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Cecile Case Study: Mrs. J.

Clinical manifestations present in mrs. j..

As Mrs. J.’s case description demonstrates, the patient was admitted to the hospital with flu-like symptoms. The clinical manifestation or the symptomatic indications of a disease or deterioration in bodily systems present in the patient include nausea, malaise, cough, and fever. The patient indicates diminished walking capacity, requires assistance, and experiences acute decompensated heart failure and acute exacerbation of chronic obstructive pulmonary disease (COPD). These clinical manifestations, in combination with the chronic conditions present in Mrs. J., namely hypertension, chronic heart failure, and COPD, serve as the basis for referring to the hospital.

Appropriateness of the Nursing Interventions at the time of Admissions and Medication Rationale

The nursing interventions at the time of admission addressed the patient’s chronic conditions. In particular, Mrs. J. had not taken her prescription medication for three days before admission. Therefore, administering the medications and oxygen to address the daily requirements under chronic conditions is essential. Moreover, the patient’s vital signs play a crucial role in deciding what nursing interventions are appropriate and the most required. At the time of admission, Mrs. J.’s oxygen saturation is low and decreased to the point of 82%; her heart rate is high with 118 beats per minute, and her blood pressure is low at 90/58. Therefore, the interventions and medications are appropriate since they were aimed at stabilizing the vital signs of the patient.

In particular, Mrs. J. was administered IV furosemide, enalapril, metoprolol, IV morphine sulphate, inhaled short-acting bronchodilator, inhaled corticosteroid, and oxygen delivered at 2L/ NC. Furosemide administered intravenously helps regulate fluid accumulation caused by heart failure. Enalapril is commonly used with furosemide to address hypertension. Metoprolol stimulates blood flow and is aimed to help with blood pressure. IV morphine sulphate is administered to manage pain in the patient. As for the oxygen, bronchodilator and corticosteroid administered for inhalation are aimed at regulating lung function, normalize oxygen saturation, and cure inflammatory processes in the respiratory system.

Cardiovascular Conditions Leading to Heart Failure and Preventative Nursing Interventions

There are multiple cardiovascular conditions that might be the triggers of predecessors of heart failure. Firstly, coronary heart disease, which is characterized by dysfunction of heart arteries, complicating the flow of blood rich in oxygen (“Heart failure,” 2021).

To prevent heart failure in the aftermath of coronary heart disease, a healthy lifestyle, regular medications, or even surgery might be appropriate. Secondly, heart inflammation is a condition that is characterized by inflammatory processes in different parts of the heart and might lead to heart failure (“Heart failure,” 2021). To prevent it, patients with heart inflammation should ensure timely diagnosis, procedural and medication-based treatment, or surgery. Thirdly, high blood pressure is another cardiovascular condition that might lead to heart failure (“Heart failure,” 2021).

To prevent it from deteriorating heart functioning, proper dieting to regulate possible body mass excess and physical activity, as well as medications, should be prioritized. Fourthly, cardiomyopathy, or the inability of the heart to deliver blood to all body parts, should be addressed by healthy dieting, medication intake, physical activity, and minimization of substance use to prevent heart failure (“Heart failure,” 2021).

Nursing Interventions Addressing Multiple Drug Interactions

As in the case of Mrs. J., the intake of several medications requires adequate nursing interventions that would minimize the risks of complications, hospitalization, and drug incompatibility. Firstly, a nurse should verify a patient’s understanding of the regimen of prescribed drugs (Azhagesan, 2017). Secondly, the information-related intervention should be implemented to provide the patient with an accurate list of all medications and the regimen of their intake, provide contacts of medical providers, and the phone number of local pharmacies.

Thirdly, educational or instructional interventions should include teaching the patient what medications are addressing her conditions and in which way, as well as their possible side effects and the risks of not taking the medications as directed (Azhagesan, 2017). Fourthly, interventions aimed at organizations include directions to dispose of old medications on time, store drugs in a specific place or refrigerator if needed, and avoid sharing medications (Azhagesan, 2017). These nursing interventions will ensure patients’ understanding of the importance of managing polypharmacy properly and prevent adverse outcomes.

