Preventing Heart Failure: Case Study Essay

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Clinical Manifestations

Adequacy of first interventions, potential cardiovascular conditions leading to heart failure, nursing interventions to prevent problems caused by multiple drug interactions, health promotion and restorative teaching plan, method for providing education, copd triggers.

Mrs. J is diagnosed with chronic heart failure, associated with inadequate perfusion of organs and tissues at rest or during exertion. During exacerbation of heart failure, Mrs. J has characteristic clinical manifestations in shortness of breath with minor physical exertion, limited ability to work, coughing fits, and restlessness. Nervousness and anxiety most often serve as the first signs of exacerbation of heart failure. In addition, objective data confirm left ventricular heart failure: PMI at sixth ICS and faint, bilateral jugular vein distention. In addition to the signs of heart failure, Mrs. J has signs of exacerbation of COPD: increased breath sounds, cough with bloody sputum. In addition, a low saturation of only 82% was noted.

Among the first interventions to resolve heart failure is fast-acting diuretics. Taking Lasix blocks the transport of sodium and potassium ions, which promotes increased urine excretion. It significantly reduces pulmonary artery pressure and left ventricular filling pressure, which is necessary for heart failure patients. Taking enalapril (Vasotec) helps to lower high blood pressure. This drug is also needed to improve hemodynamics and reduce the size of the left ventricle, so its administration is also rational. Taking Lopressor is mediated by its ability to prolong its effects (about 12 hours), and since the patient has hypertension in her diagnosis, its use is necessary.

Morphine is thought to prevent pulmonary edema and reduce dyspnea in heart failure. Mrs. J complained of shortness of breath and a racing heart, so the morphine was rational, but the dose was necessary. The administration of salbutamol (ProAir HFA) is required to relieve COPD symptoms. However, given the use of Lasix, there may be a risk of low sodium levels, which will also be detrimental to the heart. Its use should be reconsidered, and a milder drug should be chosen. The use of inhaled steroids is irrational because there is no reliable data on reducing worsening cardiovascular effects (Jing, Li, & Xu, 2018). In this regard, the administration of Flovent HFA may have been a mistake and worsened the patient’s condition. The use of oxygen through nasal cannulas reduces the load on the heart, and it is rational.

Many conditions can lead to heart failure and need to be prevented. Coronary heart disease is the most dangerous condition due to a buildup of fatty deposits in the arteries. To prevent it, it is worth changing your physical activity and, at the very least, following a micronutrient-rich diet (Virani et al., 2020). Another disease is arterial hypertension, which is also prevented by diets high in potassium, calcium, and antihypertensive drugs. Myocarditis occurs due to the body’s low immune defense: viruses most often cause the disease. Nurses may recommend hardening, vaccinations (flu, polio, measles), and prevention of bad habits. Arrhythmia always poses excellent risks for heart failure because it constantly puts extra work on the heart. Prevention is possible with a normal state of the nervous system and compliance with the regime of the day.

Almost all patients over the age of 60 take multiple medications simultaneously, so nurses should educate patients and help prevent potential problems due to polypharmacy. First and foremost, patients should be educated about the drugs and the rationale for their use to avoid abuse. Second, nurses should arrange medication administration (timing and dosing) because medication sharing or unsafe storage will harm patients (Rankin et al., 2018). Third, nurses can evaluate medication interactions and monitor medication effectiveness – this avoids unnecessary medication use. Fourth, teaching patients to assess their condition will significantly reduce the risk of harmful effects.

Mrs. J has a diagnosis of CHF and COPD, so she needs a combination of diagnostic, pharmacological, and rehabilitative interventions. A multidisciplinary approach will provide the best results because it will act on several pathological factors. It is worth including physical exercises: they will increase the peak oxygen consumption rate and improve the oxidative characteristics of the skeletal muscles. Endurance training will be beneficial to spread of obstruction and improve hemodynamics (Vitacca & Paneroni, 2018). Modified techniques include Nordic walking, which stimulates normal blood flow. In addition, the most crucial part is a healthy lifestyle: quit smoking, take proper medication, and use oxygen adequately.

Education should begin with health literacy: Mrs. J is aware of her illnesses but lacks knowledge of why stopping her medications causes her condition to worsen. The nurse should write detailed instructions in plain language so that the patient understands the purpose of the drug. Visual memory will be helpful: handouts with education, prevention, and medication schedules will help them develop intuitive reflexes to take their medications correctly. Since Mrs. J has stopped taking her medication before, we need to establish her reasons: perhaps the cost or the risk of becoming addicted frightens her.

Many factors can trigger COPD exacerbation: for Mrs. J, the first such trigger is smoking. To reduce tobacco use, health care providers can explain what risks smoking stimulates: perhaps after an exacerbation, Mrs. J will take these words seriously. Group counseling would also be helpful because it would strengthen the resolve to address tobacco. Among other triggers of COPD, the most dangerous are air pollution and respiratory infections, which increase the strain on the bronchial tree.

Jing, X., Li, Y., & Xu, J. (2018). Risk of cardiovascular events associated with inhaled corticosteroid treatment in patients with chronic obstructive pulmonary disease: A meta-analysis. Canadian Respiratory Journal , 2018 , 7097540. Web.

