In a 750-1000 word essay in APA format, critically evaluate the following scenario:
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.
- 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.
- 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
- 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.
Expert Solution Preview
Introduction:
This essay will critically evaluate the scenario of Mrs. J, a 63-year-old married woman with a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). The essay will discuss the clinical manifestations present in Mrs. J, evaluate the appropriateness of the nursing interventions during her admission, identify cardiovascular conditions that may lead to heart failure and suggest medical/nursing interventions for prevention, propose nursing interventions to prevent problems caused by multiple drug interactions in older patients, provide a health promotion and restoration teaching plan for Mrs. J, outline a method for educating her regarding medications, and discuss smoking cessation options considering her current and long-term tobacco use.
Clinical Manifestations:
Mrs. J presents with flu-like symptoms, including fever, productive cough, nausea, and malaise. She also experiences anxiety and expresses fear of death, feelings of air insufficiency, and a sensation of her heart “running away.” Furthermore, she reports exhaustion and difficulty in performing activities of daily living (ADLs). Objective findings reveal vital signs such as elevated heart rate, irregular heart rhythm, increased respiratory rate, low blood pressure, crackles in the lungs, decreased breath sounds, frothy blood-tinged sputum, low oxygen saturation, and hepatomegaly. These manifestations indicate an acute exacerbation of COPD and acute decompensated heart failure.
Nursing Interventions and Medication Rationale:
The nursing interventions provided during Mrs. J’s admission include intravenous furosemide (Lasix) to diurese excess fluid, enalapril (Vasotec) to reduce blood pressure and manage heart failure, metoprolol (Lopressor) to control heart rate and rhythm, intravenous morphine sulfate (Morphine) for pain relief and to reduce anxiety, inhaled bronchodilator (ProAir HFA) for bronchodilation, and inhaled corticosteroid (Flovent HFA) for anti-inflammatory effects. These interventions are appropriate because: Lasix helps reduce fluid overload in heart failure; Vasotec and Lopressor manage blood pressure and heart failure symptoms; Morphine alleviates pain and anxiety; bronchodilators and corticosteroids improve airway patency and reduce inflammation in COPD.
Cardiovascular Conditions Leading to Heart Failure:
Four cardiovascular conditions that may lead to heart failure are: hypertension, valvular heart disease, coronary artery disease (CAD), and cardiomyopathy. Hypertension can cause left ventricular hypertrophy and eventually heart failure. Valvular heart disease, such as mitral stenosis, aortic regurgitation, or mitral regurgitation, impairs proper cardiac output, leading to heart failure. CAD can result in myocardial infarction, ischemia, and subsequent heart failure. Cardiomyopathy, including dilated, hypertrophic, or restrictive types, weakens the heart muscle and impairs its ability to pump blood effectively. Prevention strategies for each condition involve early detection, lifestyle modifications, medication adherence, and timely medical interventions to address the underlying causes.
Preventing Problems from Multiple Drug Interactions:
To prevent problems caused by multiple drug interactions in older patients, four nursing interventions can be implemented. Firstly, medication reconciliation should be conducted during every healthcare encounter to ensure an accurate and up-to-date medication list. Additionally, healthcare providers should assess the patient’s cognitive function and understanding of their medications to identify potential adherence issues. A comprehensive review of the patient’s medication regimen should be performed to identify any duplications or potential drug interactions. Finally, patient education should be provided, including clear instructions on medication schedules, storage, administration techniques, and potential side effects. These interventions help minimize the risk of adverse drug events, enhance medication adherence, and promote patient safety.
Health Promotion and Restoration Teaching Plan:
Mrs. J’s health promotion and restoration teaching plan should focus on multidisciplinary resources for rehabilitation and modifications needed for her transition to independence. The plan should involve collaboration between various healthcare professionals, including nurses, physicians, respiratory therapists, and physical therapists. Rehabilitation resources may include pulmonary rehabilitation programs, cardiac rehabilitation programs, and support groups for patients with chronic conditions. Modifications needed for Mrs. J’s transition to independence may involve home modifications to improve safety and accessibility, education on energy conservation techniques, and assistive devices to aid with activities of daily living. These resources and modifications will support Mrs. J in optimizing her functional abilities, managing her chronic conditions, and enhancing her overall quality of life.
Educating Mrs. J on Medication Maintenance:
To educate Mrs. J regarding medications that need to be maintained to prevent future hospital admissions, a method involving clear communication and patient-centered teaching strategies is essential. The nurse should use plain language, provide written materials, use visual aids, and ensure adequate time for the patient to ask questions. The education should focus on medication names, dosages, administration techniques, potential side effects, and importance of adherence to the prescribed regimen. Rationale for the importance of medication maintenance should be provided, emphasizing the role of these medications in managing her chronic conditions, preventing disease progression, and reducing the risk of acute exacerbations and hospital admissions.
Options for Smoking Cessation:
Considering Mrs. J’s current and long-term tobacco use, various options for smoking cessation should be offered. These may include pharmacological interventions, such as nicotine replacement therapy (patches, gum, or inhalers), prescription medications like varenicline or bupropion, and referral to behavioral therapy or counseling. Additionally, providing resources for support groups or online communities can enhance Mrs. J’s motivation and accountability during her quit journey. Individualizing the approach to her specific needs and preferences will increase the likelihood of successful smoking cessation. Stressing the detrimental effects of smoking on Mrs. J’s respiratory and cardiovascular health can serve as a powerful motivator for change.
Conclusion:
In conclusion, the scenario of Mrs. J presents a complex clinical situation involving COPD exacerbation and acute decompensated heart failure. The nursing interventions provided during her admission were appropriate, aiming to address the underlying pathophysiology, relieve symptoms, and improve respiratory function. Preventive strategies for heart failure involve early detection and prompt management of cardiovascular conditions. Nursing interventions to prevent problems caused by multiple drug interactions in older patients include medication reconciliation, assessment of cognitive function, medication review, and patient education. A comprehensive health promotion and restoration teaching plan for Mrs. J should involve multidisciplinary resources and modifications to support her transition to independence. Educating Mrs. J on medication maintenance and options for smoking cessation are crucial components of her care plan. By addressing these aspects, healthcare providers can optimize Mrs. J’s health outcomes and enhance her overall well-being.
