Community health case study

I am working in the hospital setting and I'm trying to get in the mindset of a community nurse. I am having trouble getting started with this. I am trying to brainstorm out this case study.

Use the following case to answer the questions.

Ty Evans is a 73-year-old married male living with his spouse. You are making your first home care visit with Mr. Evans since his regular nurse is on vacation. He weighs 185 lbs and is 6 ft. 3 in. He has lost 10 pounds in the past 6 weeks. He had a central venous port implanted for previous chemotherapy administration for colon cancer, but the port is not currently being used. His apical heart rate is now 110 BPM, irregular and thready, with BP 110/60. His respirations are 25/minute, which he says is his usual respiratory pattern. He denies dyspnea but admits he uses three pillows under his head to sleep. The chart indicates medical diagnoses of COPD and CVA with right hemiparesis. Medications listed are as follows: Theodur 450 mg bid po, Furosemide 40 mg bid po, Proventil 4 puffs q4h INH, Lanoxin 0.25 mg qd po, Surfak 240 mg qd po.

Focus Question:

1. What questions do you have?

You learn that Mr. Evans' last ECG two weeks ago noted Atrial fibrillation with controlled ventricular response.” He has not had a digoxin level drawn for two months. He states that he was in the hospital a year ago for congestion in his heart. His respirations are recorded as being 20-27/minute and that he frequently has sonorous wheezes on expiration in the right bronchovesicular area with crackles in the right middle lobe, which you confirm through auscultation during your assessment. The home health aid has left a note from the day before for the nurse: Patient is flushed, has loose stools, and says he's nauseated.”

Focus Question:

2. What questions would you ask the client?

3. Based on this case study, how would you compare the roles of the nurses in acute care and home health clinical settings.

I feel like he is experiencing uncontrolled afib and heart failure. I am concerned with his orthopnea. extra fluid causing his sonorous wheezes? can be possible asp pna?? history of cva could he silently asp?

and I know i need to get a dig level on him and ekg. I keep telling myself that i am not at a hospital and I am having trouble

lasix, plus surfak could cause loose stools and caused electrolyte imbalance.