Health Promotion and Restoration Teaching Plan

A health promotion plan for Mr. J. should include the following:

  • smoking cessation;
  • moderate daily physical activity;
  • take medications regularly;
  • stick to a healthy diet;
  • attend to scheduled follow-up physician appointments;
  • install and use health care applications to monitor heart rate and blood pressure;
  • use online and handout resources with information on heart failure and COPD management.

The rehabilitation resources, including online materials and applications on Mrs. J.’s condition, will help her manage and modify her daily routine according to the guidelines obtained from the resources. In such a manner, the patient will have an opportunity to receive answers to her questions independently and avoid complications.

Education Method Regarding Medications

The method of education for Mrs. J. to improve her self-management and medication intake after hospitalization should be verbal education through one-on-one communication (“Choosing effective patient education materials,” 2021). According to this method, the information is delivered to the patient verbally with the opportunity to answer Mrs. J.’s questions and ensure her comprehension. The rationale for this method is based on the severity of Mrs. J.’s chronic conditions and the necessity to ensure that she comprehends possible outcomes of improper medication intake.

COPD Triggers and Smoking Cessation Options

The triggers that should be avoided include household dust and fumes from cooking or cleaning products (“COPD signs and symptoms,” 2019). Also, Mrs. J. should avoid catching a cold or pneumonia and exposure to polluted air or a cold environment. Finally, the most significant issue in Mrs. J.’s case is smoking cessation that should be prioritized to avoid repeated hospitalization with COPD. To assist the patient with the smoking cessation procedure, a nurse might introduce nicotine patches and behavioral therapy; however, medications are not recommended since the patient is already exposed to polypharmacy.

Azhagesan, C. (2017). Role of nurse in polypharmacy. Nursing and Healthcare International Journal, 1 (4), 1-4. Web.

Choosing effective patient education materials. (2021). Web.

COPD signs and symptoms . (2019). Web.

Heart failure . (2021). Web.

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NRS 410 Case Study: Mrs. J.

NRS 410 Case Study Mrs. J

The case scenario concerns Mrs. J., a 63-year-old female with hypertension, chronic heart failure, and COPD. She usually uses 2L of oxygen at home during activity but has persisted in smoking cigarettes 2PPD for the last 40 years. The purpose of this paper is to analyze the patient’s condition.

Clinical Manifestations of Patient

The patient’s subjective findings include fever, nausea, productive cough, malaise, inability to perform ADLs, anxiety, palpitations, dyspnea, and fatigue. Objective findings include obesity (BMI-31.2), mild fever, low blood pressure, tachypnea, and tachycardia with irregular heart rhythm. In addition, the patient has jugular vein distention, distant heart sounds, S gallop, faint PMI at sixth ICS, and atrial fibrillation. Respiratory findings include frothy blood-tinged sputum, reduced breath sounds, pulmonary crackles, and SpO2 82%. GI findings include hepatomegaly.

Cardiovascular Conditions in Which Mrs. J Is At Risk

            The patient’s obesity increases the risk of Coronary Artery Disease (CAD), which causes heart failure (HF) when cholesterol and fat deposits accumulate along the arteries obstructing myocardial blood flow. HF can be prevented in patients with CAD by administering lipid-lowering agents and lifestyle modification to lower cholesterol levels. Atrial fibrillation (AF) causes increased resting heart rate and an exaggerated heart rate response to exercise, causing a reduced diastolic filling time and eventually reduced cardiac output that causes HF (Schwinger, 2021). Lifestyle modification and maintaining optimal blood pressure can prevent the progression of AF to HF. Stroke induces cardiac damage like ventricular wall motion defects that increase the risk of HF. Cardiac damage can be prevented by controlling BP through antihypertensives and lifestyle modification. Myocardial infarction (MI) causes myocardial damage, stunning, and necrosis that impairs the heart’s contractility resulting in heart failure (Schwinger, 2021). HF in patients with MI can be mitigated by administering ACE inhibitors to decrease cardiac output and avoiding high-intense activities that increase oxygen demand.

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Evaluation of Nursing Interventions at Admissions

The interventions during the admission of Mrs. J. included the administration of IV Lasix, Vasotec, Lopressor, IV Morphine, inhaled ProAir HFA, Flovent HFA, and oxygen via nasal cannula. The appropriate interventions included IV Lasix, ProAir HFA, and oxygen therapy. Lasix was appropriate because it alleviates symptoms of pulmonary congestion like cough, frothy sputum, palpitations, pulmonary crackles, and jugular vein distention (Oparil et al., 2019). ProAir HFA was also appropriate because it relieves COPD exacerbations, which would increase perfusion and alleviate dyspnea.

