mrs j case study essay

• February 26, 2020
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Clinical Manifestations Present In Mrs. J

Clinical manifestation includes any physical observations made by a physician or subjective data collected from the patient which is used to conduct an effective diagnosis and developing effective treatment intervention. These may include physical symptoms related to a certain illnesses as well as changes in normal functioning of body organs (Grand Canyon University, 2018). Based on the case study the clinical manifestations present in Mrs. J include fever, nausea, malaise, and productive cough. The patient also reports requiring assistance in walking short distances, decompensated heart failure, and acute exacerbation of COPD. Subjective data from the patient indicate that the patient has a difficulty in getting enough air and is exhausted that she cannot eat or drink by herself.

Nursing Interventions at the Time of Her AdmissionsAt the time of her admission, the patient reports a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). The nursing interventions implemented to address these conditions include 2L of oxygen/nasal cannula at home during activity, antihypertensive medications to control her heart failure (Peacock, 2017). The doctor administered IV furosemide, Enalapril, Metoprolol, IV morphine sulphate, Inhaled short-acting bronchodilator, Inhaled corticosteroid, and Oxygen delivered at 2L/ NC to address the present symptoms affecting Mrs. J. These medications will help in stabilizing the health of Mrs. J. to normal functioning (Peacock, 2017). This nursing intervention is appropriate as it aims at addressing Mrs. J respiratory problems. The adddministration of IV Furosemide medication is meant to address pulmonary edema affecting Mrs. J. that is caused by heart failure. This medication is also meant to treat congestive heart failure by addressing fluid retention. The other medication that is administered to Mrs. J. is Enapril which is meant to treat hypertension (Trevor & Chipps, 2018).

This medication will help the patient since she has not taken her antihypertensive medications for three days that are important for controlling heart failure. Enapril is mostly used in emergencies due to its quick effect if administered through an injection into the vein (Trevor & Chipps, 2018). The patient is also administered Metoprolol which is a drug meant to address congestive heart failure and hypertension. Since the patient has an abnormal heart rate, this may worsen the heart failure condition which can be prevented by using this medication (Trevor & Chipps, 2018).

The physician also administers Morphine to the patient which is aimed at minimizing pain associated with congestive heart failure. This medication is also beneficial in addressing stress that may trigger hypertension symptoms (Trevor & Chipps, 2018). Inhaled short-acting bronchodilator is a quick acting reliever to address asthma attacks by opening the airways. This is helpful as the patient reports continuing to smoke on daily occasions and feels like she cannot get enough air (Trevor & Chipps, 2018). The patient is also issued with inhaled corticosteroid which is aimed at preventing asthma attacks and improving the functioning of the lungs. The last nursing intervention involves administration of oxygen which is delivered at 2L/ NC. This is meant to improve the flow of oxygen to the lungs for patients with acute exacerbation of COPD (Trevor & Chipps, 2018).

Four Cardiovascular Conditions That May Lead To Heart Failure and Nursing Interventions to Prevent the Development of Heart Failure in Each ConditionCoronary Artery DiseaseCoronary artery disease is characterized by narrowing or blocking of the coronary arteries that may be caused by obesity since cholesterol may build up on the inner walls of the arteries affecting the flow of blood to the heart and to other body parts (Hruby et al., 2016). In coronary artery disease, the fat deposits in the inner walls of the arteries may form a plaque that may rupture leading to a blood clot in the artery. This clot may cause blockage preventing the flow of blood to the heart which may deprive the heart and other body parts from adequate supply of oxygen (Hruby et al., 2016). Medical interventions to prevent coronary artery disease include addressing the risk factors associated with this disease such as obesity.

High Blood PressureHigh blood pressure is a condition where the force of the blood against the artery walls is too high. If this is not controlled, it may lead to heart problems in the long-term. High blood pressure is diagnosed by measuring the systolic and diastolic blood pressure in the blood vessels (Hruby et al., 2016). If blood pressure is above 140/90, the patient is considered to have high blood pressure. This disease may have no symptoms and may cause other health problems such as stroke or heart failure. Medical interventions to prevent high blood pressure involve taking medications to lower high blood pressure above the normal rate (Hruby et al., 2016). High-risk individuals should also exercise regularly and reduce salt intake as this triggers high blood pressure. StrokeStroke is a condition caused by a limited supply of blood to the brain that affects the supply of oxygen in the brain causing brain damage. Oxygen is important in supplying necessary nutrients in the brain to enable efficient functioning of the brain (Rahko, 2014). If there is a lack of these nutrients, brain cells will begin to die and the brain may fail to function optimally affecting other body functions as the brain is responsible for controlling diverse body functions. Medical interventions to prevent stroke is addressing and controlling risk factors that may lead to stroke (Rahko, 2014). These include high blood pressure and obesity that can be managed by adopting a healthy life style.

