Dr. Danilo Ocampo is a 74-year-old retired pathologist. He lives in his home with Lydia, his wife of 51 years.

QUESTION

Dr. Danilo Ocampo is a 74-year-old retired pathologist. He lives in his home with Lydia, his wife of 51 years. Their only child, a son, was killed at age 22 in an automobile crash. Dr. Ocampo was born and raised in the Philippines and came to the United States when he was 23. He is the last living member of his immediate family. He has a few nephews and nieces in the Philippines, but no relatives live nearby.

Dr. Ocampo’s health has been declining for the past few years. He has a medical history that includes hypertension, myocardial infarction, angina, and heart failure. Because of these cardiovascular disorders, he takes multiple medications, including metoprolol, lisinopril, furosemide, clopidogrel, atorvastatin, aspirin, and nitroglycerin. Dr. Ocampo understands the pharmaceutical properties of the medications. At times, he is doubtful of the quality of healthcare he receives because of all the medications he has been prescribed. He often does not believe the medications are helpful because he experiences many side effects, and he has been readmitted to the hospital multiple times. Dr. Ocampo usually feels better after a few days in the hospital but typically checks himself out of the hospital before his physicians are ready to discharge him.

Because Lydia has dementia, most of Dr. Ocampo’s time and energy are spent managing their household and taking care of her. He has been resistant to outside help, believing he can care for better than anyone else. Dr. Ocampo maintains a consistent schedule, and he and his wife get along quite well. Although at one time in their lives they were very socially active, at this point, they rarely go out.

Dr. Ocampo has become increasingly short of breath and is very fatigued. He notices his legs have become edematous. He goes to the neighborhood drugstore to use the “self-serve” blood pressure machine and finds his blood pressure to be 152/106 mmHg. Dr. Ocampo is resistant to the idea of seeing his physician or going to the ED for fear of being admitted. Instead, he increases the dose of furosemide and lisinopril by one tablet per day and tries to get a bit more rest. A week later when his symptoms fail to improve and seem to worsen slightly, Dr. Ocampo visits his HCP’s office and reports his symptoms and increase in medication dosages.

What are the priorities of care for this patient? (List  3)

What data would you collect from Dr. Ocampo on initial examination?

Create 2 smart goals for this patient- 1 should be long term and 1 should be short term.

What are 4 nursing interventions for this patient? These should be in priority and address your goals above.

ANSWER

Priorities of Care for Dr. Danilo Ocampo

Cardiovascular Stability: Given Dr. Ocampo’s history of cardiovascular disorders and his current symptoms of shortness of breath, fatigue, and edema, the immediate priority is to stabilize his cardiovascular condition. Uncontrolled hypertension can lead to complications such as worsening heart failure or stroke, emphasizing the need to manage his blood pressure.

Medication Management and Adherence: Dr. Ocampo’s doubts about the effectiveness of his medications and his tendency to adjust dosages on his own are concerning. Ensuring proper medication management and adherence is crucial to prevent adverse effects, hospital readmissions, and potential complications associated with cardiovascular disorders.

Comprehensive Assessment and Care Planning: A holistic assessment is needed to understand the overall physical, emotional, and social well-being of Dr. Ocampo. Given his caregiving responsibilities for his wife Lydia and his social isolation, a care plan that addresses not only his medical needs but also his emotional and social needs is essential.

Data Collection on Initial Examination

Vital Signs: Blood pressure, heart rate, respiratory rate, and oxygen saturation to assess cardiovascular stability.
Physical Examination: Assess for signs of heart failure exacerbation, such as pulmonary congestion, peripheral edema, and jugular venous distention.
Medication Review: Collect information about current medication regimen, dosages, and any self-adjustments made by the patient.
Symptom Assessment:Obtain details about the severity, duration, and progression of shortness of breath, fatigue, and edema.
Social Support and Mental Health: Assess Dr. Ocampo’s caregiving responsibilities, social activities, emotional well-being, and any signs of caregiver burnout.

SMART Goals for Dr. Ocampo

Short-term Goal (1-2 weeks): Reduce blood pressure to within the target range of 130/80 mmHg through proper medication management and lifestyle modifications, as evidenced by consecutive blood pressure readings within the desired range.
Long-term Goal (3-6 months): Improve Dr. Ocampo’s overall quality of life and well-being by implementing strategies to manage caregiver stress and social isolation, leading to increased engagement in social activities and enhanced emotional health.

Nursing Interventions for Dr. Ocampo

Immediate Blood Pressure Management: Administer prescribed antihypertensive medications as per the healthcare provider’s instructions and monitor blood pressure regularly to ensure it stays within the desired range.
Medication Education and Adherence: Engage in patient education to address Dr. Ocampo’s concerns about medication effectiveness and side effects. Emphasize the importance of following prescribed dosages and the potential risks of self-adjustments.
Collaborative Care Planning: Work with Dr. Ocampo, his healthcare provider, and other interdisciplinary team members to create a comprehensive care plan that considers his medical, emotional, and social needs. Include strategies to manage caregiver stress and promote social engagement.
Regular Follow-up and Monitoring: Schedule regular follow-up appointments to assess Dr. Ocampo’s progress, adjust medications as needed, and evaluate the effectiveness of interventions. Monitor his blood pressure, symptoms, and emotional well-being.

Conclusion

Prioritizing cardiovascular stability, medication management, and holistic care planning are key components in addressing the complex needs of Dr. Danilo Ocampo. By implementing evidence-based nursing interventions and setting SMART goals, the healthcare team can work collaboratively to improve his health outcomes, enhance his overall well-being, and provide comprehensive care tailored to his unique circumstances.