Oxygen therapy was ideal for improving the oxygen saturation levels to above 95%. Vasotec and Lopressor were inappropriate because they lower BP, which would worsen the patient’s low BP (Oparil et al., 2019). Furthermore, Morphine was unsuitable because it causes respiratory depression, which would worsen the patient’s breathing difficulties. Flovent HFA was inappropriate during admission since it is indicated for long-term COP maintenance to prevent exacerbations.

Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions

Lasix is a loop diuretic that facilitates water and sodium excretion by interfering with the chloride-binding cotransport system. This hinders the reabsorption of sodium and chloride in the ascending loop of Henle, and distal renal tubule, and lower preload in CHF (Oparil et al., 2019). Vasotec hinders the conversion of angiotensin I to angiotensin II, causing elevated plasma renin levels and reduced aldosterone secretion. This lowers blood pressure and improves HF symptoms. Lopressor is a selective beta-1-adrenergic blocker that competitively blocks beta1-receptors at low doses and blocks beta2-receptors at higher doses (Oparil et al., 2019). It is used in HF because it lowers cardiac output through negative inotropic and chronotropic effects.

Morphine is an opioid analgesic that blocks the ascending pain pathways altering pain response. It produces analgesia, sedation, and respiratory depression. ProAir HFA is a Beta 2 Agonist that relaxes bronchial smooth muscles and is indicated to alleviate acute bronchospasms (Nici et al., 2020). Flovent HFA is an inhalant corticosteroid with an anti-inflammatory effect on eosinophils, neutrophils, macrophages, lymphocytes, mast cells, and mediators

Older adults are significantly affected by multiple drug interactions due to polypharmacy since they have comorbid health conditions. Nursing interventions to prevent drug interactions include medication reconciliation, which entails identifying and documenting all drugs a patient takes and comparing the list with the physician’s orders (Kurczewska-Michalak et al., 2021). The nurse can also note a patient’s coexisting conditions and medications and assess the possibility of resulting in adverse drug effects. In addition, the nurse should educate the patient on how to take the medications, including the medications, generic and brand names, indications, and potential side effects, and explain how long the medication will likely be taken (Kurczewska-Michalak et al., 2021). Furthermore, the nurse can regularly reevaluate the patient for the need to continue prescribed medications and inform the physician to stop those that are no longer necessary or medications with higher possible risks than benefits.

Health Promotion and Restoration Teaching Plan

The health promotion and restoration education plan for Mrs. J will focus on lifestyle modification to control BP, maintain a healthy weight, delay COPD progression, and prevent COPD exacerbations. Regarding COPD, Mrs. J will be educated on the benefits of smoking cessation and avoiding environmental pollutants to delay disease progression and prevent exacerbations. Physical exercises will further be emphasized to improve lung function (Burge et al., 2020). Health education to control BP will include engaging in moderate aerobic exercises at least 40 minutes daily to improve cardiovascular functioning, lower BP, and promote weight loss. In addition, she will be educated on a healthy diet and reducing caloric intake for weight loss and to lower BP.

A multidisciplinary approach will be needed for rehabilitation and will include pulmonary rehabilitation, nutritional counseling, education, and self-management. Pulmonary rehabilitation is a multidisciplinary intervention for COPD established to improve exercise tolerance, dyspnea, and health-related QoL (Young et al., 2021). Nutritional counseling by a dietitian is vital for COPD patients who are underweight or overweight. Education and self-management are vital aspects of the multidisciplinary approach. They involve educational sessions educating patients on the nature and course of COPD and how to live with the impact of the disease.

COPD Triggers and Options for Smoking Cessation

Mrs. J can be provided individual psychotherapy to help with smoking cessation and group-based behavioral counseling. Pharmacotherapy intervention for smoking cessation includes Nicotine replacement therapy (NRT). The patient can be administered nicotine transdermal patches, gum, lozenges, inhalers, or nasal spray (Krist et al., 2021). COPD triggers that can cause exacerbations and readmission include tobacco smoke, exposure to dust, and environmental pollutants like carbon monoxide, which cause bronchoconstriction.

