Discharge Teaching: Patient with Hypertension and Depression

Directions

1. Review the case study that is located with the assignment section of the course.  Consider the following when you are evaluating this case: holistic approach (consideration of biopsychosocial, culture and spiritual needs of individual as well as their environment).
2. Using a Word document complete the Discharge Teaching Plan form that is provided for this assignment.  This project is limited to 6 pages maximum.  You may use bullets to provide your responses.
3. It is expected that scholarly writing will be used for this project which includes proper grammar, syntax, and APA format where appropriate.
4. You are to provide a minimum of two sources of scholarly evidence to support your recommendations.  You may use your textbook but this does not count as a scholarly source.  Scholarly sources include: peer-reviewed journals published within the last 5 years, government and other credible websites.  You must use at least one journal article as a scholarly source.  As professional nurses you must be able to identify sources of evidence to support your decision making process.
5. This assignment is due Sunday at 11:55 pm ET in week 2.  Please contact your instructor is you have any questions regarding this assignment.

Case Study

Mrs. Delia Teal, is a 68 year old, Caucasian woman who has never left the town where she was born and raised: Franklin, West Virginia.  One of the unique features of Mrs. Teal’s state is that it is the only state that is completely located with Appalachia.  Appalachia is characterized by its beautiful rural areas.  Its citizens are very family oriented and have strong family ties.  There are significant barriers to health maintenance in this state including but not limited to: poverty, limited education, limited healthcare resources and economic activity being directly linked to environmental resources (eg. Coal mining).

Mrs. Teal has been hospitalized for the past four days with uncontrolled hypertension.  Her health history includes: hypertension, hyperlipidemia, obesity, poor dentition, and acute depression.  It is noted that her husband of 54 years passed away related to a chronic lung condition.  Mrs. Teal has 8 children varying in age from 53 to 45.  All of the children except the one have remained local.  They are highly supportive of their mother and have been in frequently to visit during this hospitalization.

Mrs. Teal’s doctors and the hospital are 40 miles from her home.  She must travel over the Blue Ridge Mountains to receive medical care.  Since her husband’s passing, Mrs. Teal states “She has gotten to worrin’ and not feelin’ up to much.”  She has stopped tending her vegetable garden (an important food source for her) as well as attending her weekly church service (also very important to her).  She describes her 54 year marriage as “like everyone else’s.  We raised our kids with rod, teachin’ proper doin’, and they done well for themselves.  I miss my Fred bad.”  When asked about her understanding of her hypertension she responds “Don’t know much about that.”

The following is the discharge information from Mrs. Teal’s chart.

Discharge Date: (assume it is tomorrow)

Name: Delia Teal

Gender: Female         Age: 68           Race: Caucasian

Weight: 100 kg (220 pounds) Height: 160 cm ( 5 foot 3 inches)

Religion: Protestant

Major Support Systems: 8 children (Joseph does not live in area); church members

Phone: XXX-XXX- XXXX (land line only)

Allergies: None known

Immunizations: Unknown.  Patient relates she has never had an influenza vaccine or pneumonia vaccine

Attending Physician: Dr. Michael Ross

Past Medical History: Obesity and Poor dentition (patient has multiple missing teeth and extreme tooth decay).

History of Present Illness: Mrs. Teal was brought to hospital via ambulance accompanied by daughter, Anne.  She had complaints of severe headache and feeling poorly for several days. Admission B/P was 240/118.  Admission labs: Cholesterol 260 mg/dL; Triglycerides 180mg/dL; Fasting glucose:  110 mg/dL.

Medications

1. Lisinopril 20 mg po daily
2. Hydralazine hydrochloride 50 mg bid
3. Simvastatin  40 mg daily at bedtime

Social History: widow (husband died 4 months -  54 year marriage). Did not graduate from high school.  Completed the 6^th grade.

Discharge Diagnoses: hypertension; hyperlipidemia; depression – acute, situational

Nursing Diagnoses:

1. Imbalanced nutrition: More than body requirements
2. Ineffective health maintenance
3. Grieving

Prepare a discharge teaching plan for Mrs. Teal and her family.