Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions. Case Scenario
Mrs. 3. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.
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 so exhausted she cannot eat or drink by herself. Objective Data
- Height 175 cm; Weight 95.5 kg
- Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
- Cardiovascular: Distant S1, 52, 53, 54 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; 5p02 82%
- Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin
Critical Thinking Questions
What nursing interventions are appropriate for Mrs.]. at the time of her admission? Drug therapy is started for Mrs. 3. to control her symptoms. What is the rationale for the administration of each of the following medications?
- IV furosemide (Lasix)
- Enalapril (Vasotec)
- Metoprolol (Lopressor)
- IV morphine sulphate (Morphine)
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 rationale for each of the interventions you recommend.
How to solve
Discussion 3 Mrs. 3. is a 63-year-old woman who has a history of hypertension Nursing Assignment Help
Introduction: In this case scenario, Mrs. 3, a 63-year-old woman with a complex medical history, has been admitted to the hospital ICU with acute decompensated heart failure. As a medical professor, we will provide appropriate nursing interventions for Mrs. 3’s admission and discuss the rationale for the administration of specific medications. Additionally, we will describe four cardiovascular conditions that may lead to heart failure and propose medical/nursing interventions to prevent heart failure in each condition. Lastly, we will address the potential problems caused by multiple drug interactions in older patients and suggest four nursing interventions to prevent such problems.
Answer 1: The nursing interventions appropriate for Mrs. 3 at the time of her admission include:
1. Assessing and monitoring vital signs: It is crucial to regularly assess Mrs. 3’s vital signs, including temperature, heart rate, respiratory rate, and blood pressure. Monitoring these parameters will help identify any changes or abnormalities that may require immediate attention.
2. Administering supplemental oxygen: Since Mrs. 3 feels like she cannot get enough air, providing supplemental oxygen will help improve her oxygenation status and alleviate her respiratory distress.
3. Administering IV fluids: Mrs. 3 is unable to eat or drink by herself due to exhaustion. Administering intravenous fluids will ensure adequate hydration and prevent further complications.
4. Providing emotional support and reassurance: Mrs. 3 is anxious and expresses concerns about her life. Offering emotional support and reassurance can help alleviate her anxiety and improve her overall well-being.
Answer 2: The rationale for the administration of the following medications in Mrs. 3’s case are as follows:
1. IV furosemide (Lasix): Furosemide is a loop diuretic that helps remove excess fluid from the body, reducing the workload on the heart and relieving symptoms of heart failure such as fluid overload and pulmonary congestion.
2. Enalapril (Vasotec): Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that helps lower blood pressure and reduce the workload on the heart. It also improves cardiac output and decreases fluid retention, thus alleviating symptoms of heart failure.
3. Metoprolol (Lopressor): Metoprolol is a beta-blocker that slows the heart rate, reduces blood pressure, and improves cardiac function. By blocking the effects of adrenaline on the heart, it helps reduce the workload on the heart and control arrhythmias.
4. IV morphine sulphate (Morphine): Morphine is used to relieve severe pain and anxiety in patients with heart failure. It helps reduce preload and afterload, thereby improving cardiac function and relieving symptoms such as dyspnea and anxiety.
Answer 3: Four cardiovascular conditions that may lead to heart failure are:
1. Coronary artery disease (CAD): CAD can cause myocardial infarction (heart attack), leading to damaged heart muscle and impaired pumping function. Medical interventions to prevent heart failure in CAD include lifestyle modifications (e.g., smoking cessation, healthy diet, exercise), medication management (e.g., antiplatelet therapy, statins), and revascularization procedures (e.g., angioplasty, coronary artery bypass grafting).
2. Hypertension (high blood pressure): Uncontrolled hypertension can strain the heart and lead to heart failure. Preventive measures involve lifestyle modifications (e.g., healthy diet, regular exercise, stress reduction), adherence to antihypertensive medications, and routine blood pressure monitoring.
3. Valvular heart disease: Conditions such as aortic stenosis or mitral regurgitation can progressively weaken the heart and result in heart failure. Treatment options may include medications to manage symptoms, surgical repair or replacement of the affected valve, and regular follow-up to monitor valve function.
4. Dilated cardiomyopathy: This condition causes enlargement and weakening of the heart chambers, impairing its pumping ability. Preventive measures involve managing underlying causes (e.g., alcohol cessation, treating infections or toxins), medications (e.g., ACE inhibitors, beta-blockers), implantable devices (e.g., defibrillators), and potential heart transplantation.
Answer 4: To prevent problems caused by multiple drug interactions in older patients taking several prescription medications, the following nursing interventions can be implemented:
1. Medication reconciliation: Performing a comprehensive review of the patient’s medication list, including all prescribed and over-the-counter drugs, supplements, and herbal remedies. This helps identify potential drug interactions, duplications, or contraindications.
2. Consultation with pharmacists: Collaborating with pharmacists who specialize in geriatric care can provide valuable input regarding potential drug interactions and individual patient considerations. Pharmacists can help optimize medication regimens and provide education on drug administration and potential side effects.
3. Patient education: Providing clear and concise instructions to patients regarding their medication regimen, including the importance of adherence, potential drug interactions to be mindful of, and when to seek medical attention. Promoting patient empowerment and understanding can help prevent medication-related problems.
4. Regular monitoring and follow-up: Implementing appropriate monitoring protocols, such as regular laboratory tests, blood pressure checks, and medication reviews, to identify and address any emerging drug-related issues. Consistent follow-up appointments allow healthcare professionals to assess the effectiveness and safety of the prescribed medications.
By implementing these nursing interventions, healthcare providers can minimize the risk of adverse drug reactions, improve medication adherence, and optimize the overall management of complex medication regimens in older patients.
Note: The answer provided includes nursing interventions and rationales for different aspects of the case scenario.