Mrs. J has a risk of cardiovascular conditions like Coronary Artery Disease, Atrial fibrillation, Stroke, and Myocardial infarction. IV Lasix, ProAir HFA, and oxygen therapy were appropriate since they improve symptoms of pulmonary congestion and COPD exacerbations. However, Vasotec and Lopressor lower BP, which is unsuitable for the patient due to the low BP. Morphine would have caused respiratory depression, while Flovent HFA is indicated for long-term COPD maintenance and thus was inappropriate. The health education plan for Mrs. J focuses on lifestyle modification to control BP, promote weight loss, delay COPD progression, and prevent COPD exacerbations.

Burge, A. T., Cox, N. S., Abramson, M. J., & Holland, A. E. (2020). Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD).  The Cochrane database of systematic reviews ,  4 (4), CD012626. https://doi.org/10.1002/14651858.CD012626.pub2

Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., … & US Preventive Services Task Force. (2021). Interventions for tobacco smoking cessation in adults, including pregnant persons: US Preventive Services Task Force recommendation statement.  Jama ,  325 (3), 265-279. doi:10.1001/jama.2020.25019

Kurczewska-Michalak, M., Lewek, P., Jankowska-Polańska, B., Giardini, A., Granata, N., Maffoni, M., Costa, E., Midão, L., & Kardas, P. (2021). Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions.  Frontiers in pharmacology ,  12 , 734045. https://doi.org/10.3389/fphar.2021.734045

Nici, L., Mammen, M. J., Charbek, E., Alexander, P. E., Au, D. H., Boyd, C. M., … & Aaron, S. D. (2020). Pharmacologic management of chronic obstructive pulmonary disease. An official American Thoracic Society clinical practice guideline.  American journal of respiratory and critical care medicine ,  201 (9), e56-e69. DOI: 10.1164/rccm.202003-0625ST

Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2019). Hypertension.  Nature reviews. Disease primers , p. 4 , 18014. https://doi.org/10.1038/nrdp.2018.14

Schwinger, R. H. G. (2021). Pathophysiology of heart failure.  Cardiovascular diagnosis and therapy ,  11 (1), 263–276. https://doi.org/10.21037/cdt-20-302

Young, M., Villgran, V., Ledgerwood, C., Schmetzer, A., & Cheema, T. (2021). Developing a Multidisciplinary Approach to the COPD Care Pathway.  Critical care nursing quarterly ,  44 (1), 121–127. https://doi.org/10.1097/CNQ.0000000000000345

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.

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Case study: mrs. j, case study overview.

Mrs. J presents with anxiety, shortness of breath at rest, heart palpitations, and easy fatigability. She has a BMI of 31.2, classified as obesity, and vital signs indicate a low-grade fever of 37.6C, tachycardia with irregular heart rhythm, tachypnea, and low blood pressure of 90/58. Positive physical findings at the chest include S gallop, faint peripheral pulses, and faint PMI at the 6 th ICS, which suggest left ventricular enlargement. Besides, the patient has bilateral jugular vein distention, which suggests congestive heart failure. Respiratory examination revealed pulmonary crackles, decreased breath sounds on the right lower lobe, cough with frothy blood-tinged sputum, and SpO2 of 82%. This indicates excessive secretions in the airways, presence of fluid in the lungs, limited flow of oxygen to the lungs, and inadequate tissue perfusion. The abdominal exam reveals hepatomegaly of 4cm below the costal margin.

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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

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. NRS 410 Case Study: Mrs. J.

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.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

NRS-410 Topic 1 DQ 1

Among non-communicable diseases, cardiovascular diseases are the leading cause of death globally. Coronary heart disease is an example of cardiac dysfunction that affects the blood vessels supplying the heart muscle. The cause of coronary heart disease is the build–up of plaque that causes the narrowing of the arteries, limiting the blood inflow to the heart. The dysfunction can bring several symptoms, such as a heart attack., chest pain, and stroke. The risk factors for coronary heart disease or any other cardiac dysfunction include an unhealthy diet, physical inactivity, harmful use of alcohol and tobacco use (Dong et al., 2019). The behavioral risk factors of coronary heart disease can present themselves as raised blood pressure, increased blood glucose, raised blood lipids, overweight, and obesity.