Congenital Heart Disease

Congenital heart disease is a condition characterized by a problem with the structure of the heart. A person may be born with a heart defect that can affect the walls of the heart, heart valves, arteries, or veins near the heart affecting normal flow of blood (Rahko, 2014). This defect may block the flow of blood or cause blood to flow to the wrong place failing to reach the heart. This condition can be prevented by using medications that improve the functioning of the heart and the flow of blood to the heart (Rahko, 2014). Pace makers can also be used to regulate an abnormal heart as well as prevent some of the problems associated with a defective heart. Four Nursing Interventions That Can Help Prevent Problems Caused By Multiple Drug Interactions in Older PatientsOne of the ways to prevent help prevent problems caused by multiple drug interactions in older patients is educating the patients and close family members to enable them understand the effects of this process and effective ways of managing the effects (Golchin, Frank, Vince, Isham, Meropol, 2015). This will help the patient and family members to monitor the health of the patient and implement effective measures accordingly. The second nursing intervention involves undertaking medical reviews where patients have regular appointments with doctors to determine the state of their health and determine effective interventions to implement based on the health status of the patient (Golchin et al., 2015).

This can also enable the doctor to determine some of the unnecessary medications that can be stopped. Another nursing intervention to prevent problems caused by multiple drug interactions in older patients is addressing any negative side effects affecting patients due to the use of multiple drugs (Golchin et al., 2015). Patients should seek medical help after detecting any changes in their health to prevent adverse effects of using multiple drugs. The last nursing intervention involves the use of other alternatives to medications. These may include behavior changes or changes in diet (Golchin et al., 2015).

Health Promotion and Restoration Teaching Plan for Mrs. J.

One effective way for Mrs. J. to ensure stable health is to adopt a healthy lifestyle due to the conditions affecting her health. This requires a good diet, exercise, and controlling the underlying conditions using appropriate medications. Despite the patient requiring 2L of oxygen/nasal cannula at home during activity, the patient continues to smoke two packs of cigarettes a day. This has negatively affected her health and the patient should implement effective strategies to reduce the habit that will drastically improve her health. The patient can seek rehabilitation services to help her with the addiction problem. The patient is also reluctant to take her antihypertensive medications to control her heart failure which needs to be addressed. Patient education will help the patient to understand the risk factors that have contributed to her current status and what effective strategies can be implemented at home to help her improve her health in diverse forms.

Providing Education for Mrs. J.Patient education is important in helping the patient to adopt a healthy lifestyle as well as control the health conditions currently affecting her. This will also help her to become responsible for her own health, as she will be able to take an active role in managing her own care (Grand Canyon University, 2018). One way of providing patient education to Mrs. J. is taking advantage of technology as this makes education materials more accessible to patients. Patients can access education materials at the touch of a button anytime using their smart phones (Grand Canyon University, 2018). This is important in addressing individual patient needs as Mrs. J. can access adequate information regarding the risk factors associated with inadequate management of the underlying conditions well as effective measures to apply in improving her health. Mrs. J. can also use reminders to remind her on the time to take her drugs and prevent some of the negative effects of not taking her medications effectively (Grand Canyon University, 2018).

COPD Triggers That Can Increase Exacerbation Frequency, Resulting In Return VisitsOne COPD trigger that can increase exacerbation frequency is tobacco smoke which is the leading cause of COPD and increases the progression of the disease. Tobacco smoke can lead to difficulty in breathing, coughing, and wheezing as experienced by the patient who continues to smoke two packs of cigarettes a day regardless of her health condition (Baker & Fatoye, 2019). Second hand is also harmful to non-smokers as this can also trigger COPD exacerbations. Another trigger is air pollution such as vehicle exhaust, fumes at the gas pump station, and pollution from factories as these may irritate the lungs triggering a COPD flare up (Baker & Fatoye, 2019). High-risk individuals should avoid exposure to these chemicals while performing outside activities such as walking, shopping, or exercising. Considering Mrs. J. s current and long-term tobacco use, the doctor may administer Varenicline which a prescription medication that aims at reducing cravings for tobacco as well as controlling nicotine withdrawal symptoms by blocking nicotine receptors in the brain (Baker & Fatoye, 2019).

Baker, E., & Fatoye, F. (2019). Patient perceived impact of nurse-led self-management interventions for COPD: A systematic review of qualitative research. International Journal of Nursing Studies, 91, 22-34. doi: 10.1016/j.ijnurstu.2018.12.004. Epub 2018 Dec 31.Golchin, N., Frank, S. H., Vince, A., Isham, L., Meropol, S. B. (2015).

