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Posted: June 14th, 2023
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 subjective and objective clinical manifestations present in Mrs. J.
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?
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?
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.
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.
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.
You are required to cite a minimum of three 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.
Clinical Manifestations Present in Mrs. J.
Mrs. J. presented with several subjective and objective clinical manifestations. Subjective data revealed that she was anxious, had difficulty breathing, felt like her heart was racing, and was exhausted, which prevented her from eating or drinking by herself. Objective data showed that Mrs. J. had a fever, productive cough, nausea, malaise, crackles in her lungs, decreased breath sounds in the right lower lobe, coughing frothy blood-tinged sputum, and bilateral jugular vein distension. She also had a ventricular rate of 132 and atrial fibrillation, which were detected by initial cardiac monitoring. Additionally, Mrs. J. had distant S1, S2, and S3 sounds present, and her PMI was faint, and all peripheral pulses were 1+. Finally, her blood pressure was 90/58, and her oxygen saturation was at 82%.
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Cardiovascular Conditions and Interventions to Prevent Heart Failure
Mrs. J. has a history of hypertension, chronic heart failure, and COPD, which puts her at risk for several cardiovascular conditions that may lead to heart failure. These conditions include coronary artery disease, atrial fibrillation, valvular heart disease, and cardiomyopathy. To prevent the development of heart failure in these conditions, medical/nursing interventions should include lifestyle modifications such as smoking cessation, a low-sodium diet, exercise, weight management, and medication management. Medication management includes medications such as angiotensin-converting enzyme inhibitors (ACE inhibitors) and beta-blockers, which are used to manage hypertension and heart failure. Anticoagulants such as warfarin or direct oral anticoagulants may be used to manage atrial fibrillation. In cases of valvular heart disease or cardiomyopathy, surgical interventions such as valve replacement or implantation of a ventricular assist device may be necessary.
Evaluation of Nursing Interventions at Admissions and Prevention of Readmission
The nursing interventions provided to Mrs. J. at admissions were beneficial to stabilize her condition. The use of IV furosemide (Lasix) and Enalapril (Vasotec) helped manage her hypertension and heart failure, and the use of Morphine and inhaled bronchodilators helped manage her respiratory distress. In addition, providing oxygen through nasal cannula at 2L/NC helped improve her oxygen saturation levels. However, the lack of medication adherence by Mrs. J. could have been addressed earlier to prevent the development of acute decompensated heart failure and acute exacerbation of COPD. Therefore, nursing interventions could be focused on medication management and education to improve medication adherence and prevent readmission.
Evaluation of Medications and Nursing Interventions to Prevent Drug Interactions
The medications administered to Mrs. J. include IV furosemide (Lasix), Enalapril (Vasotec), Metoprolol (Lopressor), IV morphine sulfate (Morphine), inhaled short-acting bronchodilator (ProAir HFA), and inhaled corticosteroid (Flovent HFA). IV furosemide (Lasix) is a loop diuretic that helps remove excess fluid from the body to manage hypertension and heart failure. Enalapril (Vasotec) is an ACE inhibitor that helps lower blood pressure and improve heart function. Metoprolol (Lopressor) is a beta-blocker that helps manage hypertension and heart failure. IV morphine sulfate (Morphine) is a potent opioid that helps manage pain and respiratory distress. Inhaled short-acting bronchodilator (ProAir HFA
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