NR 305 Week 2 Discussion Topic, General Survey-Skin-Nutrition
Your home health agency has received an order from a local hospital to evaluate and treat an
elderly woman being discharged from its medical surgical unit.
Millie Gardner, an 83-year-old female patient, is being discharged home today to the care of her
husband Fred (87 years old) following a 9-day hospitalization for pneumonia, dehydration, and
failure to thrive. She has a history of hypertension (HTN), Type II Diabetes, and cerebral
vascular accident (CVA) with left-sided weakness. Patient is alert and oriented but does have
periods of forgetfulness during the overnight hours. Patient has intermittent incontinence of
bowel and bladder and requires assistance with all activities of daily living (ADLs).
Medications:
Lopressor
Lisinopril
Plavix
Metformin
Novolin R per sliding scale *NEW*
Multivitamin
Colace
Zithromax *NEW*
Upon arrival, you are greeted by Champ, the couple's rambunctious miniature Doberman
pinscher dog. Millie is in her wheelchair staring blankly out the window, and Fred is busy in the
kitchen preparing the couple's lunch.
The prognosis for Mrs. Millie Gardner, our Home healthcare’s pending new admit is not very
dire overall, but her presentations are rather challenging. As I drive towards her home and Fred’s
her husband, thoughts about her and her peculiar health needs that I’ve gathered from her
doctor’s face sheet and admission orders raced through my mind. However, I look forward to
this initial encounter with the Gardner family.
Based on the scenario above, please use the general survey process to describe the
areas that you would be observing immediately upon entry to the home.
The overall attributes of the individual are regarded as the general survey. As a nurse,
initial contact with the patient should begin with this brief overview (Jarvis, 2016). The
general survey commences immediately you come into the vicinity of the patient; it
includes your observation of the patient and the patient’s surroundings as well
(Chamberlain College of Nursing, 2017).
Pertaining to my client today, who is 83-year-old Millie Gardner, my assessment by
simple observation as I entered her home focused on the parameters below (Chamberlain
College of Nursing, 2017).
, Her distress level and general mien was important to me. The client was noted to be alert
and oriented but was also very forgetfulness. She concurred that this is especially so
during the overnight hours. She was also found on my arrival to her home, to be staring
blankly out of the window today, (which is also very revealing), while her husband
prepared her meals. The room where she sat and the kitchen area where Fred cooked
from was spick and span. Her kudos and credit she added, goes to her husband and
caregiver for that. The client’s Physical appearance as she sits in her wheelchair this
morning starring out of the window was noted to be rather spotless as well; Mrs. Gardner
was dressed appropriately for today’s weather conditions, with intact, and dry and well-
oiled skin. Her behavior was appropriate for the situation of folks her age. Age wise,
client and husband also look and act their stated age while the client’s skin is thin,
rubbery and with no visible signs of cachexia which was necessary to be assessed due to
her status as a recovering dehydration patient. Her skin was also taunt with no
discolorations and no open areas, and evidently, with no visible signs of abuse and
neglect gleaned from her appearance. The client however, demonstrated limited mobility
with left sided weakness noted to upper and lower extremities. She’s with impaired gait
and balance, and always ambulates with the assistance of her wheelchair. However, it is
important to educate the family of the risk to slips and falls that could result from keeping
a pet in the home and how to avoid this health hazard. Her environment was well lighted,
while the entire house including outside of the home and the entrance, was clutter free
with no throw rugs insight to constitute safety hazards. The pleasant aroma of her
husband is cooking permeates the rooms with no offensive odors either. There were grab
bars already installed in the bathroom with a bathroom stool and anti-slip and fall mat
also available for the client who stated that she receives assistance with her ADLs from
her husband (Chamberlain College of Nursing, 2017).
What, if any, concerns related to Millie's skin and nutritional status do you have?
Urinary incontinence is highly prevalent in women than in men 80 years of age or younger
(Minassian, Stewart & Wood, 2008). However, women and men are almost equally affected
after age 80 (Markland, Goode, Redden, Wu, Vaughan, Burgio, & Richter, 2010). Frequent
skin exposure to urine and feces leads to dermatitis, a skin condition, which if not treated
could lead to more serious skin integrity problems. Therefore, it is important to look for signs
of inflammation in the folds of Mrs. Gardner’s skin, to examine her skin for the presence of
erythema (redness)-a very bright red skin areas-and to assess her skin for any visible erosion
(and to instruct her husband and caregiver to do this daily inspection while assisting the
client with her ADLs and report his findings to the home health nurse). Pressure sores or
ulcers are also likely to develop due to untreated bowel incontinence (Zaykoski, 2010).
The client is at risk for incontinence-associated dermatitis (IAD), a skin related problem
associated with her disease process of intermittent incontinence of bowel and bladder which is
the body’s inability to control the release of urine or stool. The symptoms of IAD include,
Your home health agency has received an order from a local hospital to evaluate and treat an
elderly woman being discharged from its medical surgical unit.