Humans must prevent and reduce their chances of developing coronary heart disease or other cardiac dysfunctions. These dysfunctions often deteriorate the health and wellbeing of the patients; therefore, healthcare providers must work around and improve the health status of the patients. The basic ways to prevent the dysfunction include consuming a healthy diet, smoking and alcohol cessation, and engaging in physical activity (Khan et al., 2020). For instance, a patient with coronary heart disease can improve their health status by stopping tobacco use, reducing salt consumption in their diet, eating more fruits and vegetables, and engaging in regular physical fitness activities. A good diet and physical fitness activities are essential for the wellbeing and wellness of any human being. The body often takes in some substances they do not need; therefore, these substances are excreted as waste through physical activities.

Dong, Y., Chen, H., Gao, J., Liu, Y., Li, J., & Wang, J. (2019). Molecular machinery and interplay of apoptosis and autophagy in coronary heart disease. Journal of molecular and cellular cardiology, 136, 27-41.  https://doi.org/10.1016/j.yjmcc.2019.09.001

Khan, M. A., Hashim, M. J., Mustafa, H., Baniyas, M. Y., Al Suwaidi, S. K. B. M., AlKatheeri, R., … & Lootah, S. N. A. H. (2020). Global epidemiology of ischemic heart disease: results from the global burden of disease study. Cureus, 12(7). doi:10.7759/cureus.9349

Course Code Class Code Assignment Title Total Points NRS-410V NRS-410V-O500 Case Study: Mrs. J. 120.0

Criteria Percentage Unsatisfactory (0.00%) Less Than Satisfactory (75.00%) Satisfactory (79.00%) Good (89.00%) Excellent (100.00%) Content 80.0% Clinical Manifestations of Mrs. J. 10.0% Clinical manifestations are omitted. Clinical manifestations are partially presented. There are major omissions and inaccuracies. Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete. Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms. Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.

Evaluation of Nursing Interventions at Admissions 10.0% Evaluation of appropriateness of nursing interventions at the time of admission and explanation of the rationale for each of the medications listed are not discussed. Evaluation of appropriateness of nursing interventions at the time of admission is partially presented. An incomplete explanation for each of the medications listed is presented. The discussion contains significant inaccuracies. Evaluation of appropriateness of nursing interventions at the time of admission is summarized. A general explanation and some rationale for each of the medications listed are presented. There are minor inaccuracies. Evaluation of appropriateness of nursing interventions at the time of admission is discussed. An explanation and general rationale for each of the medications listed are presented. Some information is required for accuracy or clarity. Evaluation of appropriateness of nursing interventions at the time of admission is thoroughly discussed. A well-supported explanation for each of the medications listed is presented. Strong and compelling rationale is provided. NRS 410 Case Study: Mrs. J.

Cardiovascular Conditions Leading to Heart Failure and Interventions 10.0% Fewer than three cardiovascular conditions that may lead to heart failure, and medical or nursing interventions to prevent the development of heart failure in each condition, are described. Four cardiovascular conditions that may lead to heart failure are partially described. Medical or nursing interventions to prevent the development of heart failure in each condition are incomplete. There are significant inaccuracies. Four cardiovascular conditions that may lead to heart failure are summarized. Medical or nursing interventions to prevent the development of heart failure in each condition are generally discussed. There are some inaccuracies. Four cardiovascular conditions that may lead to heart failure are described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. There are minor inaccuracies, or information is needed for clarity. Four cardiovascular conditions that may lead to heart failure are clearly described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. Overall, the discussion demonstrates insight into medical and nursing interventions used to prevent heart failure.

Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions 10.0% Fewer than three nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are presented. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are partially presented. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are summarized. Overall, the discussion meets assignment criteria but requires more rationale for the interventions. There are minor inaccuracies. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. Overall, the discussion meets assignment criteria and general rationale for the interventions is provided. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. The discussion fulfills the assignment criteria and strong rationale for the interventions is provided.

Health Promotion and Restoration Teaching Plan 15.0% A health promotion and restoration teaching plan for the patient is omitted. A health promotion and restoration teaching plan for the patient is partially presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are omitted or incomplete. An explanation for how rehabilitation resources and modifications assist patient transition to independence is omitted or incomplete. A health promotion and restoration teaching plan for the patient is summarized. Multidisciplinary resources for rehabilitation and any modifications that may be needed are generally presented. A summary for how rehabilitation resources and modifications assist patient transition to independence is presented. There are minor inaccuracies. A health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are discussed. An explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. A well-developed health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are clearly discussed. An strong explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. The overall discussion is well-supported.