Rankin, A., Cadogan, C. A., Patterson, S. M., Kerse, N., Cardwell, C. R., Bradley, M. C., Ryan, C., & Hughes, C. (2018). Interventions to improve the appropriate use of polypharmacy for older people. The Cochrane Database of Systematic Reviews , 9 (9), CD008165. Web.

Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., Djousse, L., Elkind, M., Ferguson, J. F., Fornage, M., Khan, S. S., Kissela, B. M., Knutson, K. L., Kwan, T. W., Lackland, D. T., Lewis, T. T., … American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee (2020). Heart disease and stroke statistics-2020 update: A report from the American heart association. Circulation , 141 (9), e139–e596. Web.

Vitacca, M., & Paneroni, M. (2018). Rehabilitation of patients with coexisting COPD and heart failure. COPD , 15 (3), 231–237. Web.

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Alicia Case Study: Mrs. J

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The work of medical staff includes assessing patient health parameters and reaching final verdicts. In this case, the choice of specific practices, diets, and exercises should be justified by the individual characteristics of the patient. The clinical picture of the disease should consist not only of biological health indicators but also psychological well-being. A patient who shows good results in the course of therapy, but is not in the mood for recovery, risks staying in the hospital room. This work aims to create an epicrisis for Mrs. J. based on her anamnesis.

The initial parameter for analysis may be Mrs. J’s heart rate, equal to 118 beats per minute. Such a rate is higher than the norm for an adult, which may be inextricably linked to rapid breathing and a sense of anxiety. Patients’ lungs are at 34 moves per minute, which is also above average. There is an increase in body temperature that can be justified as natural for a person with inflammatory processes (Miravitlles & Ribera, 2017). According to biometrical parameters, the body mass index of a woman exceeds value 31 that speaks about obesity of the first degree. The lungs do not have enough oxygen, as its maximum concentration does not exceed 82 percent. Pathologies in the lungs can hurt the heart, so medical personnel should take steps to facilitate heart attacks. The described results, along with foamy blood sputum and dilation of the jugular vein, indicate a potential presence of COPD in the patient (Miravitlles & Ribera, 2017). The overall clinical picture may be supplemented by heart failure, obesity, and arrhythmia.

The deterioration of the patient’s condition in the last three days shows the ineffectiveness of the measures applied by nurses. Mrs. Jay continued to smoke, although, in her state, it is strictly forbidden. The nurse should talk to the patient and explain the severity of the consequences of continued smoking. Given the length of time, Mrs. J. has smoked, it will be difficult for clinicians to dissuade her without effect on treatment from bad habits (Ianosi et al., 2018). To ensure that the patient’s condition does not deteriorate due to stress, it is recommended that she be offered alternative ways of delivering nicotine to the blood, such as patching. Moreover, the nurses should act as psychologists and friends for the sick person. In connection with the panic attacks observed in Mrs. J., the clinic staff should pay attention to this problem, just as they should ensure that the woman’s food and water consumption is comfortable. It should be reminded of the importance of leading a good life and following a diet, especially for her situation. Daily physical activity may include a short walk or breathing practice. The patient’s actions should be monitored at first, but over time this should become the norm for the woman. If medical rules are not followed, she smokes, becomes infected with additional infections, or overstresses, COPD risks becoming more acute.

Increasing body weight may be associated with heart failure. It is known that in pathologies of the heart, there is excess moisture and salts stored by the body. IV furosemide can quickly reduce the load on the heart by expanding veins ( Medications Used , 2017). It reduces the pressure in the pulmonary artery and the filling pressure in the left ventricle. Taking Enalapril is not the first necessity in this case, but still, it is worth pointing out that the drug promotes the regeneration of the walls of blood vessels, as well as reduces pressure and dilates the lumen of veins and arteries ( Medications Used , 2017). Metoprolol, by blocking β-adrenoceptors of the heart, reduces heart rate, depresses conductivity and excitability, and reduces contractility of the myocardium. Morphine, injected intravenously, allows quite quickly neutralize panic and pain syndrome, and, in addition, minimize cough reflexes. ProAir HFA, in the form of inhalation, relieves bronchospasm and relaxes smooth muscles. Flovent HFA acts directly on the lungs, suppressing the inflammatory process, what is especially important in COPD and asthma. Oxygen in the volume of 2L/ NC is needed to restore gas concentration in the respiratory system. At the same time, it is important to remember that the possibility of sharing drugs should be analyzed, as improperly designed medication can be harmful to health. Mrs. J has the right to refuse medication or ask for an analog, but such cases must be addressed on time. The nurse should explain to the patient the importance of taking combination medication and the harm caused by not following the instructions.

