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.
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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/
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