Method for Providing Education to Prevent Hospital Readmissions 15.0% A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is omitted. The method is not appropriate for the client or health status. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is partially summarized. The method may not be relevant to for this situation. More information is needed. There are major inaccuracies. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is summarized. The method is generally appropriate. Some rationale is provided for support. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is described. Overall, the method is appropriate. General rationale is provided for support. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is thoroughly described. The method is clearly appropriate for the client and prevents readmission. Strong rationale is provided for support.

COPD Triggers and Options for Smoking Cessation 10.0% COPD triggers exacerbating return visits and options for smoking cessation are omitted. Some COPD triggers exacerbating return visits are partially presented. Options for smoking cessation are incomplete; it is unclear if the options are relevant to the patient. General COPD triggers exacerbating return visits are generally presented. Some options for smoking cessation relevant to the patient are summarized. Some support or information is needed. Key COPD triggers exacerbating return visits are outlined. General options for smoking cessation relevant to the patient are summarized. All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.

Organization, Effectiveness, and Format 20.0% Thesis Development and Purpose 5.0% Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction 5.0% Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.

Paper Format (use of appropriate style for the major and assignment) 2.0% Template is not used appropriately, or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.

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[ANSWERED] Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

Last Updated on February 14, 2023 by Admin

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

Case study: mrs. j..

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

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.

You are required to submit this assignment to LopesWrite. Refer to the  LopesWrite Technical Support articles for assistance.

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

Expert Answer and Explanation

Mrs. J Case Study

RN-BSN prepared nurses should be ready to have an enhanced understanding of the different pathophysiological processes of disease, where they should be in a position to attend to patients who affect them across the lifespan. One of the disease conditions where nurses are expected to practice holistic care by applying the understanding of these pathophysiological processes is Chronic Obstructive Pulmonary Disease (COPD) (Fitzsimmons et al., 2016).

This condition is often caused by long-term exposure to irritants such as smoke. Mrs. J. a 63-yr-old married woman, presents to the facility with acute exacerbation of COPD and decompensated heart failure. The nurse practitioner should perform specific interventions that guide her in managing the condition throughout her lifespan.

Clinical Manifestations Present in Mrs. J

Part of the objective data that shows the extent to which Mrs. J. is sick is that she feels anxious, asking whether she is going to succumb to the illness. Though she denies pain, she says she has trouble getting enough air. She also has troubles with her activities of daily living (ADL), and even walking for short distances requires assistance. Among some of the symptoms that Mrs. J presents is having a productive cough, fever, malaise, and nausea.

Appropriateness of Mrs. J’s Nursing Interventions at the time of Admission

The interventions administered to Mrs. J upon her admission to the facility are appropriate, and are enough to help her to at least recover to a normal life. The IV morphine sulphate given helps to solve her symptoms of pain, and help also to focus her mind so that she does not pay too much to the suffering she is facing.

The two inhalants give, the short-acting bronchodilator (ProAir PFA) and the Inhaled Corticosteroid help her to improve the movement of air in her airways. Also, oxygen is delivered to her at 2L/NC, and this helps in ensuring her body systems, including that of the vital organs such as the brain, remain functional (Fitzsimmons et al., 2016). However, the therapy could be even better if it included more non-medicinal activities such as interviews to ease the tensions she notably has.

The Four Cardiovascular Conditions that Could Lead to Heart Failure and their Nursing Interventions

Myocardial infarction is one of the major conditions that can directly result in heart failure. This condition occurs when an artery that supplied blood to muscles of the heart is blocked. When blood supply to the heart is cut off, it means that nutrients and oxygen can no longer pass to the heart. The contraction and relaxation of the heart becomes faulty, and hence leading to the inability of the heart to function well (Anderson & Morrow, 2017).

People with a past heart attack are at greater risk of the condition. One of the nursing interventions of myocardial infarction is giving the affected patient vasodilators that help to ease any tension in the heart muscles that could otherwise lead to blockage. High blood pressure is another condition that can easily result to heart failure. Under this condition, the heart pumps blood at a very high rate and the heart chambers could end up getting larger and weaker. The nursing intervention for the same is giving medications that reduce heart pressure to at most 130/80mmHg.