Medical staff should regularly monitor Mrs. J’s basic biophysical parameters of health. Due to low pressure and elevated temperature, these parameters should be strictly controlled. In addition, the patient should be examined daily for HR, RR, and body weight. A continuing trend in increasing body weight while on a clinical diet may be an indicator of developing heart failure. If the patient is not being cared for correctly or if the woman does not comply with the doctor’s instructions, the situation may deteriorate to the point of acute heart failure. Smoking, abnormal blood pressure, obesity, and attacks of asphyxiation may be the leading causes of the worsening situation ( Causes of heart failure , 2017). Higher or lower blood pressure does not have a positive effect on heart muscle wear, so a nurse should prescribe normalizers. The presence of excess weight forms a fat layer around the heart, preventing the free pumping of blood. For the heart to continue working usually, a woman needs to lose weight. Obesity is often the cause of asphyxiation, during which the patient can have an acute lack of oxygen.

Causes of heart failure . (2017). American Heart Association. Web.

Ianosi, E. S., Postolache, P., Macovei, L. A., Szathmary, M., Szasz, S., Nemes, R. M., & Jimborean, G. (2018). Smoking cessation in COPD patients by a selective partial nicotinic agonist. Revista de Chimie, 69 (7), 1766-1769. Web.

Medications Used to Treat Heart Failure . (2017). American Heart Association. Web.

Miravitlles, M., & Ribera, A. (2017). Understanding the impact of symptoms on the burden of COPD. Respiratory research, 18 (1), 67-78. Web.

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Pathophysiology Case Study: Mrs. J.

Type: Essay

Subject: Pathophysiology

Subject area: Nursing

Education Level : Undergraduate

Length: 4 pages

Referencing style: APA

Preferred English : US English

Spacing Option : Double

Title: Case Study: Mrs. J.

Instructions: 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 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 subjective and objective clinical manifestations present in mrs. j. 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? 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? 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. 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. 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. prepare this assignment according to the guidelines found in the apa style guide, located in the student success center.

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Pathophysiology

Course Title

Pathophysiology      

At her age (62 years), Mrs. J. has a history of hypertension and other chronic diseases. despite her health complications, she continues to smoke 2 packs of cigarettes a day which she has done for the last 40 years.  Based on the supplied facts, it is clear that Mrs. J. is going through a health crisis. She has presented a history of chronic health difficulties which has led to the deterioration of her current health. It is important to note that, her not taking medication as prescribed has exacerbated her illness. 

Because of her age and severity, she is anxious and asks whether she is going to die. Based on her continuous chronic health difficulties, she says it is difficult for her to get enough air. After developing flu-like symptoms which included fever, productive cough, nausea, and malaise, she has been unable to perform basic ADLs. Additionally, she has since been able to take her antihypertensive medications to control her heart condition for the last three days. Upon admission, she had vitals signs read; T 37.6C, HR 118 and irregular, RR 34, BP 90/58. Decreased breath within the respiratory range. 

           Following the presentation of Mrs. J, she is at risk of these four cardiovascular conditions which include; coronary heart disease, stroke, peripheral arterial disease, and aortic disease. Coronary heart disease occurs when the heart muscle is interrupted by the build-up of fatty substances which can be greatly impacted by hypertension (Green, 2020). A stroke occurs when the blood supply to the brain is disturbed. Our case has a history of heart failure which may result in a stroke. Mrs. J's inability to perform ADLs and require assistance suggests peripheral arterial disease which occurs when there is a blockage in the arteries to the limps making it difficult for the patient to locomote. The last cardiovascular condition that Mrs. J is at risk of is Aortic disease which occurs when the wall of the aorta becomes weakened and bulges outwards causing enormous pain. All these conditions may lead to heart failure. 

           Nurses in this case have the role of assessing the vital signs. They should therefore assess SPO2 and cardiac monitoring to ensure Mrs. J's respiratory returns to normal. Given the role Smoking played in the development of chronic heart conditions, smoking cessation should be a priority intervention. Therefore, to stabilize her breath, ACE inhibitors are to be used especially in this case where the patient has cases of decompensated heart failure (Longhini et al., 2022; Fuchs & Whelton, 2020). This will further decrease venous and arterial pressures which improve oxygen consumption lowering the level of vasoconstrictors and primarily aid in the stimulation of beta 1receptors within the myocardial tissue which will lead to recovery of inotropic and chronotropic sensitivity. 

           Nurses can also offer a full set analysis of vital signs and telemetry to indicate other varied interventions including the medications that are necessary to control Mrs. J’s symptoms. Considering her age and tobacco abuse, nurses need to conduct auscultation of her heart, lung field, and abdomen to not only speed up recovery processes but also determine other necessary interventions. As an intervention, they can use intravenous Lasix is a loop diuretic hence it is important because of her history of chronic heart failure and the objective presence of pulmonary crackles, decreased breath, and jugular vein distensions (Renzi et al., 2022). These objective data indicate pulmonary congestion and acute decompensated heart failure. This will manage water levels which is related to fluid overload within the chest cavity. 

           To reduce anxiety, IV morphine can be administered which will further help in decreasing breathing. Normally, when opiates are administered to patients with anxiety and stress-related issues, they improve arteriolar and venous dilation. Supplementary oxygen is also an intervention but is not advisable to patients with SpO2 levels greater than 90 because of the risk of vasoconstriction and reduction of cardiac output (Renzi et al., 2022). At the time of admission, interventions that were conducted had the priority of stabilizing his breath. Administering furosemide (lasix), morphine sulfate, and supplementary oxygen played a critical role in ensuring the patient's breathing is stable. I would not change any intervention; I would introduce one non-pharmacological intervention; resting to help Mrs. J to recover because some of the conventional drugs administered to her need to rest. 

