Grand Canyon University Health History and Medical Information for 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

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5kg.
  2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
  3. 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.
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
  5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)
  5. Inhaled short-acting bronchodilator (ProAir HFA)
  6. Inhaled corticosteroid (Flovent HFA)
  7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

  1. Describe the clinical manifestations present in Mrs. J.
  2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
  3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
  4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
  5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
  6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
  7. 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.

Expert Solution Preview

Introduction:
The case of Mrs. J is a complex scenario that requires a critical evaluation of her health history, medical information, and nursing interventions. This critical thinking essay will discuss the clinical manifestations present in Mrs. J, the appropriateness of nursing interventions, cardiovascular conditions that may lead to heart failure and interventions to prevent its development, nursing interventions to help prevent problems caused by multiple drug interactions in older patients, a health promotion and restoration teaching plan for Mrs. J, education about medications, and options for smoking cessation.

1. Describe the clinical manifestations present in Mrs. J.
Mrs. J presents symptoms of acute decompensated heart failure (ADHF) and acute exacerbation of chronic obstructive pulmonary disease (COPD). These symptoms include fever, productive cough, nausea, malaise, difficulty in performing activities of daily living (ADL), inability to walk short distances without assistance, anxiety, dyspnea, and fatigue. Objective data shows an irregular heart rate, pulmonary crackles, decreased breath sounds on the right lower lobe, coughing frothy blood-tinged sputum, SpO2 of 82%, hepatomegaly, and peripheral edema.

2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
The nursing interventions administered to Mrs. J. were appropriate considering her presenting symptoms and medical history. The medications administered were IV furosemide (Lasix), Enalapril (Vasotec), Metoprolol (Lopressor), IV morphine sulfate (Morphine), inhaled short-acting bronchodilator (ProAir HFA), inhaled corticosteroid (Flovent HFA), and oxygen delivered at 2L/NC. These medications were used to treat symptoms of heart failure and COPD, such as pulmonary congestion, fluid overload, hypertension, and bronchoconstriction. Furosemide and enalapril were given to increase urine output and reduce pulmonary congestion. Lopressor was administered to reduce heart rate and blood pressure. Morphine was used to relieve anxiety, dyspnea, and decrease preload. Bronchodilators and corticosteroids were given to reduce bronchoconstriction and to improve gas exchange. Oxygen was provided to improve oxygenation and reduce the workload on the heart and lungs.

3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
Four cardiovascular conditions that may lead to heart failure are coronary artery disease, hypertension, myocardial infarction, and valvular heart disease. To prevent the development of heart failure in coronary artery disease, medical interventions such as cholesterol-lowering medications, antiplatelet agents, and revascularization procedures may be necessary. Nursing interventions include patient education regarding lifestyle modifications, medication adherence, and management of risk factors such as smoking and obesity. In hypertension, medication adherence, lifestyle modifications, and careful monitoring of blood pressure are essential in preventing heart failure. In myocardial infarction, medical interventions such as thrombolytics, percutaneous intervention, and coronary artery bypass surgery may be necessary. Nursing interventions include patient education about the importance of seeking medical attention immediately after symptoms start and appropriate lifestyle modifications. Lastly, in valvular heart disease, timely intervention through surgical or percutaneous valve replacement or repair is necessary, along with patient education regarding medication adherence and regular follow-up with a healthcare provider.

4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
Four nursing interventions to help prevent problems caused by multiple drug interactions in older patients include medication reconciliation, communication with healthcare providers, education regarding medication use, and medication review. Medication reconciliation involves comparing all medications prescribed by providers and ensuring that each medication is necessary and has no potential interactions. Communication with healthcare providers involves discussing potential side effects, medication changes, and drug interactions with healthcare providers. Education regarding medication use includes providing written and verbal instructions, including the purpose of each medication, how and when to take them, and potential side effects. Medication review involves periodically reviewing medications to ensure that they are still necessary and that there are no interactions. These interventions help to prevent medication errors, adverse drug reactions, and drug interactions in older adults.

5. 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.
A health promotion and restoration teaching plan for Mrs. J. would involve providing education about lifestyle modifications such as smoking cessation, weight loss, and stress reduction. Multidisciplinary resources for rehabilitation may include physical therapy, respiratory therapy, and dietary counseling. Modifications that may be needed include alterations in physical activity, changes in medication adherence, and environmental alterations such as oxygen use at home. These resources and modifications will assist Mrs. J. in regaining independence by improving her physical and respiratory function and providing education and support for lifestyle modifications.

6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
A method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission is through the teach-back method. The teach-back method involves rephrasing and explaining instructions provided to a patient to ensure understanding. This method ensures that patients have a clear understanding of their medications, the purpose of each medication, how and when to take them, and potential side effects. Providing education through the teach-back method helps to prevent medication errors, improve adherence to medication regimes and reduce the risk of readmission.

7. 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.
COPD triggers that can increase exacerbation frequency include cigarette smoke, air pollution, respiratory infections, and weather changes. Considering Mrs. J.’s current and long-term tobacco use, nicotine replacement therapy and smoking cessation counseling should be offered. Nicotine replacement therapy includes the use of gum, patches, and inhalers to help manage withdrawal symptoms and reduce cravings. Counseling and behavioral modification techniques such as motivational interviewing and cognitive-behavioral therapy may also be effective in helping patients quit smoking. By quitting smoking, Mrs. J. can reduce the frequency and severity of exacerbations, improve lung function, and reduce the risk of readmission to the hospital.

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