Case Study: Mrs. J.
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
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.
- 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.
- 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.
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.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
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Expert Answer and Explanation
Mrs. J Case Study
RN-BSN prepared nurses should be ready to have an enhanced understanding of the different pathophysiological processes of disease, where they should be in a position to attend to patients who affect them across the lifespan. One of the disease conditions where nurses are expected to practice holistic care by applying the understanding of these pathophysiological processes is Chronic Obstructive Pulmonary Disease (COPD) (Fitzsimmons et al., 2016). This condition is often caused by long-term exposure to irritants such as smoke. Mrs. J. a 63-yr-old married woman, presents to the facility with acute exacerbation of COPD and decompensated heart failure. The nurse practitioner should perform specific interventions that guide her in managing the condition throughout her lifespan.
Clinical Manifestations Present in Mrs. J
Part of the objective data that shows the extent to which Mrs. J. is sick is that she feels anxious, asking whether she is going to succumb to the illness. Though she denies pain, she says she has trouble getting enough air. She also has troubles with her activities of daily living (ADL), and even walking for short distances requires assistance. Among some of the symptoms that Mrs. J presents is having a productive cough, fever, malaise, and nausea.
Appropriateness of Mrs. J’s Nursing Interventions at the time of Admission
The interventions administered to Mrs. J upon her admission to the facility are appropriate, and are enough to help her to at least recover to a normal life. The IV morphine sulphate given helps to solve her symptoms of pain, and help also to focus her mind so that she does not pay too much to the suffering she is facing. The two inhalants give, the short-acting bronchodilator (ProAir PFA) and the Inhaled Corticosteroid help her to improve the movement of air in her airways. Also, oxygen is delivered to her at 2L/NC, and this helps in ensuring her body systems, including that of the vital organs such as the brain, remain functional (Fitzsimmons et al., 2016). However, the therapy could be even better if it included more non-medicinal activities such as interviews to ease the tensions she notably has.
The Four Cardiovascular Conditions that Could Lead to Heart Failure and their Nursing Interventions
Myocardial infarction is one of the major conditions that can directly result in heart failure. This condition occurs when an artery that supplied blood to muscles of the heart is blocked. When blood supply to the heart is cut off, it means that nutrients and oxygen can no longer pass to the heart. The contraction and relaxation of the heart becomes faulty, and hence leading to the inability of the heart to function well (Anderson & Morrow, 2017). People with a past heart attack are at greater risk of the condition. One of the nursing interventions of myocardial infarction is giving the affected patient vasodilators that help to ease any tension in the heart muscles that could otherwise lead to blockage. High blood pressure is another condition that can easily result to heart failure. Under this condition, the heart pumps blood at a very high rate and the heart chambers could end up getting larger and weaker. The nursing intervention for the same is giving medications that reduce heart pressure to at most 130/80mmHg.
The third condition that could lead to heart failure is coronary artery disease. Under this condition, fat and cholesterol deposits build up on the walls of the heart (atherosclerosis), and the result could be immediate heart attack (Braunwald, 2016). The nurse intervention for coronary artery disease is reducing the concentration of LDLs in the blood. The fourth condition that puts someone at great risk of heart failure is endocarditis, which is an infection of the heart valves, and in some cases it can be a condition present from birth. In this condition, the valves have trouble opening and closing, and the heart results in pumping blood at a higher rate to achieve the same effect. Though surgery is the only sure way of correcting the condition, nurses can help to control the symptoms, which in a large way helps to maintain the patients’ emotional state at the right levels and hence preventing a possible heart attack.
Nursing Interventions to Prevent Problems of Multiple Drug Interactions
Among the most efficient methods of preventing problems associated with polypharmacy, such as multiple drug interactions, is keeping a careful track of the side effects. Also, the nurse should help the patient with information of what food should not be taken with specific drugs (Siddarama et al., 2019). Most importantly, they should ensure clarity in giving directions for each of the drugs.
Health Promotion and Restoration Teaching Plan
In the health promotion plan of restoring the health of Mrs. J, she should be educated about the condition she faces, and how the medication given helps in the control. Also, she should be given some of the modifications that may be necessary for her to gain her normal living. These include things such as support of walking sticks and wheelchair until she is able to walk by herself.
How Rehabilitation Resources will contribute to Patient’s Transition to Independence
One of the reasons why the patient is facing the condition is that despite warning from doctors, she has been smoking cigarettes for the past forty years. The rehabilitation resources will help her to reduce her dependence on these drugs and to assume a normal life without using drugs (Weldam et al., 2017). These resources will also help her transition to independence as they will help her to be in more control of her thoughts and actions.
Method of Educating Mrs. J to Prevent Future Hospital Admission
The best method of educating Mrs. J to prevent future hospital admission is using a home nurse, who helps her to perform various activities that build on her knowledge of taking care of her condition. This nurse can also monitor some of the activities that Mrs. J performs and correct them on a one-on-one basis. Considering the age of Mrs. J, this method is the most efficient.
COPD Triggers that can increase Exacerbation Frequency
Bacterial lung infection is one of the COPD triggers that could increase the frequency of exacerbation. Exposure to things such as smoke, air pollution, and dust, can also lead to exacerbations of COPD (Weldam et al., 2017). Depending on the cause these COPD exacerbations can last up to 2 days.
COPD is one of the most troublesome conditions among individuals who are ageing. Some of the diseases that can lead to a heart attack include hypertension, endocarditis, myocardial infarction, and coronary heart disease. For the case of Mrs. J, the interventions given are appropriate as they help her to achieve the first step of her normalcy. The treatment plan should include procedures in which the patient can efficiently resume her ability to perform the activities of daily living. Rehabilitation is also useful for her, as it is one of the ways she can reduce her dependence on tobacco as well as adopt healthy lifestyle and eventually prevent COPD exacerbations.
Anderson, J. L., & Morrow, D. A. (2017). Acute myocardial infarction. New England Journal of Medicine, 376(21), 2053-2064.
Braunwald, E. (2016). Treatment of left main coronary artery disease. N Engl J Med, 375(23), 2284-2285.
Fitzsimmons, D. A., Thompson, J., Bentley, C. L., & Mountain, G. A. (2016). Comparison of patient perceptions of Telehealth-supported and specialist nursing interventions for early stage COPD: a qualitative study. BMC health services research, 16(1), 420.
Siddarama, R., Naidu, J. B., Joshisree, K. P., & Lakshmi, V. S. (2019). Polypharmacy induced drug interactions, adverse drug reactions (ADR) and medication errors in tertiary care South Indian hospital. Int J Pharm Sci, 5, 88-93.
Weldam, S. W., Lammers, J. W. J., Zwakman, M., & Schuurmans, M. J. (2017). Nurses’ perspectives of a new individualized nursing care intervention for COPD patients in primary care settings: a mixed method study. Applied nursing research, 33, 85-92.
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