           Furosemide is classified as a loop diuretic. It works to increase the excretion of Na+ and water by processes of the kidney and further inhibiting their reabsorption from both proximal and distal tubules and the loop of Henle (Zapata, 2021). It is therefore important for the treatment of fluid congestion due to fluid overload. Enalapril is in a class called the angiotensin-converting enzyme (ACE) inhibitors. This drug works by limiting certain chemical reactions that tighten blood vessels such that the blood flows smoothly. It is important to patients with heart failure, hypertension, and CVDs. Metoprolol is classified as a beta blocker (Zapata, 2021). Its functionality is to relax blood vessels slowing heart rate to improve blood flow. This decreases blood pressure. It is important to patients with heart failure, hypertension, and CVDs. Morphine is classified as an opiate. Its main role is to change how the nervous system perceives reception when in severe pain. It can also be used for patients with stress, anxiety, and other mental health conditions. Bronchodilators are beta-2 agonists. They are important as they dilate the lung's airways (Zapata, 2021). Often, they are used together with a type of drug known as the beta-antagonist. Corticosteroid is anti-inflammatory and is used to treat asthma among other CVDs. 

           To fully promote and restore Mrs. J’s health will require extensive support and education before being discharged from the hospital. Health education should focus on managing self-care to improve health. Understanding disease processes of heart and CVDs to maximize pulmonary hygiene to optimize lung functions. Nurses can also educate their patients on the importance of home health. Home health will improve patients to adapt to recovery optimal levels. Mrs. J's independence will therefore be merited on rehabilitative strategies including medication discipline. Tobacco cessation must be the priority determinant to ensure recovery.  

Fuchs, F. D., & Whelton, P. K. (2020). High blood pressure and cardiovascular disease.  Hypertension ,  75 (2), 285-292. 

Green, T. (2020). Polypharmacy Among Older Adults in Long Term Care Facilities.

Longhini, J., Canzan, F., Mezzalira, E., Saiani, L., & Ambrosi, E. (2022). Organisational models in primary health care to manage chronic conditions: A scoping review.  Health & Social Care in the Community ,  30 (3), e565-e588. 

Renzi, E., Baccolini, V., Migliara, G., De Vito, C., Gasperini, G., Cianciulli, A., ... & Massimi, A. (2022). The impact of eHealth interventions on the improvement of self- care in chronic patients: An overview of systematic reviews.  Life ,  12 (8), 1253. 

Zapata, F., Matey, J. M., Montalvo, G., & García-Ruiz, C. (2021). Chemical classification of new psychoactive substances (NPS).  Microchemical Journal ,  163 , 105877. 

https://www.studocu.com/en-us/document/grand-canyon-university/pathophysiology-and-nursing-management-of-clients-health/case-study-mrs-jdocx/16187853# :~:text=2695880%26Issue_ID%3D3236493-,Amakali%2C%20K.%20(2015)%20Clinical%20care%20for%20the%20patient%20with%20heart%20failure,Cardiovascular%20Pharmacology%2C%204(2),-.%20Retrieved%20from%3AAmakali, K. (2015) Clinical care for the patient with heart failure: A nursing care perspective. 

Cardiovascular Pharmacology, 4(2).

Amakali, K. (2015) Clinical care for the patient with heart failure: A nursing care perspective. 

Cardiovascular Pharmacology, 4(2)

CARDIORESPIRATORY CASE STUDY  14

Alpert, P. T., & Gatlin, T. (2015). Polypharmacy in older adults. Lippincott Nursing Center, 

33(10), 524-529. Retrieved from: https://www.nursingcenter.com/cearticle?

an=01845097-201511000-00003&Journal_ID=2695880&Issue_ID=32364

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Case Study: Mrs. J.

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 750-900 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. 6.Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence. 7. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale. 8. 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. This has a Rubric

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Treatment of Cardiovascular Diseases in the Case of Mrs. J

Smoking harms the heart and blood circulation, heightens the risk of coronary artery disease, stroke, peripheral vascular disease, and cerebrovascular disease (damaged arteries that supply blood to the brain) (Fowler & Landry, 2019). In Mrs. J’s case, the disease history shows that her condition is related to the unhealthy lifestyle that she led, including ongoing smoking. Her account of chronic heart failure, chronic obstructive pulmonary disease (COPD), and hypertension may as well be related to the fact that Mrs. J smokes and has been doing so for the last 40 years. Moreover, her condition is worsening even further, since Mrs. J has not taken the medications prescribed for her to control heart failure and antihypertensive medications for three days.