Millie Gardner, an 83-year-old female patient, is being discharged home today to the care of her
husband Fred (87 years old) following a 9-day hospitalization for pneumonia, dehydration, and
failure to thrive. She has a history of hypertension (HTN), Type II Diabetes, and cerebral
vascular accident (CVA) with left-sided weakness. Patient is alert and oriented but does have
periods of forgetfulness during the overnight hours. Patient has intermittent incontinence of
bowel and bladder and requires assistance with all activities of daily living (ADLs).
Medications:
Lopressor
Lisinopril
Plavix
Metformin
Novolin R per sliding scale *NEW*
Multivitamin
Colace
Zithromax *NEW*
Upon arrival, you are greeted by Champ, the couple's rambunctious miniature Doberman
pinscher dog. Millie is in her wheelchair staring blankly out the window, and Fred is busy in the
kitchen preparing the couple's lunch.
The prognosis for Mrs. Millie Gardner, our Home healthcare’s pending new admit is not very
dire overall, but her presentations are rather challenging. As I drive towards her home and Fred’s
her husband, thoughts about her and her peculiar health needs that I’ve gathered from her
doctor’s face sheet and admission orders raced through my mind. However, I look forward to
this initial encounter with the Gardner family.
Based on the scenario above, please use the general survey process to describe the
areas that you would be observing immediately upon entry to the home.
The overall attributes of the individual are regarded as the general survey. As a nurse,
initial contact with the patient should begin with this brief overview (Jarvis, 2016). The
general survey commences immediately you come into the vicinity of the patient; it
includes your observation of the patient and the patient’s surroundings as well
(Chamberlain College of Nursing, 2017).
Pertaining to my client today, who is 83-year-old Millie Gardner, my assessment by
simple observation as I entered her home focused on the parameters below (Chamberlain
College of Nursing, 2017).
, Her distress level and general mien was important to me. The client was noted to be alert
and oriented but was also very forgetfulness. She concurred that this is especially so
during the overnight hours. She was also found on my arrival to her home, to be staring
blankly out of the window today, (which is also very revealing), while her husband
prepared her meals. The room where she sat and the kitchen area where Fred cooked
from was spick and span. Her kudos and credit she added, goes to her husband and
caregiver for that. The client’s Physical appearance as she sits in her wheelchair this
morning starring out of the window was noted to be rather spotless as well; Mrs. Gardner
was dressed appropriately for today’s weather conditions, with intact, and dry and well-
oiled skin. Her behavior was appropriate for the situation of folks her age. Age wise,
client and husband also look and act their stated age while the client’s skin is thin,
rubbery and with no visible signs of cachexia which was necessary to be assessed due to
her status as a recovering dehydration patient. Her skin was also taunt with no
discolorations and no open areas, and evidently, with no visible signs of abuse and
neglect gleaned from her appearance. The client however, demonstrated limited mobility
with left sided weakness noted to upper and lower extremities. She’s with impaired gait
and balance, and always ambulates with the assistance of her wheelchair. However, it is
important to educate the family of the risk to slips and falls that could result from keeping
a pet in the home and how to avoid this health hazard. Her environment was well lighted,
while the entire house including outside of the home and the entrance, was clutter free
with no throw rugs insight to constitute safety hazards. The pleasant aroma of her
husband is cooking permeates the rooms with no offensive odors either. There were grab
bars already installed in the bathroom with a bathroom stool and anti-slip and fall mat
also available for the client who stated that she receives assistance with her ADLs from
her husband (Chamberlain College of Nursing, 2017).
What, if any, concerns related to Millie's skin and nutritional status do you have?
Urinary incontinence is highly prevalent in women than in men 80 years of age or younger
(Minassian, Stewart & Wood, 2008). However, women and men are almost equally affected
after age 80 (Markland, Goode, Redden, Wu, Vaughan, Burgio, & Richter, 2010). Frequent
skin exposure to urine and feces leads to dermatitis, a skin condition, which if not treated
could lead to more serious skin integrity problems. Therefore, it is important to look for signs
of inflammation in the folds of Mrs. Gardner’s skin, to examine her skin for the presence of
erythema (redness)-a very bright red skin areas-and to assess her skin for any visible erosion
(and to instruct her husband and caregiver to do this daily inspection while assisting the
client with her ADLs and report his findings to the home health nurse). Pressure sores or
ulcers are also likely to develop due to untreated bowel incontinence (Zaykoski, 2010).
The client is at risk for incontinence-associated dermatitis (IAD), a skin related problem
associated with her disease process of intermittent incontinence of bowel and bladder which is
the body’s inability to control the release of urine or stool. The symptoms of IAD include,
