Case Study: Mrs. J
Question 1
In 200-250 words, Discuss what resources are often necessary for nonacute care for cardiorespiratory issues. Explain how they support patient independence and decrease readmission.
Question 2
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
1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. 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.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:
1. Describe the clinical manifestations present in Mrs. J.
2. 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.
3. 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.
4. 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.
5. 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.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
7. 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.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite.
CASE STUDY: MRS J 8
Case Study: Mrs J
Name
Institutional Affiliation
Date
The clinical manifestation of Mrs. J
The symptoms presented by Mrs. J is an indication that she might be suffering from chronic obstructive pulmonary disease (COPD) and high blood pressure. Some of the pieces of evidence or symptoms pointing out to these two conditions are due to the rise in temperature, productive cough, malaise, and nausea. The patient is having a reduced ADL ability and requires support from other people. The patient is emotionally affected due to the worry about her condition and is becoming much concerned that she might die soon. She is having a problem with getting adequate air, an indication that she might also be suffering from the asthmatic attack. She is experiencing headaches, dizziness, and nose bleeding as a result of not being able to have food. The patient foot, leg, and ankles are swollen and this is due to the inadequate supply of air into the body tissues (Alqahtani et al., 2020).
Discussion on whether nursing interventions at her time of admission were suitable and the reason for each medication
The key important aspect in the diagnosis of the patient is the performance of the assessment i.e. both subjective and objective data. Before the admission of the patient, it was necessary to assess the patient to determine the type of problem that she was experiencing. The performance of the systematic health assessment was important towards the development of a suitable cure since the patient had some heart problems. The assessment in this case could have been important in the identification of the causative factors, the associated risk factors, the current clinical status, the aggravating factors, and the quality of life. The head to toe assessment of the patient’s health is important in this situation since it helps in the detection of the abnormalities (Batelaan et al., 2016).
The patient is provided with the Lasix to help in dealing with the fluid overload to help in the improvement of the adequate supply of the extracellular fluid that helps in the generation of the circulatory overload and increase in the mean artery pressure. The intravenous morphine sulfate is prescribed to help in the relaxation of the respiratory. Metoprolol help in the reduction in the pumping rate of the heart and the possibility of tachycardia development. Enapril is prescribed to help in increase in the supply of oxygenated blood into the heart (Alqahtani et al., 2020).
The four cardiovascular conditions that are likely to cause heart failure the medication or nursing intervention to prevent such developments
Diabetes is one of the cardiovascular conditions linked to heart failure. Diabetes is exposing individuals to high LDL cholesterol and insufficient HDL cholesterol. It causes biochemical and molecular changes thus leading to diastolic dysfunction. This condition is prevented by following the guideline son diabetes management and proper insulin medication. Dyslipidemia is associated with a high level of LDL and insufficient HDL cholesterol. This exposes individuals to heart failure as a result of the blockage of the blood vessels. Engagement in physical activities helps in burning unhealthy and excess fats in the body (Alqahtani et al., 2020).
Atherosclerosis causes the narrowing of the blood vessels and exposing individuals to diabetes and a high level of cholesterol. The disease results in poor flow of blood into the heart hence hardening of the heart and exposing individuals to heart failure. The prevention approaches are targeted at salt reduction intake and engaging in exercise to reduce weight gain. The risk for the development of heart failure is also associated with sleep apnea. This condition leads to the stoppage of breathing for about five-time every hour. The condition is caused by obesity and this exposes individuals to the closure of the airways thus leading to breathing difficulties. This condition is prevented through having regular physical exercise and healthy nutrition (Mantoani et al., 2016).
The nursing interventions that can help in the prevention of the problems associated with multiple drug interaction in elderly patients
Polypharmacy is a term used to describe a situation where there is an intake of multiple medications in managing health problems. The prevention of polypharmacy can be achieved through ensuring that there are accurate lists of the medications i.e. the dosing frequencies, reasons for the medication, the dosages, and the brand or generic names. Another approach is ensuring that there is close monitoring through ongoing communication with healthcare providers. The patients must also be informed about the side effects of multiple medications (Higginson & Parry, 2018).