The third condition that could lead to heart failure is coronary artery disease. Under this condition, fat and cholesterol deposits build up on the walls of the heart (atherosclerosis), and the result could be immediate heart attack (Braunwald, 2016). The nurse intervention for coronary artery disease is reducing the concentration of LDLs in the blood.

The fourth condition that puts someone at great risk of heart failure is endocarditis, which is an infection of the heart valves, and in some cases it can be a condition present from birth. In this condition, the valves have trouble opening and closing, and the heart results in pumping blood at a higher rate to achieve the same effect. Though surgery is the only sure way of correcting the condition, nurses can help to control the symptoms, which in a large way helps to maintain the patients’ emotional state at the right levels and hence preventing a possible heart attack.

Nursing Interventions to Prevent Problems of Multiple Drug Interactions

Among the most efficient methods of preventing problems associated with polypharmacy, such as multiple drug interactions, is keeping a careful track of the side effects. Also, the nurse should help the patient with information of what food should not be taken with specific drugs (Siddarama et al., 2019). Most importantly, they should ensure clarity in giving directions for each of the drugs.

Health Promotion and Restoration Teaching Plan

In the health promotion plan of restoring the health of Mrs. J, she should be educated about the condition she faces, and how the medication given helps in the control. Also, she should be given some of the modifications that may be necessary for her to gain her normal living. These include things such as support of walking sticks and wheelchair until she is able to walk by herself.

How Rehabilitation Resources will contribute to Patient’s Transition to Independence

One of the reasons why the patient is facing the condition is that despite warning from doctors, she has been smoking cigarettes for the past forty years. The rehabilitation resources will help her to reduce her dependence on these drugs and to assume a normal life without using drugs (Weldam et al., 2017). These resources will also help her transition to independence as they will help her to be in more control of her thoughts and actions.

Method of Educating Mrs. J to Prevent Future Hospital Admission

The best method of educating Mrs. J to prevent future hospital admission is using a home nurse, who helps her to perform various activities that build on her knowledge of taking care of her condition. This nurse can also monitor some of the activities that Mrs. J performs and correct them on a one-on-one basis. Considering the age of Mrs. J, this method is the most efficient.

COPD Triggers that can increase Exacerbation Frequency

Bacterial lung infection is one of the COPD triggers that could increase the frequency of exacerbation. Exposure to things such as smoke, air pollution, and dust, can also lead to exacerbations of COPD (Weldam et al., 2017). Depending on the cause these COPD exacerbations can last up to 2 days.

COPD is one of the most troublesome conditions among individuals who are ageing. Some of the diseases that can lead to a heart attack include hypertension, endocarditis, myocardial infarction, and coronary heart disease. For the case of Mrs. J, the interventions given are appropriate as they help her to achieve the first step of her normalcy.

The treatment plan should include procedures in which the patient can efficiently resume her ability to perform the activities of daily living. Rehabilitation is also useful for her, as it is one of the ways she can reduce her dependence on tobacco as well as adopt healthy lifestyle and eventually prevent COPD exacerbations.

Anderson, J. L., & Morrow, D. A. (2017). Acute myocardial infarction.  New England Journal of Medicine ,  376 (21), 2053-2064.

Braunwald, E. (2016). Treatment of left main coronary artery disease.  N Engl J Med ,  375 (23), 2284-2285.

Fitzsimmons, D. A., Thompson, J., Bentley, C. L., & Mountain, G. A. (2016). Comparison of patient perceptions of Telehealth-supported and specialist nursing interventions for early stage COPD: a qualitative study.  BMC health services research ,  16 (1), 420.

Siddarama, R., Naidu, J. B., Joshisree, K. P., & Lakshmi, V. S. (2019). Polypharmacy induced drug interactions, adverse drug reactions (ADR) and medication errors in tertiary care South Indian hospital.  Int J Pharm Sci ,  5 , 88-93.

Weldam, S. W., Lammers, J. W. J., Zwakman, M., & Schuurmans, M. J. (2017). Nurses’ perspectives of a new individualized nursing care intervention for COPD patients in primary care settings: a mixed method study.  Applied nursing research ,  33 , 85-92.

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD)

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