The clinical manifestations present in Mrs. J include elevated body temperature, fever, cough, nausea, and malaise. Besides, she has been very anxious about the situation and has complained about certain discomfort in the heart area. Considering all the above, the following medications were administered to control her symptoms. Lasix is applied to prevent heart failure, since it reduces pressure in the pulmonary artery, while Enalapril is used to treat Mrs. J’s arterial hypertension (Cooper & Gosnell, 2018). Consequently, Metoprolol is combined with other antihypertensive agents (Enalapril) to treat the patient’s arterial hypertension (Cooper & Gosnell, 2018). In Mrs. J’s case, Morphine is administrated to reduce the severe pain associated with coughing and shortness of breath. In order to alleviate Mrs. J’s cough and breathing troubles, inhaled short-acting bronchodilator and corticosteroid are also provided. Furthermore, Mrs. J was given oxygen to increase the blood oxygenation levels as a part of her respiratory therapy (Cooper & Gosnell, 2018). All of the nursing interventions and the drugs administrated served as an adequate measure in preventing further complications in Mrs. J’s case.

Cardiovascular diseases refer to a group of heart and blood vessel conditions that include, for example, coronary heart disease, arterial hypertension, chronic heart failure, and pulmonary hypertension, all of which can lead to a fatal outcome (Fowler & Landry, 2019). The primary manifestation of coronary heart disease is chest pain, the severity of which may vary from mild discomfort and burning in the chest area to severe pain. For secondary heart failure prevention, modern drug treatment of coronary heart disease, in addition to taking antianginal and anti-ischemic drugs, should include the use of antithrombotic, lipid-lowering drugs, ACE inhibitors and metabolic agents (Fowler & Landry, 2019). Arterial hypertension predisposes the development of cardiovascular diseases, the complications of which often lead to heart failure (Fowler & Landry, 2019). Consequently, pulmonary hypertension is a potentially lethal disease, so providing anticipatory care to prevent the further development of the disease is of priority: prompt care upon extension of pulmonary hypertension and monitoring responses to medical intervention is the primary responsibility for a nurse in such cases.

Polypharmacy may increase the potential risk of adverse effects, such as errors in administering medication and drug interactions, and it is even a more acute issue with senior patients. The role of nurses in preventing the harmful effects of polypharmacy is crucial, and the nursing interventions, in this case, should be: instructing the elderly patients, implementing informative programs, providing consultations, and organizing assistance (Cooper & Gosnell, 2018). A nurse is supposed to teach the patients about each medication (for instance, its name, effects, and appearance) and efficiently convey the dangers of polypharmacy. Additionally, nursing personnel organizes secure medication storage for a patient, for instance, to avoid sharing. Suggesting the patients to keep a list of medications and instructions is another nursing intervention that helps avoid polypharmacy.

Foremost, Mrs. J’s health promotion and restoration teaching plan would include recommendations concerning quitting smoking and the ways to achieve it, as it is one of the main damaging factors in her case. The patient’s post-stationary period rehabilitation would consist of a diet, maintaining a proper lifestyle, physical activity, taking supportive medications, and regular monitoring by specialists (Cooper & Gosnell, 2018). After inpatient treatment, physical activity should gradually increase, helping the patient to achieve more independence: walking and therapeutic exercises are considered especially useful. Mrs. J would be recommended to start with 15 minutes of physical activity per day, increasing the time by five minutes weekly, until the duration of the physical activity reaches an hour. However, a doctor should determine the number and type of exercises: excessive diligence can lead to negative results.

The question of inadequate usage of medication by patients remains a complex and urgent problem, and the issue of the patient informing quality, and the sufficiency of advisory support remains open at the moment. In Mrs. J’s case, the following aspects regarding her medication should be explained: its purpose, effects and side effects, names, warnings, and specific instructions such as food and alcohol interactions (Talbot, 2019). Nevertheless, multi-paged complicated documentation may seem overwhelming to some patients; thus, specific educational sheets may be developed, incorporating color-coding to help patients in navigating the instructions.

In order to prevent an increase in exacerbation frequency, COPD triggers should be minimized. Such substances as dust, strong odors, perfumes, aerosols, and pet fur should be avoided. In Mrs. J’s case, tobacco is another powerful trigger, which leads to the importance of her stopping smoking. Smoking cessation may be extremely difficult for Mrs. J considering the number of years that she has been doing so. Nevertheless, there are two main strategies to achieve it: nicotine replacement therapy (patches and nasal sprays) and prescribing specific medication that reduces the craving for smoking. Provided that Mrs. J improves her lifestyle and adheres to the recommendations, further hospital admission may be prevented, and her habitual life may be renewed.

Cooper K., & Gosnell K. (2018). Foundations of nursing (8 th ed.). Elsevier.

Fowler L. H., & Landry J. (Eds.). (2019). Interventions for cardiovascular disease, an issue of critical care nursing clinics of North America (vols. 1–31). Elsevier.

Talbot, B. (2019). Improving patient medication education. Nursing , 48 (5), 58-60.

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Clinical Manifestations Present in Mrs. J

Mrs. J is a 63-year-old married woman. From the medical information offered, it is clear that she has a medical history of COPD, heart failure, hypertension, and smoking. Her initial weight of 55.5kg and a height 1.75m denotes that she is obese. Moreover, the BMI acquired from the clinical condition is 21.2, which is slightly above 30.  Currently, the patient suffers from hypertension, respiratory distress, and low-grade fever tachycardia arrhythmia. There is also a sign of pulmonary edema, made worse by grave heart failure. This disorder, together with dyspnea, and tachycardia, are several of the symptomatic indications that Mrs. J may be ailing from congestive heart failure. Both HR and RR are elevated.

