Review the SPICES tool and watch the video https://hign.org/consultgeri/try-this-series/fulmer-spices-overall-assessment-tool-older-adults Consider the scenario of our patient, Millie Larsen: Millie Larsen is an 84-year-old female who lives alone in a small home. Her husband, Harold, passed away a year ago and she has a cat, Snuggles, who is very important to her. Millie has one daughter, Dina Olsen, who is 50, that lives nearby, and is Millie's major support system. Her current medical problems include: hypertension, glaucoma, osteoarthritis of the knee, stress incontinence, osteoporosis, and hypercholesterolemia. Last night she was admitted to the medical-surgical unit after being brought to the Emergency Department by her daughter following a fall and feeling lightheaded at home. Listen to the scenario from the perspective of our patient, Millie Larsen, by following the following instructions: Click the link: https://www.nln.org/education/teaching-resources/professionaldevelopment-programsteaching-resourcesace-all/ace-s/unfolding-cases/millie-larsena22fc65c-7836-6c70-9642-ff00005f0421 On the left side of the page under the box titled Millie Larsen, click expand all and listen to #1 (monologue audio file). You can refer back to #2 (monologue script) as you complete the assignment. Recognizing cues: 1. What is the important information you need to collect about Millie, some of which is based on the signs and symptoms you identify that may indicate an issue in Millie’s life that needs to be addressed? 2. What may you see in the environment that would indicate issues important to address? 3. How did the SPICES tool help you organize analysis of Millie’s story? 4. Review the following from the nursing assessment conducted on Millie. Determine what additional data you should collect and how to determine if the data is accurate. a. The nursing assistant/tech reports “the urine in the drainage bag appears to be infected”. b. Blood pressure in the right arm is 70/30 and pulse is 76 c. The nurse from the previous shift reported that the patient is refusing to eat any meals. d. The patient complains of burning on the coccyx. The nurse on the previous shift charted skin over the coccyx was intact with no red or pink areas. Analyzing cues: 1. What are Millie’s strengths? 2. What are your concerns about Millie? 3. Which of your concerns, if left unaddressed, represent potential complications that may occur? 4. Which members of the health care team would you want to contact about any aspect of Millie’s care? 5. What concerns would you address with the health care team? Prioritize hypotheses and generate solutions: 1. What are Millie’s potential complications? 2. Based on your answer from #1, what actions would you take to prevent the identified potential complications? 3. What would you do should any of your identified potential complications arise? Be specific to each complication. Take action: 1. Which actions would you expect to take given how Millie is presenting? Consider: a. Nurse-initiated interventions b. Physician-initiated interventions c. Collaborative nursing interventions Evaluate outcomes 1. How would you evaluate the success of your actions? 2. How would you determine if and/or when Millie is ready for discharge? 3. What steps should you take to prepare Millie for discharge?
