Mrs. J Case Study
Question
Assessment Description
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.
Evaluate the Health History and Medical Information for Mrs. J., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Subjective Data
Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is "running away."
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.'s situation. Include the following:
-Describe the clinical manifestations present in Mrs. J.
-Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
-Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
-Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
-Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients' transition to independence.
-Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
-Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.'s current and long-term tobacco use, discuss what options for smoking cessation should be offered.
You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Top level essay Service
Our professional unemployed professors are waiting for your signal to offer you the best academic writing service you so deserve.
Solution
Mrs. J Case Study
The clinical manifestations of Mrs.
J
Productive
cough
Fever
Nausea
Malaise
BP 90/58
Decreased
breath
Blood
accompanied sputum
Oxygen
saturation 82%
Appropriateness of the provided
nursing Interventions
IV
furosemide was one of the nursing interventions provided during the admission.
Clinically, IV furosemide is used to treat edema (fluid retention) that mainly
results from preexisting medical conditions such as cardiac complications and
pulmonary diseases (Vera, 2019). From the case study, it is evident that Mrs. J
experienced cardiac complications and several pulmonary issues, and therefore
the administration of IV furosemide is appropriate.
Enalapril
is also among the provided nursing interventions. Enalapril medication is
mainly used in the treatment of blood pressure and to reduce hypertension.
Evidently, from Mrs. J's clinical assessment provided, Mrs. J suffers from
hypertension and obstructive heart failure (Vera, 2019). Therefore, the
medication appropriately alleviates Mrs. J of her cardiac and hypotensive pain.
Metoprolol
medication is used in the treatment of high blood pressure. The medications are
also used in the clearing of obstructed veins and are effective in reducing the
workload provided to the heart and the arteries as far as the pumping mechanism
of the heart is concerned (Vera, 2019). It is, therefore, an appropriate nursing
intervention.
IV
morphine effectively alleviates chronic pain that mainly records 1-2 in the
pain recording scale. IV morphine is among the provided nursing intervention
for the provided condition. This medication is a wrong intervention considering
Mrs. J's medications also possess a pain-alleviating effect (Vera, 2019). The
medication is therefore inappropriate.
A
short-acting bronchodilator is also a provided nursing intervention.
Bronchodilators or by reducing clogging within the bronchioles to facilitate
easier aeration. Mrs. J is hypoxic, and bronchial clogging is the reason for
such. Implementation of bronchodilators is critical in improving aeration and
alleviating the hypoxia that she experiences (Vera, 2019). A short-acting
bronchodilator is an appropriate intervention.
Cardiovascular Conditions that can
cause heart failure
Coronary
artery disease. Coronary Heart disease mainly manifests due to the accumulation
of fat deposits in the arteries that cause blockage. In the arteries, blood
flows under high pressure and the blockage cause blood to force its way through
the narrow lumen left by the clogged arteries. The clogging spreads to the
heart until the heart can no longer pump blood into the other parts of the body
(Mayo Clinic, 2021). The heart then collapses “heart failure”.
High
blood pressure. High blood pressure or hypertension often occurs due to
narrowed veins and arteries that make it hard for adequate blood circulation in
the body. The blood deficit creates exertion on the heart. Continuous heart
exertion results in stiff and weak heart muscles (Mayo Clinic, 2021). Weakened
heart muscles are an insinuation of a reduced pumping mechanism and heart
failure results.
Arrhythmias.
Arrhythmias is when the heart experiences uneven rhythms due to changes in the
heart tissues. The results cause uneven contraction of the lower chamber
ventricles. Since the ventricles are charged with the responsibility of pumping
blood to the other parts of the body, the uneven rhythms distract the pumping
mechanism (Mayo Clinic, 2021). Poor contraction of the ventricles means that
the heart cannot easily fill with blood, which translates to reduced pumping
and collapse.
Damage
to the heart muscles. The heart muscles are responsible for the blood pumping
mechanism into the other parts of the body (Mayo Clinic, 2021). Weakened heart
muscles result in a poor pumping mechanism. Continuous damage prevents the
pumping mechanism and heart attack results.
