Nursing

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.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

ANSWER

Mrs. J Case Study

Introduction

Health promotion and disease prevention focus on keeping people healthy through empowering communities and individuals to rely on healthy behaviors and make changes that will lower diseases and promote quality health. This requires environmental interventions that are structured to protect and benefit individuals’ quality of life and people’s health by preventing and addressing the root cause of illness. This paper will critically evaluate Mrs. J’s clinical condition and discuss their nursing interventions and drug medications that can help in preventing the health problems. Nurses have to be prepared to handle a range of diseases and offer personalized interventions to the patients.

Clinical Manifestations

Mrs. J a 63-year-old female who has a health history of chronic heart failure, hypertension, and chronic obstructive pulmonary disease. Mrs. J presented was complaining of a three-day history of sudden flu-like symptoms onset, including productive cough, fever, malaise, and nausea. Mrs. J has been unable to perform ADLs and needs assistance while walking short distances. She has difficulties in conducting her daily activities due to exhaustion which has gone to the extent that she cannot eat or drink by herself. Mrs. J is very anxious and keeps on asking whether she is going to die. She adds that she cannot get enough air and, like her heart, is running away since she has an uncomfortable condition, making it challenging to get enough air into the lungs.

Nursing Interventions

The various nursing interventions at the time of admission were appropriate for Mrs.J. During her stay in the ICU. She received IV furosemide (Lasix), Enalapril, Metoprolol, IV morphine sulfate, an Inhaled short-acting bronchodilator, an inhaled corticosteroid, and oxygen delivered 2L/NC. Lasix was essential in helping get rid of unwanted salt and water through urine, making it easier to control blood pressure and how the heart pumps. Enalapril was essential since it treats heart failure and high blood pressure. IV Morphine was administered to lower vascular tone, allow peripheral circulation, and relieve any discomfort.

Inhaled short-acting bronchodilator and inhaled corticosteroid were essential in relieving asthma symptoms through muscle relaxation around the airways. This allows the airways to open, thus letting the air come in and out of the lungs, thus improving breath. The oxygen prescription significantly increases the amount of oxygen getting into the lungs since the patient complained of shortness of breath and increased heart rate. All the nursing interventions played an essential role in reducing the severity of heart failure and acute exacerbation of COPD.

Cardiovascular conditions

The four common cardiovascular conditions that may lead to heart failure include myocardial infarction, coronary artery disease, hypertension, and atrial fibrillation. To prevent the development of heart failure through coronary artery disease, there are several interventions, such as lowering cholesterol levels and blood pressure. Combining a healthy diet and physical activity can reduce the chances of heart failure through coronary artery disease. The most basic interventions for atrial fibrillation include a healthy diet rich in fruits, vegetables, and plant-based foods, keeping a normal weight, not smoking, being physically active, and controlling blood pressure. Managing diabetes, blood pressure, choosing good nutrition, aiming healthy weight, and avoiding smoking are effective interventions for atrial fibrillation. To eliminate the complications of high blood pressure that lead to heart failure, moderation of alcohol intake, more physical activity, and consumption of a diet rich in vegetables, fruits, and low fat is required. All these interventions are essential in reducing the risk of heart failure that results from cardiovascular conditions.

Polypharmacy Interventions

Four interventions in multiple medications include conducting periodic medication reconciliation, maintaining an accurate medication list, educating the patient about the multiple medications, and screening tools to identify polypharmacy. For instance, collaborative medication review can enable healthcare professionals to ensure the right medication since they can compare the current medication problem with the patient’s health issue. Properly organizing medication in a list that includes the brand name, dosage, frequency, and reason for the prescribed medication enables the patient to understand why they are taking the prescribed medications (Ulley et al., 2019). Proper medication education entails reviewing the potential side effects, recognition of adverse or toxic reactions that need immediate action. The ability to review the medication can minimize the chances of polypharmacy.

Health promotion and Restoration

Mrs. J requires multidisciplinary resources for care, rehabilitation, and restoration. She needs to be educated on how she can adapt to changes in her lifestyle to improve her health status. Health education should focus on managing self-care, including monitoring vital signs, diet modification, patient lifestyle modification, administration, and coordination of care. Medication in conjunction with exercise and diet will help in the treatment of all conditions. Education and home health physical therapy will improve the overall condition and transition her independence at home.

Health Education

The Teach-back method is an essential technique of providing education to Mrs. J regarding their medications to avoid future complications and readmission. The teach-back method is a method of checking the patient’s understanding by requesting patients to state in their own words what is required regarding their health condition (Centrella-Nigro and Alexander, 2017). This confirms that the health education has been explained in a manner that the patient understands.

COPD Triggers

COPD triggers restrict breathing and lead to life-threatening complications that can increase the disease progression. COPD triggers that can lead to exacerbation frequency are caused by bacterial or viral lung infection (Viniol and Vogelmeier, 2018). They can also be triggered by being exposed to air pollution. For instance, exacerbations can occur from inhaling irritating substances in the environment or allergies. Long-term tobacco use or smoking damages the airways, air sacs, and linings of the lungs, thus triggering COPD and disease severity. A nicotine replacement therapy is essential in reducing nicotine withdrawal and makes it easier to stop using cigarettes.

Conclusion

Mrs. J has progressive cardiorespiratory conditions that require acute and ongoing treatment. Nurses play an essential role in coordinating care and helping patients to transition from hospitals into their homes. Nursing interventions for this case include controlling blood pressure, lifestyle modifications, advising the patient to quit smoking, and medication education. Healthcare providers need to focus on a care plan that improves the quality of life and health outcomes.

References

Centrella-Nigro, A. M., & Alexander, C. (2017). Using the teach-back method in patient education to improve patient satisfaction. The Journal of Continuing Education in Nursing, 48(1), 47-52.

Ulley, J., Harrop, D., Ali, A., Alton, S., & Davis, S. F. (2019). Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review. BMC geriatrics, 19(1), 1-13.

Verweij, N., Eppinga, R. N., Hagemeijer, Y., & van der Harst, P. (2017). Identification of 15 novel risk loci for coronary artery disease and genetic risk of recurrent events, atrial fibrillation, and heart failure. Scientific reports, 7(1), 1-9.

Viniol, C., & Vogelmeier, C. F. (2018). Exacerbations of COPD. European Respiratory Review, 27(147).