Assessment and Planning
First visit and ongoing:
Assess for other disciplines: PT, OT, Speech, SW, HHA. If needed;
- Obtain approval from D.O.N
- Speak with MD, obtain verbal orders; site and send interim orders
- Request in Managed Care Report
Reassess d/c plan at every visit
If further visits needed- at least 1 week prior to planned D/C date:
- Obtain approval from D.O.N
- Speak with MD, obtain verbal orders, write and send Interim Orders,
- Write Managed Care Report 1 week prior to any change.
INTERVENTIONS TO OCCUR DURING CARE PERIOD
- Assess/reconcile all medications, Assess knowledge. Instruct in purpose, route, frequency, side effects.
- Assess circulatory/cardiac status: VS; heart rate/rhythm; weight, edema; note change in status. Initial visit, establish target weight, take BP in both arms in 2 positions, identify arm with higher BP, document and continue using that arm for BP.
- Assess level of dyspnea with activity and at rest, note change in status.
- Assess LE edema, measuring bilateral ankle and calf at SOC and regularly. Instruct in self assessment. If edema, assess regularly for skin, breakdown, and instruct in self assessment.
- Instruct to record weight daily, report gain of 2-3 lbs. one day/5 lbs. one week or as per physician order.
- Instruct on use of oxygen for disease process, if applicable.
- Instruct on self-monitoring: weight, edema, pulse, S/S pain; actions to take with abnormal findings.
- Instruct on hidden sources of sodium in commercial foods; provide written information as needed.
- Instruct on effects of cholesterol, salt, and fat on cardiac disorders.
- Instruct on salt substitutes and need for physician approval and how to flavor foods with herbs and spices.
- Instruct on foods high in potassium if on potassium-depleting diuretic; provide list of foods.
- Instruct on importance of frequent rest periods, pacing activities, and avoiding overexertion.
- Instruct to elevate feet/legs when sitting or laying if appropriate.
- Instruct on semi or high fowlers position to improve breathing/ respirations if appropriate.
- Assess home for fire extinguisher and other oxygen safety precautions.
- Evaluate knowledge of safe and correct use of oxygen, instruct as needed.
- Instruct to reduce or stop smoking if applicable.
PATIENT/CAREGIVER OUTCOMES (V) VERBALIZE (D) DEMONSTRATES
- Compliance/understanding of purpose, route, frequency, side effects of all medications. (V)
- Importance of monitoring daily weight. Weight consistent with goals. (D & V)
- Compliance with activities to improve cardiac status; gradual increases, feet/legs elevated, positioning, etc. (V & D)
- Decreased edema, if appropriate. (D)