide) 80mg twice a day. At home, she is already taking Lasix 40mg once a day and she seems unaware that she is repeating the same medication. She also mentions in the video that she began taking the new medications at night. The Lasix is supposed to be taken twice a day and if she is only taking the medication at night, she is not adhering to doctors’ orders. Another repeated medication is Digoxin (Lanoxin). On her new discharge orders, she has Digoxin 0.25mg once a day, but also has Lanoxin at home 0.125 mg every other day. This could explain why her heart rate is lower than normal.

a. Nursing Intervention- The nurse should go through each medication with Sallie Mae to determine how, when, and why she is taking each one. If there are any duplicate medications, the nurse should explain to Sallie Mae why she is to discontinue taking it and that medication should be disposed of. The nurse can work with Sallie Mae’s pharmacy to ensure that she isn’t getting duplicate medications and the nurse should also ensure that Sallie Mae is only going to one pharmacy. After going through all medications, the nurse can help Sallie Mae with organizing her medications by putting them into a pill organizer with each day of the week listed and breakfast, lunch and dinner listed. By organizing all the pills into boxes, Sallie Mae will be able to keep track of her medications and know what time of day to take them. She will also know that she has taken all her required medications for that specific day.

2) Oxygen – Upon Sallie Mae’s discharge, 2 liters of oxygen via nasal cannula was ordered as needed. Sallie Mae say’s that she turned the oxygen away when the company tried to deliver it because she didn’t want to be charged extra. Sallie Mae says that she has been very tired and hasn’t had much energy. Part of this could be the lack of oxygen which is related to her congestive heart failure. The supplemental oxygen would help Sallie Mae by increasing her oxygen saturation and decreasing her shortness of breath.