Nursing Interventions to reduce
polypharmacy
Encouraging
dietary and herbal preparations. Polypharmacy results from the intake of
multiple drugs to aid in managing certain pathological conditions. Implementing
herbal preparations and dietary modification can help reduce this problem
greatly. For example, Ginkgo Biloba has been embraced for its ability to solve
multiple health problems (Resnick, 2020). The herb stands for several
medications, and its implementation reduces multiple drug intake, and the
result is reduced polypharmacy.
Taking
time before providing a given dosage. The pharmacokinetics and pharmacokinetics
of some of the medications are the same. The nurses should therefore take their
time before deciding on a given prescription. The step is to ensure that
maximum considerations regarding the functionality of the drugs are adhered to
to prevent prescribing it with medication similar to its action (Resnick,
2020). Taking time will therefore reduce polypharmacy among older people.
Occasional
medical check-ups. Among older people, polypharmacy may result from reduced
functionality of the liver cells. An increase in age leads to the aging of the
cells and thus reduced functionality of the cells. The liver is charged with
detoxifying drugs in the human body, and weakened liver cell insinuates reduced
detoxification (Resnick, 2020). Occasional medical check-ups rectify any
problem, thus reducing polypharmacy among older people.
Adherence
to one’s medication. Most of the multiple du interactions leading to
polypharmacy are taking unprescribed medication or medication prescribed for
someone else (Resnick, 2020). The nurses should teach older people the
importance of adherence to one’s medication. Adherence to one’s medication can
improve the health of older people while also reducing multiple drug interactions.
Method of providing education
regarding medication
Using
patient education handouts. For the complex regimen, education handouts can
prove effective a great deal. The education handouts contain details of a given
drug, the methods of intake and the ethical considerations of the medications,
such as effects. While considering the use of educational handouts, the
information in the handouts should be a republic and simple and should consider
a comic format (Jeannette, 2019). The nurses implementing this strategy should
take the older people through the main points before allocating them to the
patients. Researches reveal that implementation of the strategy is a method of
education. The method can therefore reduce hospital readmissions.
Relying
more on visuals. According to the visual teaching alliance for the gifted, 65%
of the global population are visual learners. We tend to remember what we
visually witnessed rather than what we heard. The same example is practical for
older people. Older people tend to remember what they see rather than what they
hear (Jeannette, 2019). The information about the medication needs to be
provided in visual images and given to them as they are taught. Implementing
this strategy allows the information to sink, thus preventing occasional
hospital readmission.
COPD triers that can increase the
frequency of further returns
Smoking
leads to the accumulation of nicotine on the bronchial walls. Increased
nicotine on the walls obstructs oxygen intake through the pulmonary vein.
Continuous smoking permanently obstructs the pulmonary vein opening into the
blood vessels leading to Chronic obstructive pulmonary disease. For the case of
Mrs. J, Nicotine replacement therapy is the best cessation remedy for this
patient. Bupropion medication can also be a pharmacological idea to stop
smoking.
References
Jeannette. (2019). Counseling COPD Patients on Smoking
Cessation on Every Visit. Contemporaryclinic. https://www.contemporaryclinic.com/view/counseling-copd-patients-on-smoking-cessation-on-every-visit
Mayo Clinic. (2021, July
21). Heart Failure - Symptoms and Causes.
Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
Resnick, R. (2020, March
24). 7 Methods to Improve Medication
Compliance Education. Blog.cureatr.com.
https://blog.cureatr.com/7-methods-to-improve-medication-compliance-education
Vera, M. (2019, August
21). Heart Failure Nursing Care Plans: 15
Nursing Diagnosis - Nurseslabs. Nurseslabs.
https://nurseslabs.com/heart-failure-nursing-care-plans/
About Author
Tough Essay Due? Hire Tough Essay Writers!
We have subject matter experts ready 24/7 to tackle your specific tasks and deliver them ON TIME, ready to hand in. Our writers have advanced degrees, and they know exactly what’s required to get you the best possible grade.
Find the right expert among 500+
We hire Gradewriters writers from different fields, thoroughly check their credentials, and put them through trials.
View all writers