From the Guidelines
Skilled nursing interventions for this 96-year-old female patient with CKD, HTN, Alzheimer's, and high cholesterol should prioritize comprehensive care management, focusing on medication management, regular cognitive and skin assessments, nutritional support, and collaboration with physical therapy to promote mobility and prevent complications. The patient's complex medical needs require a multidisciplinary approach to care. The nurse should monitor vital signs regularly, particularly blood pressure due to her hypertension and lisinopril use, as well as ensure proper administration of all medications, including Aricept 10mg daily for Alzheimer's, Zoloft 25mg at bedtime for mood, lisinopril 10mg daily for hypertension, famotidine 40mg daily for gastric protection, ferrous sulfate 325mg daily for anemia prevention, vitamin D monthly, and nephrocaps for kidney support 1.
Regular cognitive assessments are crucial to track Alzheimer's progression and adjust care accordingly, considering the patient's individual needs and preferences 1. Skin assessments are also vital since the patient is bedbound, with implementation of a turning schedule every 2 hours to prevent pressure ulcers. The nurse should monitor nutritional status and hydration, ensuring adequate intake while considering CKD dietary restrictions, and provide meals in a pleasant, homelike atmosphere, taking into account the patient's personal preferences and needs 1.
Laboratory monitoring as ordered every 3 months should focus on kidney function, electrolytes, and complete blood count to assess CKD progression and medication effects. The nurse should collaborate with physical therapy to reinforce therapeutic exercises and mobility interventions, aiming to improve physical functioning and reduce the risk of falls 1. Pain assessment and management should be ongoing, with special attention to non-verbal cues due to potential communication difficulties from Alzheimer's.
These interventions are essential to address the patient's complex medical needs while supporting her quality of life despite being bedbound with cognitive impairment. By prioritizing comprehensive care management and considering the patient's individual needs and preferences, the nurse can help prevent complications, promote mobility, and improve the patient's overall well-being 1.
Some key aspects of care include:
- Monitoring vital signs and medication management
- Regular cognitive and skin assessments
- Nutritional support and hydration
- Collaboration with physical therapy to promote mobility
- Pain assessment and management
- Considering the patient's individual needs and preferences in care planning
- Providing meals in a pleasant, homelike atmosphere
- Implementing a turning schedule to prevent pressure ulcers
- Educating caregivers on nutritional problems related to dementia and possible strategies to intervene 1.
By addressing these aspects of care, the nurse can provide high-quality, patient-centered care that prioritizes the patient's comfort, safety, and well-being.
From the Research
Skilled Nursing Interventions
The patient's complex medical history, including CKD, HTN, Alzheimer's, and high cholesterol, requires a comprehensive approach to skilled nursing interventions. The following interventions can be considered:
- Monitoring of medication compliance, vitals, and lab collection as ordered, every 3 months, to ensure the patient's conditions are well-managed 2
- Collaboration with the patient's healthcare team to develop a care plan that addresses the patient's complex health needs, including CKD management and anemia treatment 3, 4
- Implementation of evidence-based strategies to manage the patient's CKD, such as cardiovascular risk reduction, treatment of albuminuria, and avoidance of potential nephrotoxins 3
- Regular assessment of the patient's anemia and adjustment of treatment as needed, including oral or intravenous iron supplements and erythropoiesis stimulating agents (ESA) 4
- Development of a personalized care plan that takes into account the patient's complex medical history, including comorbidities and polypharmacy 5
- Use of care plans to manage the patient's complex clinical needs, including information about patient history, current medical needs, and future care plans 6
Medication Management
The patient's medication regimen, including Aricept, Zoloft, vitamin D, lisinopril, famotidine, ferrous sulfate, and nephrocaps soft gel, requires close monitoring to ensure the patient's safety and effectiveness of treatment.
- Regular review of the patient's medication list to ensure accuracy and completeness
- Monitoring of the patient's response to medication and adjustment of treatment as needed
- Education of the patient and caregivers on medication management and potential side effects
Collaboration with Healthcare Team
Collaboration with the patient's healthcare team, including the primary care physician, nephrologist, and other specialists, is essential to ensure comprehensive care.
- Regular communication with the healthcare team to ensure coordination of care and management of the patient's complex health needs
- Collaboration with the patient's healthcare team to develop and implement a care plan that addresses the patient's unique needs and goals
- Referral to specialists as needed, such as a nephrologist, to ensure the patient receives comprehensive care 3