Nursing Interventions upon Admission

The interventions administered upon Mrs. J entail numerous medical procedures and oxygen at 2 LPM by using the nasal cannula from the case study . A review of the critical signs was also done. This includes monitoring cardiac activities and SPO2 telemetry and auscultation of her abdomen, lung fields, and heart, which may help demonstrate the other necessary interventions to regulate Mrs. J’s symptoms. With jugular vein distension, a decrease in breathing, the existence of pulmonic crackles, and an account of protracted heart failure, the management of intravenous Lasix were indispensable. According to Colucci (2018), they are revealing indicators for acute decompensated heart failure and pulmonary congestion. Enalapril, an ACE, was suitable as a result of Mrs. J’s decompensated heart failure. Moreover, another significant intervention is the Metoprolol intervention that reduces vasoconstrictors’ concentration, which includes both renin and norepinephrine.

Cardiovascular Conditions that can Course Heart Failure and Prevention of Heart Failure

Some of the cardiovascular situations that may result in heart failure if not treated, comprise hypertension and coronary artery ailment.  Other ailments may include myocardial infarction and atrial fibrillation. With these disorders, adherence to medical procedures and modification of lifestyle practices, weight loss, and averting tobacco use may significantly impact reducing the risk of heart failure. It is essential for health practitioners to guarantee that patients abide by the medical procedures and assist the patients that may require an adjustment of their lifestyle practices and educating the patients on the disease.  According to Carroll et al. (2020), one of the top-most priority for most patients ailing from heart failure should be to stop smoking. Therefore, it is essential for health practitioners to raise awareness of smoking risks on cardiovascular health.  Similarly, patients need to comprehend the link between physical activities and the diminished threat of cardiovascular disorders.

Polypharmacy and Nursing Implications

According to Custodio et al. (2015) , Polypharmacy entails numerous forms of medication by a patient and is considered a common aspect amongst the elderly. The challenges linked to this form of treatment may include failing to comply, falls, and potential multiple drug interactions.  Some of the interventions that may help prevent these challenges include patient education regarding the medication and maintenance of an appropriate list of medications.  The medication list should comprise the generic and brand names, the aims of the prescriptions, and dose to guarantee that each patient comprehends the reasons for ingesting the medicines. Whereas regular medication reconciliation aids averting medication faults, appropriate organization of the medical procedures will help improve patients’ adherence to healthy practices.

Health Promotion Strategy and Restoration Plan for Mrs. J

The patient may require wide-ranging training and backing prior to and after being discharged from the medical facility. In her stay at the medical facility, Mrs. J will be well-informed on adapting to the changing environment due to her health condition.  Also, she will obtain tips on ways of conducting a self-assessment and self-care at her residence.  A respiratory therapist may be required to continually update Mrs. J on COPD and processes a patient can undertake in the event of heart failure. There ought to be an early connection in case supervision during the admission period. This assists in evaluating the patient’s needs when released from the hospital, if she may need to proceed to a nursing home or return to her place of residence. In this case, Mrs. J may require more aid in terms of physical rehabilitation and a home-based nurse.  A home-based practitioner will help assess her health status changes and manage her medications (Mantovani et al., 2015).  Incorporating the interventions in Mrs. J’s care will help understand, gain independence, and information the significance of being compliant.

Methods for Providing Medication Education

Health practitioners are crucial in offering education to patients regarding medicine and compliance to medical practices.  One mode that may be utilized in providing education is by integrating the teach-back approach.  The nurses should consider her willingness to be taught, including psychological and physical preparedness, to sufficiently take part sessions concerning medication training. Moreover, the providers should evaluate and comprehend the patient’s health knowledge to institute an expressive and patient-centered training mechanism. The teach-back method involves requesting Mrs. J to explain what was previously expounded in their own words and the significance of the material accorded to them.

COPD Triggers

There are many causes that lead to chronic obstructive pulmonary disease (COPD). The first significant COPD trigger is smoking.  In the Nursing case study assignment , cessation of smoking should be prioritized.  Other COPD causes include breathing infections, air pollution, high humidity levels, and life-threatening weather environment. With the long smoking history, the approaches for ceasing smoking that may be suitable for Mrs. J entail behavioral and pharmacological resources. 5A’s method will help the nurses offer quality nursing care to Mrs. J, bringing an end to smoking.  The health practitioners shall evaluate the patient’s willingness to abandon the practice, provide a quitting mechanism, and organize for check-ups.

Generally, Mrs. J requires comprehensive education, recommendations, and supplementary care. She also requires support from the family and home-based assessment to guarantee medical adherence.  Presenting Mrs. J with the resources she requires shall significantly advance her quality of life, comprehend her medical condition, and explain why it is vital to sustaining her treatment.

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The state of AI in early 2024: Gen AI adoption spikes and starts to generate value

If 2023 was the year the world discovered generative AI (gen AI) , 2024 is the year organizations truly began using—and deriving business value from—this new technology. In the latest McKinsey Global Survey  on AI, 65 percent of respondents report that their organizations are regularly using gen AI, nearly double the percentage from our previous survey just ten months ago. Respondents’ expectations for gen AI’s impact remain as high as they were last year , with three-quarters predicting that gen AI will lead to significant or disruptive change in their industries in the years ahead.