Health promotion and restoration teaching plan for Mrs. J and how rehabilitation resources and modifications are helpful to the transition and independence of the patient
The condition of Mrs. J can be linked to some of the triggers that are either present in her environment or her behavior. Therefore, the patient, in this case, is educated on the importance of avoiding some triggers for example the behavior to ensure that she remains healthy. The patient is advised to take part in physical activities or exercise to reduce the risk of having a healthy weight and excess fats in the body. The patient provided with the dietary steps to help in ensuring that the required meals are taken to ensure that the condition is managed effectively. The patient is taught on the importance of avoiding the smoking habit. The patient is also advised to follow the prescriptions as indicated by the healthcare provider (Demeyer et al., 2017).
The method of providing education to Mrs. J concerning the medications to help in maintaining health
The teaching program will involve the use of the teach-back to help in assessing the understanding of the patient concerning her health and some of the control measures. The patient is involved in a brainstorming teaching process by being asked to mention some of the recommended proposals in making improvements in her health condition. The method is important in ensuring that the patient is adhering to the proposed guidelines in managing her condition (Baker & Fatoye, 2019).
The COPD triggers
One of the potential triggers is the smoking habit since Mrs. J is using tobacco. Therefore the patient is advised to stop the smoking habit by informing her about some of the consequences or health complications associated with tobacco use. In this case, cognitive-behavioral therapy would be helpful since it improves the cognition of the patient to change the behavior. The patient is also advised to avoid exposure to heavy air pollution to prevent any complication that might exacerbate the condition (Higginson & Parry, 2018).
References
Alqahtani, J. S., Oyelade, T., Aldhahir, A. M., Almehmadi, M., & Alqahtani, A. S. (2020). Prevalence, severity, and mortality associated with COPD and smoking in patients with COVID-19: a rapid systematic review and meta-analysis. PloS one,, 1(5), e0233147. doi.org/10.1371/journal.pone.0233147
Baker, E., & Fatoye, F. (2019). Patient perceived impact of nurse-led self-management interventions for COPD: a systematic review of qualitative research. International Journal of Nursing Studies, 91, 22-34. https://doi.org/10.1016/j.ijnurstu.2018.12.004
Batelaan, N. M., Seldenrijk, A., Bot, M., van Balkom, A., & Penninx, B. (2016). Anxiety and new onset of cardiovascular disease: critical review and meta-analysis. The British journal of psychiatry, 208(3), 223-231. doi.org/10.1192/bjp.bp.114.156554
Demeyer, H., Louvaris, Z., Rabinovich, A., Hopkin, N., & de Jong, C. (2017). Physical activity is increased by a 12-week semiautomated telecoaching program in patients with COPD: a multicentre randomized controlled trial. Thorax, 72(5), 415-423. doi.org/10.1136/thoraxjnl-2016-209026
Higginson, R., & Parry, A. (2018). Managing chronic obstructive pulmonary disease in the community setting. British journal of community nursing, 23(1), 6-12. doi.org/10.12968/bjcn.2018.23.1.6
Lahman, A., McDonald, C., & Holland, A. E. (2016). Exercise training alone or with the addition of activity counseling improves physical activity levels in COPD: a systematic review and meta-analysis of randomized controlled trials. International Journal of Chronic Obstructive Pulmonary Disease, 11, 3121. doi.org/10.2147/copd.s121263
Mantoani, L. C., Rubio, N., McKinstry, B., MacNee, W., & Rabinovich, R. A. (2016). Interventions to modify physical activity in patients with COPD: a systematic review. European Respiratory Journal, 48(1), 69-81. DOI: 10.1183/13993003.01744-2015
Read Chapter 1 in Pathophysiology: Clinical Applications for Client Health.
URL:
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/pathophysiology_clinical-applications-for-client-health_1e.php
Explore the Global Initiative for Chronic Obstructive Lung Disease (GOLD) website.
URL:
Read “Patient Perceived Impact of Nurse-Led Self-Management Interventions for COPD: A Systematic Review of Qualitative Research,” by Baker and Fatoye, from International Journal of Nursing Studies (2019).
URL:
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S002074891830258X
Read “Severe Asthma in Primary Care: Identification and Management,” by Trevor and Chipps, from American Journal of Medicine (2018).
URL:
https://www.amjmed.com/article/S0002-9343(18)30024-X/fulltext
Read “Acute Myocardial Infarction,” by Reed, Rossi and Cannon, from The Lancet (2017).
URL:
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0140673616306778
Read “A Nursing Care of Patients After Cardiac Arrest in the Course of Myocardial Infarction,” by Kaminska and Krzeminska, from Journal of Education, Health and Sport (2018).
URL:
https://doaj.org/article/39ac6a139c46478997596aa30cf17811?