Polypharmacy in the elderly. Journal of Research in Pharmacy Practice, 4(2), 85-88.Grand Canyon University. (2018).

Pathophysiology: Clinical Applications for Client Health. Grand Canyon University.Hruby, A., Manson, J. E., Qi, L., Malik, V. S., Rimm, E. B., Sun, Q., Willett, W. C., & Hu, F. B. (2016).

Determinants and Consequences of Obesity. American Journal of Public Health, 106(9), 1656-1662.Peacock, W. F. (2017). Short Stay Management of Acute Heart Failure. Cham: Springer International Publishing.Rahko, P. S. (2014).

Heart failure: A case-based approach. New York: Demos Medical.Trevor, J. L., & Chipps, B. E. (2018).

Severe Asthma in Primary Care: Identification and Management. The American Journal of Medicine, 131(5), 484-491. doi: 10.1016/j.amjmed.2017.12.034. Epub 2018 Mar 30

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Alicia Case Study: Mrs. J

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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NursingBird. (2023, November 8). Alicia Case Study: Mrs. J. https://nursingbird.com/alicia-case-study-mrs-j/

"Alicia Case Study: Mrs. J." NursingBird , 8 Nov. 2023, nursingbird.com/alicia-case-study-mrs-j/.

NursingBird . (2023) 'Alicia Case Study: Mrs. J'. 8 November.

NursingBird . 2023. "Alicia Case Study: Mrs. J." November 8, 2023. https://nursingbird.com/alicia-case-study-mrs-j/.

1. NursingBird . "Alicia Case Study: Mrs. J." November 8, 2023. https://nursingbird.com/alicia-case-study-mrs-j/.

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NursingBird . "Alicia Case Study: Mrs. J." November 8, 2023. https://nursingbird.com/alicia-case-study-mrs-j/.

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Preventing Heart Failure: Case Study Essay

Clinical manifestations.

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.

Adequacy of First Interventions

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.

Potential Cardiovascular Conditions Leading To Heart Failure

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.

Nursing Interventions to Prevent Problems Caused By Multiple Drug Interactions

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.

Health Promotion and Restorative Teaching Plan

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.

Method for Providing Education

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.

COPD Triggers

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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Case Study: Mrs. J

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.

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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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[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..

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.

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.

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Critical Thinking Essay on MRS J Case Study

Mrs j case study.

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; S pO2 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.

Answer preview Nurses are required to establish an enriched understanding of the pathological progressions of illnesses, the clinical manifestations, how they affect patients, and their treatment protocols. It requires a professional evaluation of the health history of a patient and the medical information to be able to do the assessment. Regarding the above, the paper will dwell on Mrs. J cases study health history and ailment to critically evaluate her situation professionally and provide a conclusion on the same. Critical Analysis of Mrs. ‘J’s Health Condition The development of chronic illness in Mrs. ‘J’s illness is fatal regarding the COPD where she is a critical condition. There is blood seen in her sputum, which suggests that chronic respiratory infection is at its critical stage…

(1100 words)

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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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Mrs. J's Case Study: 21 Nursing Problems Theories

Introduction.

Concerning Mrs. J's case study, I would use the 21 Nursing Problems Theories as to the most suitable theory for this particular theory. This given theory gets derived from the art as well as science which helps in molding various attitudes, competencies, technical skills as well as intellectual of a particular nurse through his desires and abilities to assist individual, either sick people or well people in helping them to achieve and manage their health requirements in our society.

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The Nursing Theorist in this Case

In this case, the nursing theorist is Faye Glen Abdellah. This answer is very authentic since he is the theorist who ensured active development of the Theory of 21 Nursing Problems, whereby she majorly emphasized on the nursing care plan which involved changing from the illness-centered, to the patient-centered and later started including care for both your families as well as the aging people in the nursing care (Florin, et al. 2005). For instance, Mrs J has proved to be a caring woman, as he takes good care of her two children and her ailing and elderly parents. Generally, Mrs J applies her technical skills, competency knowledge, and attitudes through her desire and ability to assist her parents and children who are significantly in need of her support. Faye Glen is overall one of the best and most celebrated theorists of nursing, the military nurse, as well as a leader in the nursing research study.

