Anita is admitting a 76-year-old patient with severe cardiomyopathy for recurrent pneumonia. During the admission, the patient, tells Anita that she lives alone with her two cats but has been having trouble lately going up the stairs to the only bathroom in the house. Knowing that the patient’s heart condition will only get worse, Anita questions the patient about the type of house she lives in, how many stairs are in the home, whether any family or friends live nearby, and how she feels about her ability to care for herself living alone. The patient states that she has never been married and has no children. She has some friends who live nearby, but the youngest ones are in their late 70s. Anita is concerned about the patient’s ability to care for herself after discharge, and she informs the physician when he makes his rounds. The physician orders extended care placement for the patient after discharge, full lab work, bronchoscopy, sputum sample, echocardiography, CT scan of the chest, and daily chest x-rays for 3 days. Use the Nursing Today textbook for your responses and cite reference:1.(with reference cited) how did Anita advocate for her patient?2. What concerns should Anita have regarding the information obtained during admission?3. Which issues of fiscal responsibility, if any, are raised by the physician’s orders?4. During discharge, Anita reviews the list of new medications prescribed for the patient. Almost every medication the patient was previously taking has changed in dose or has been replaced by a different medication. What can Anita do to ensure that the patient has the means to obtain the new medications and that she understands how to take them?

Solution

1. Anita’s Advocacy for her Patient:
   • Anita advocates for her patient by proactively assessing the patient’s living situation, functional status, and support network during the admission process. Recognizing potential challenges the patient may face upon discharge, Anita communicates her concerns to the physician, advocating for the patient’s well-being and ensuring appropriate care planning.
   • Anita’s actions align with the nursing role of patient advocacy, which involves promoting patients’ rights, preferences, and safety throughout the healthcare experience (Taylor, Lillis, Lynn, & LeMone, 2019, p. 39).
2. Concerns Regarding Admission Information:
   • Anita should be concerned about the patient’s ability to safely manage activities of daily living, such as climbing stairs to access the bathroom, especially considering her worsening cardiomyopathy and recurrent pneumonia.
   • Additionally, the patient’s lack of immediate family support and reliance on elderly friends raise concerns about her social support network and potential challenges in receiving assistance with activities such as transportation, medication management, and household tasks after discharge.
3. Fiscal Responsibility Issues:
   • The physician’s orders for extensive diagnostic testing (bronchoscopy, echocardiography, CT scan, daily chest x-rays) raise concerns about the cost-effectiveness of care and the appropriate utilization of healthcare resources.
   • Anita may need to consider the financial implications of these orders, advocate for cost-conscious care decisions, and collaborate with the healthcare team to ensure that the patient receives necessary diagnostic evaluations while minimizing unnecessary testing and associated expenses.
4. Ensuring Medication Access and Understanding:
   • To ensure that the patient has the means to obtain new medications and understands how to take them, Anita can take several steps:
     • Collaborate with the hospital’s pharmacy or social work department to assist the patient in accessing affordable medication options, such as patient assistance programs or prescription discount cards.
     • Provide comprehensive medication education to the patient, including instructions on medication administration, potential side effects, and the importance of adherence to the prescribed regimen.
     • Facilitate communication between the patient and her healthcare providers to address any questions or concerns about the medication changes and ensure continuity of care post-discharge.

Reference: Taylor, C., Lillis, C., Lynn, P., & LeMone, P. (2019). Fundamentals of Nursing: The Art and Science of Person-Centered Care (9th ed.). Wolters Kluwer.