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.
Expert Solution Preview
Introduction:
Mrs. J is a 63-year-old woman with a medical history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). She was admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD. In this critical thinking essay, we will evaluate Mrs. J’s clinical manifestation, nursing interventions, and medical conditions that potentially lead to heart failure. We will also discuss nursing interventions to prevent drug interaction in older patients and a health promotion and restoration teaching plan for Mrs. J. Lastly, we will outline COPD triggers that can increase exacerbation frequency and discuss smoking cessation options for Mrs. J.
1. Describe the clinical manifestations present in Mrs. J:
Mrs. J has flu-like symptoms including fever, productive cough, nausea, and malaise. She also experiences anxiety, shortness of breath, and exhaustion. Objective data indicates irregular heart rate, respiratory crackles, decreased breath sounds, blood-tinged sputum, hepatomegaly, and low oxygen saturation. These symptoms suggest acute exacerbation of COPD and heart failure.
2. Discuss whether the nursing interventions at the time of her admission were appropriate for Mrs. J. and explain the rationale for each of the medications listed:
The medications administered to Mrs. J were appropriate for her condition. IV furosemide (Lasix) was given to reduce fluid overload, Enalapril (Vasotec) and Metoprolol (Lopressor) to control her heart failure, and IV morphine sulphate (Morphine) to alleviate pain and anxiety. Inhaled short-acting bronchodilator (ProAir HFA) and inhaled corticosteroid (Flovent HFA) were administered to manage her COPD symptoms. Oxygen delivered at 2L/ NC was given to maintain oxygen saturation. These medications were necessary to stabilize her condition and prevent complications.
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:
a) Coronary Artery Disease (CAD): Tight control of hypertension, cholesterol, and blood sugar can help prevent CAD. Medical interventions such as coronary artery bypass graft or angioplasty can improve blood flow to the heart, preventing heart failure.
b) Heart valve disorders: Early detection and management of valve disorders can prevent heart failure. Valve replacement surgery or medication can slow the progression of the disease and prevent complications.
c) Cardiomyopathy: Medications to manage hypertension, heart rate, and blood clotting can prevent heart failure in people with cardiomyopathy. In severe cases, surgery may be necessary.
d) Arrhythmia: Control of hypertension, treating the underlying cause of the arrhythmia, and use of medications or medical devices can prevent heart failure in people with arrhythmia.
4. Taking into consideration 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:
a) Medication reconciliation: It ensures that patients receive and continue the required medications while preventing the duplication of therapy.
b) Monitoring of adverse effects: Monitoring patients for adverse effects of medications and promptly reporting to healthcare providers can help prevent complications and improve patient outcomes.
c) Simplify medication regimen: Reducing the number of medications and dosages can help prevent drug interactions and improve patient compliance.
d) Patient education: Educating patients about their medications, their side effects, and importance of adherence can help prevent drug interactions and adverse outcomes.
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:
The health promotion and restoration teaching plan for Mrs. J. should include the following:
a) Smoking cessation programs: Encourage Mrs. J to stop smoking and refer to smoking cessation programs to support her.
b) Healthy lifestyle: Teach Mrs. J about heart-healthy lifestyle changes such as regular exercise, a heart-healthy diet, reducing alcohol intake, and stress reduction techniques.
c) Rehabilitation resources: Refer Mrs. J to community-based rehabilitation resources that can provide physical therapy, occupational therapy, and speech therapy.
d) Home modifications: Evaluate Mrs. J’s home environment and recommend modifications such as improving lighting, adding handrails in the bathroom, and reducing tripping hazards.
These rehabilitation resources and modifications will provide Mrs. J. with the necessary support needed to function and live independently.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale:
To provide education to Mrs. J. regarding medications, the following method should be adopted:
a) Simplify medication instructions: Simplifying medication instructions and using visuals such as pillboxes and medication charts can help Mrs. J. understand and adhere to her medication regimen.
b) Teachback method: Using the teachback method, the nurse should ask Mrs. J. to repeat instructions taught to ensure understanding and retention of information.
c) Multidisciplinary team: Involve other healthcare professionals such as pharmacists and physicians in medication education to provide a comprehensive understanding of medications.
These methods will improve Mrs. J’s adherence to medications and reduce future hospital admissions.
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:
COPD triggers that can increase exacerbation frequency include smoking, environmental pollutants, respiratory infections, and extreme weather conditions. Considering Mrs. J.’s long-term tobacco use, smoking cessation should be offered using various options such as nicotine replacement therapy, behavioral counseling, and prescription medications such as bupropion and varenicline. A multidisciplinary approach involving respiratory therapists, physicians, and social workers can provide Mrs. J. with the necessary support and resources to quit smoking.
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