About the authors

This article is a collaborative effort by Alex Singla , Alexander Sukharevsky , Lareina Yee , and Michael Chui , with Bryce Hall , representing views from QuantumBlack, AI by McKinsey, and McKinsey Digital.

Organizations are already seeing material benefits from gen AI use, reporting both cost decreases and revenue jumps in the business units deploying the technology. The survey also provides insights into the kinds of risks presented by gen AI—most notably, inaccuracy—as well as the emerging practices of top performers to mitigate those challenges and capture value.

AI adoption surges

Interest in generative AI has also brightened the spotlight on a broader set of AI capabilities. For the past six years, AI adoption by respondents’ organizations has hovered at about 50 percent. This year, the survey finds that adoption has jumped to 72 percent (Exhibit 1). And the interest is truly global in scope. Our 2023 survey found that AI adoption did not reach 66 percent in any region; however, this year more than two-thirds of respondents in nearly every region say their organizations are using AI. 1 Organizations based in Central and South America are the exception, with 58 percent of respondents working for organizations based in Central and South America reporting AI adoption. Looking by industry, the biggest increase in adoption can be found in professional services. 2 Includes respondents working for organizations focused on human resources, legal services, management consulting, market research, R&D, tax preparation, and training.

Also, responses suggest that companies are now using AI in more parts of the business. Half of respondents say their organizations have adopted AI in two or more business functions, up from less than a third of respondents in 2023 (Exhibit 2).

Gen AI adoption is most common in the functions where it can create the most value

Most respondents now report that their organizations—and they as individuals—are using gen AI. Sixty-five percent of respondents say their organizations are regularly using gen AI in at least one business function, up from one-third last year. The average organization using gen AI is doing so in two functions, most often in marketing and sales and in product and service development—two functions in which previous research  determined that gen AI adoption could generate the most value 3 “ The economic potential of generative AI: The next productivity frontier ,” McKinsey, June 14, 2023. —as well as in IT (Exhibit 3). The biggest increase from 2023 is found in marketing and sales, where reported adoption has more than doubled. Yet across functions, only two use cases, both within marketing and sales, are reported by 15 percent or more of respondents.

Gen AI also is weaving its way into respondents’ personal lives. Compared with 2023, respondents are much more likely to be using gen AI at work and even more likely to be using gen AI both at work and in their personal lives (Exhibit 4). The survey finds upticks in gen AI use across all regions, with the largest increases in Asia–Pacific and Greater China. Respondents at the highest seniority levels, meanwhile, show larger jumps in the use of gen Al tools for work and outside of work compared with their midlevel-management peers. Looking at specific industries, respondents working in energy and materials and in professional services report the largest increase in gen AI use.

Investments in gen AI and analytical AI are beginning to create value

The latest survey also shows how different industries are budgeting for gen AI. Responses suggest that, in many industries, organizations are about equally as likely to be investing more than 5 percent of their digital budgets in gen AI as they are in nongenerative, analytical-AI solutions (Exhibit 5). Yet in most industries, larger shares of respondents report that their organizations spend more than 20 percent on analytical AI than on gen AI. Looking ahead, most respondents—67 percent—expect their organizations to invest more in AI over the next three years.

Where are those investments paying off? For the first time, our latest survey explored the value created by gen AI use by business function. The function in which the largest share of respondents report seeing cost decreases is human resources. Respondents most commonly report meaningful revenue increases (of more than 5 percent) in supply chain and inventory management (Exhibit 6). For analytical AI, respondents most often report seeing cost benefits in service operations—in line with what we found last year —as well as meaningful revenue increases from AI use in marketing and sales.

Inaccuracy: The most recognized and experienced risk of gen AI use

As businesses begin to see the benefits of gen AI, they’re also recognizing the diverse risks associated with the technology. These can range from data management risks such as data privacy, bias, or intellectual property (IP) infringement to model management risks, which tend to focus on inaccurate output or lack of explainability. A third big risk category is security and incorrect use.

Respondents to the latest survey are more likely than they were last year to say their organizations consider inaccuracy and IP infringement to be relevant to their use of gen AI, and about half continue to view cybersecurity as a risk (Exhibit 7).

Conversely, respondents are less likely than they were last year to say their organizations consider workforce and labor displacement to be relevant risks and are not increasing efforts to mitigate them.

In fact, inaccuracy— which can affect use cases across the gen AI value chain , ranging from customer journeys and summarization to coding and creative content—is the only risk that respondents are significantly more likely than last year to say their organizations are actively working to mitigate.

Some organizations have already experienced negative consequences from the use of gen AI, with 44 percent of respondents saying their organizations have experienced at least one consequence (Exhibit 8). Respondents most often report inaccuracy as a risk that has affected their organizations, followed by cybersecurity and explainability.