Describe the 21 Nursing Problems Theory

Regarding the Faye Abdellah's 21 Nursing Problems Theory, "Nursing is based on art and science that molds the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs." This theory got developed from the practice and by a renowned and most celebrated military nurse known as Faye Glen Abdellah. Overall, this particular theory gets regarded as the theory of human needs, as it majorly encourages the nurses to give back to the society by helping the elderly individuals, family members, the poor and the sick irrespective of their social and economic status (Gordon, & Sweeney, 2009). Additionally, this nursing theory gets created with a primary purpose of making it as the nursing education techniques. Therefore, it is very appropriate to use in the nursing fields, whereby various models of nursing are beneficial and guiding to ensure multiple hospitals and health care institutions take good care of their patients in both community and government's healthcare institutions.

Assumptions of the 21 Nursing Problems Theories

Several hypotheses regarding Abdellah's nursing theory, highlights various changes as well as the expected changes affecting nursing entities; that is, the desire to congratulate the interconnectedness of the social organizations as well as the social challenges affecting people in the society, result of the obstacles like poverty rate, environmental pollution, rate of racism and education on the health as well as the delivery of appropriate healthcare services, alteration of knowledge, continuous education services for the professional and skilled nurses, as well as developing nursing leaders from the underserved groups in the nursing sector to the patients. These strategies include; learning how to know and understand your patient, sorting out of the relevant as well as the essential data, and development of the compressive nursing care plan.

Four Major Nursing Metaparadigsms of this Theory

Based on the 21 Nursing Problems Theory, the following are the primary conceptions of health as well as the nursing challenges, problem-solving, which is a logical activity in nature. They include:

Individuals: In this case, individuals are those who are receiving nursing services as family members and people. Hence, concerning Mrs. J's matter, she has individuals who include her family members, that is her two children, and her elderly parents with whom she tries to support.

Health: Health itself or health services are the primary functions of the nursing services. Abdellah advocates for improved health services on people and society at large by providing quality health services to them.

Nursing Problems: Generally, patients' health requirements can get seen as a significant problem. This concept may get viewed as the initial condition or the covert challenges or maybe hidden problems. Since hidden challenges may be psychological and emotional, interpersonal, or sociological, people usually misunderstood them. While on several occasions, solving individual's hidden challenges may help in solving some apparent problems as well.

Society and Environment: Additionally, the community is also involved in the strategic planning process for the maximum health services at the local and global levels. The environment should also get included in the elaborate plan to enhance the local and universal health care services by keeping it clean desirable.

Descriptions of Each Step in the Theory's Plan Care

Typically, the nursing activities in the Glen Abdellah's 21 Nursing Problems Theories consist of assessment, the nursing diagnosis, nursing strategic planning, implementation, as well as the evaluation processes.

Assessment Stage: This is the first stage of the nursing theory's plan care. In this stage, the nursing challenges help in implementing a standard step in collecting data. Hence, the main principle in the procedure for problem-solving is for each problem observed, the researchers collect private and pertinent information. Usually, either open or hidden nature of the challenges enhances both direct and indirect approaches for dealing with the various nursing problems among the people. Furthermore, the result of the data collected, firstly, concludes multiple challenges affecting the patients, which can either grouped in one type or many more health problems, which in turn leads to the formulation of the nursing diagnosis.

After the process of nursing diagnosis formulation, the researchers then developed an elaborate and effective planning process of health care. In the planning phase, the nurses adopt practical solutions to help in solving the arising problem in the patient's life (Jerlock et al. 2003). This phase is one of the critical aspects of this particular theory as it helps most nurses in treating their patients with effective nursing technology.

Again, after the planning phase, the researchers then identify major nursing interventions to help in solving various challenges affecting their patients. Then, the nurse fulfills the implementation phase by ensuring that all the interventions adopted and put into practice appropriately.

Lastly, in this stage, nurses carry out an elaborate analysis concerning the implemented policies on health care services. This evaluation process enables several nurses to determine various strengths and weaknesses when providing health care services to patients.

Overall, Glen Abdellah's 21 Nursing Problems Theory is regarded as a conceptual strategy since it is mainly concerned as well as the patient's requirements as well as the nurses' duties in determining challenges by the use of the analysis of the problem techniques. Individuals are also the main reason why nursing as a profession exists. Hence, this theory is critical since it caters to the patients' needs and the various problems they face.

Florin, J., Ehrenberg, A., & Ehnfors, M. (2005). Patients' and nurses' perceptions of nursing problems in an acute care setting. Journal of Advanced Nursing, 51(2), 140-149.

Gordon, M., & Sweeney, M. A. (2009). Methodological problems and issues in identifying and standardizing nursing diagnoses. Advances in Nursing Science, 2(1), 1-16.

Jerlock, M., Falk, K., & Severinsson, E. (2003). Academic nursing education guidelines: a tool for bridging the gap between theory, research, and practice. Nursing & health sciences, 5(3), 219-228.

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Case Study: Mrs. J

Case Study: Mrs. J. 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.

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