Case Study: 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

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Introduction:

Mrs. J is a 63-year-old woman with a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease. She has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD. In this critical thinking essay, we will evaluate the health history and medical information of Mrs. J and formulate a conclusion based on our evaluation. We will also answer specific questions related to her health status, including subjective and objective clinical manifestations, cardiovascular conditions, nursing interventions, medication explanation, health promotion, smoking cessation, and COPD triggers.

1. Describe the subjective and objective clinical manifestations present in Mrs. J.

The subjective clinical manifestations reported by Mrs. J include anxiety, shortness of breath, the feeling of the heart “running away,” exhaustion, and inability to eat or drink. The objective clinical manifestations observed in Mrs. J include fever, productive cough, nausea, malaise, crackles in the lungs, decreased breath sounds, coughing frothy blood-tinged sputum, SpO2 of 82%, distant S1, S2, S3, ventricular rate of 132, atrial fibrillation, hepatomegaly, and bilateral jugular vein distention.

2. Describe four cardiovascular conditions in which Mrs. J is at risk, and that may lead to heart failure. What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions?

Mrs. J is at risk of developing heart failure due to hypertension, chronic heart failure, chronic obstructive pulmonary disease, and smoking. To prevent the development of heart failure in each of these conditions, medical/nursing interventions such as lifestyle modifications, medication management, and patient education can be implemented. For hypertension, medication adherence, salt intake reduction, and regular exercise can be helpful. For chronic heart failure, medication management, daily weight monitoring, and symptom monitoring can be beneficial. For chronic obstructive pulmonary disease, smoking cessation, bronchodilator therapy, and oxygen therapy can improve outcomes. And for smoking, smoking cessation counseling and nicotine replacement therapy can be effective.

3. By following the nursing process, were the interventions at the time of admissions beneficial for Mrs. J? Would you change any of the interventions to ensure patient independence and prevent readmission?

Based on the information provided, the interventions at the time of admission were beneficial for Mrs. J. However, additional interventions such as patient education on medication adherence, smoking cessation counseling, and pulmonary rehabilitation could be implemented to ensure patient independence and prevent readmission.

4. Explain each of the seven medications listed in the scenario above. Include the classification, the action, and the rationale for each of these. 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.

The seven medications listed in the scenario are Furosemide (Lasix), Enalapril (Vasotec), Metoprolol (Lopressor), Morphine Sulphate (Morphine), ProAir HFA (short-acting bronchodilator), Flovent HFA (corticosteroid), and Oxygen. Furosemide is a loop diuretic that increases urine output and reduces fluid accumulation. It is used to treat fluid overload in heart failure patients. Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that lowers blood pressure and improves heart function. It is used to treat heart failure. Metoprolol is a beta-blocker that decreases heart rate and blood pressure. It is used to treat heart failure and hypertension. Morphine is an opioid analgesic that relieves pain and anxiety. It is used to treat severe pain associated with heart failure exacerbation. ProAir HFA and Flovent HFA are both used to treat COPD by opening airways and reducing inflammation. Oxygen is used to treat hypoxemia.

Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients include medication reconciliation, regular medication reviews, patient education on medication adherence and purpose, and collaboration with healthcare providers. Medication reconciliation ensures that the patient’s current medications are accurately recorded and reviewed. Regular medication reviews involve the evaluation of medication regimens for possible drug interactions, adverse effects or modifications. Patient education on medication adherence and purpose ensures that patients understand their medications and are taking them as prescribed. Collaboration with healthcare providers involves communication with the prescriber, pharmacist, or other healthcare providers to identify or prevent medication-related problems. These interventions can prevent medication-related complications such as adverse effects, hospital readmissions or death.

5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence and prevent readmission.

A health promotion and restoration teaching plan for Mrs. J includes patient education on smoking cessation, medication adherence, symptom monitoring, diet modification, and daily weight monitoring. Smoking cessation counseling with nicotine replacement therapy can be provided to help Mrs. J quit smoking. Patient education on medication adherence, medication purpose, and side effects can be provided to improve medication compliance. Symptom monitoring can be encouraged to detect the early signs of exacerbation. Diet modification can be recommended to limit salt and fluid intake while adhering to a heart-healthy diet plan. Daily weight monitoring can be recommended and communicated to her healthcare provider. Multidisciplinary resources such as pulmonary rehabilitation, cardiology, and social work services can be provided to Mrs. J for rehabilitation and support services. The rehabilitation resources and modifications can help Mrs. J transition to independence and prevent readmission by improving outcomes, self-management and by providing the necessary support services to achieve optimal health.

6. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits.

The options for smoking cessation that can be offered to Mrs. J include counseling, nicotine replacement therapy, and prescription medication. Counseling can help Mrs. J modify her behavior and beliefs surrounding smoking. Nicotine replacement therapy can help her quit smoking by reducing nicotine urges and withdrawal symptoms. Prescription medication such as bupropion or varenicline can help her quit smoking by reducing cravings and the pleasurable effects of smoking. COPD triggers that can increase exacerbation frequency include respiratory infections, air pollution, cold temperature, high humidity, allergens, irritants, and stressors. Avoiding these triggers can reduce the risk of exacerbation and improve COPD symptoms, as well as prevent return visits to the hospital.