Our previous research has found that there are several elements of governance that can help in scaling gen AI use responsibly, yet few respondents report having these risk-related practices in place. 4 “ Implementing generative AI with speed and safety ,” McKinsey Quarterly , March 13, 2024. For example, just 18 percent say their organizations have an enterprise-wide council or board with the authority to make decisions involving responsible AI governance, and only one-third say gen AI risk awareness and risk mitigation controls are required skill sets for technical talent.

Bringing gen AI capabilities to bear

The latest survey also sought to understand how, and how quickly, organizations are deploying these new gen AI tools. We have found three archetypes for implementing gen AI solutions : takers use off-the-shelf, publicly available solutions; shapers customize those tools with proprietary data and systems; and makers develop their own foundation models from scratch. 5 “ Technology’s generational moment with generative AI: A CIO and CTO guide ,” McKinsey, July 11, 2023. Across most industries, the survey results suggest that organizations are finding off-the-shelf offerings applicable to their business needs—though many are pursuing opportunities to customize models or even develop their own (Exhibit 9). About half of reported gen AI uses within respondents’ business functions are utilizing off-the-shelf, publicly available models or tools, with little or no customization. Respondents in energy and materials, technology, and media and telecommunications are more likely to report significant customization or tuning of publicly available models or developing their own proprietary models to address specific business needs.

Respondents most often report that their organizations required one to four months from the start of a project to put gen AI into production, though the time it takes varies by business function (Exhibit 10). It also depends upon the approach for acquiring those capabilities. Not surprisingly, reported uses of highly customized or proprietary models are 1.5 times more likely than off-the-shelf, publicly available models to take five months or more to implement.

Gen AI high performers are excelling despite facing challenges

Gen AI is a new technology, and organizations are still early in the journey of pursuing its opportunities and scaling it across functions. So it’s little surprise that only a small subset of respondents (46 out of 876) report that a meaningful share of their organizations’ EBIT can be attributed to their deployment of gen AI. Still, these gen AI leaders are worth examining closely. These, after all, are the early movers, who already attribute more than 10 percent of their organizations’ EBIT to their use of gen AI. Forty-two percent of these high performers say more than 20 percent of their EBIT is attributable to their use of nongenerative, analytical AI, and they span industries and regions—though most are at organizations with less than $1 billion in annual revenue. The AI-related practices at these organizations can offer guidance to those looking to create value from gen AI adoption at their own organizations.

To start, gen AI high performers are using gen AI in more business functions—an average of three functions, while others average two. They, like other organizations, are most likely to use gen AI in marketing and sales and product or service development, but they’re much more likely than others to use gen AI solutions in risk, legal, and compliance; in strategy and corporate finance; and in supply chain and inventory management. They’re more than three times as likely as others to be using gen AI in activities ranging from processing of accounting documents and risk assessment to R&D testing and pricing and promotions. While, overall, about half of reported gen AI applications within business functions are utilizing publicly available models or tools, gen AI high performers are less likely to use those off-the-shelf options than to either implement significantly customized versions of those tools or to develop their own proprietary foundation models.

What else are these high performers doing differently? For one thing, they are paying more attention to gen-AI-related risks. Perhaps because they are further along on their journeys, they are more likely than others to say their organizations have experienced every negative consequence from gen AI we asked about, from cybersecurity and personal privacy to explainability and IP infringement. Given that, they are more likely than others to report that their organizations consider those risks, as well as regulatory compliance, environmental impacts, and political stability, to be relevant to their gen AI use, and they say they take steps to mitigate more risks than others do.

Gen AI high performers are also much more likely to say their organizations follow a set of risk-related best practices (Exhibit 11). For example, they are nearly twice as likely as others to involve the legal function and embed risk reviews early on in the development of gen AI solutions—that is, to “ shift left .” They’re also much more likely than others to employ a wide range of other best practices, from strategy-related practices to those related to scaling.

In addition to experiencing the risks of gen AI adoption, high performers have encountered other challenges that can serve as warnings to others (Exhibit 12). Seventy percent say they have experienced difficulties with data, including defining processes for data governance, developing the ability to quickly integrate data into AI models, and an insufficient amount of training data, highlighting the essential role that data play in capturing value. High performers are also more likely than others to report experiencing challenges with their operating models, such as implementing agile ways of working and effective sprint performance management.

About the research

The online survey was in the field from February 22 to March 5, 2024, and garnered responses from 1,363 participants representing the full range of regions, industries, company sizes, functional specialties, and tenures. Of those respondents, 981 said their organizations had adopted AI in at least one business function, and 878 said their organizations were regularly using gen AI in at least one function. To adjust for differences in response rates, the data are weighted by the contribution of each respondent’s nation to global GDP.

Alex Singla and Alexander Sukharevsky  are global coleaders of QuantumBlack, AI by McKinsey, and senior partners in McKinsey’s Chicago and London offices, respectively; Lareina Yee  is a senior partner in the Bay Area office, where Michael Chui , a McKinsey Global Institute partner, is a partner; and Bryce Hall  is an associate partner in the Washington, DC, office.

They wish to thank Kaitlin Noe, Larry Kanter, Mallika Jhamb, and Shinjini Srivastava for their contributions to this work.

This article was edited by Heather Hanselman, a senior editor in McKinsey’s Atlanta office.

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