before discharge she had progressed to a soft, high-carbohydrate, low-protein, low-fat diet; had all drains removed; and has regained enough strength to walk in the hall. Prior to discharge, Mr. Schliefer was given a referral to a community health agency in the small rural town where she lives.
Assessment: Mrs. Schliefer's husband and two daughters greet the community health nurse, Lee Quinn, and the door. Mrs. Schliefer is resting on the cough in the living room, wearing a housecoat. Ms. Quinn asks Mrs. Schliefer to return to bed so that she can carry out an assessment. Ms. Quinn also asks Mrs. Schliefer's family to be available to discuss Mrs. Schliefer's health cares needs so that a nursing care plan can be developed.
On assessment, Ms. Quinn finds that Mrs. Schliefer is thin and appears anxious and tired. Mrs. Schliefer states that she had lost 30 lbs (13.6 kg) in the hospital and now weighs only 102 lbs (46 kg). She is 66 inches (168 cm) tall. Her vital signs are within normal limits. Mrs. Schliefer has a well-healed upper abdominal scar and two round wounds (from drains) on each side of her abdomen. The wounds are closed but still have scabs. Her skin is cool and dry, and turgor is poor. She is alert and oriented and responds appropriately to questions. Blood glucose levels are normal. Mrs. Schliefer states that her main problems are lack of energy and lack of appetite for the low-fat diet that has been prescribed. Ms. Quinn confers with Mrs. Schliefer husband and daughters, who express concern about their ability to care for Mrs. Schliefer. They feel that although they have been taught all about the disease and how to provide care, they still are not sure they know exactly what should be done now that Mrs. Schliefer is at home.