Assignment: Pathophysiology of Nursing Management of Client’s Health

Assignment: Pathophysiology of Nursing Management of Client’s Health

Assignment: Pathophysiology of Nursing Management of Client’s Health

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.

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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 subjective and objective clinical manifestations present in Mrs. J.
2. Describe four cardiovascular conditions in which Mrs. J is at risk, and that may lead to heart failure. What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions?
3. By following the nursing process, were the interventions at the time of admissions beneficial for Mrs. J? Would you change any of the interventions to ensure patient independence and prevent readmission?
4. Explain each of the seven medications listed in the scenario above. Include the classification, the action, and the rationale for each of these. Discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence and prevent readmission.
6.  Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits.

You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

A Sample Of This Assignment Written By One Of Our Top-rated Writers

Pathophysiology of Nursing Management of Client’s Health

The case study depicts Mrs. J a 63-year-old woman with a history of hypertension, chronic heart failure, and COPD. She is admitted to the ICU due to acute decompensated heart failure and acute COPD exacerbation. The purpose of this paper is to analyze the case and discuss the teaching plan.

Subjective and Objective Clinical Manifestations Present In Mrs. J

Mrs. J’s subjective findings include flu-like symptoms like fever, productive cough, nausea, and malaise. She has difficulties carrying out ADLs and has activity intolerance.  Besides, she reports dyspnea, palpitations, and increased fatigue. Objective findings include mild fever at 37.6C, tachypnea (RR-34), hypotension (BP-90/58), and tachycardia with irregular rhythm (HR-118). In the cardiovascular system, the patient has bilateral jugular vein distention, S gallop, a faint PMI at the sixth ICS, and atrial fibrillation. In the respiratory system, she has diminished breath sounds on the right lower lobe, frothy blood-tinged sputum cough, pulmonary crackles, and low oxygen saturations.

Cardiovascular Conditions in Which Mrs. J Is At Risk

Mrs. J is at risk of coronary artery disease (CAD), atrial fibrillation, cardiomyopathy, and Myocardial Infarction (MI). These conditions can lead to heart failure. CAD is a lifestyle disease that can be prevented through lifestyle interventions like regular physical exercises, cessation of smoking, and reducing caloric dietary intake.  Atrial fibrillation can be prevented from progressing to heart failure through calcium channel blockers and beta blockers, which control the heart rhythm. The progression of cardiomyopathy to heart failure can be prevented through healthy diets and physical exercises and by lowering BP using ACE inhibitors, beta-blockers, angiotensin II receptor blockers, and calcium channel blockers (Heidenreich et al., 2022). Furthermore, heart failure can be prevented in patients with MI by prescribing ACE inhibitors since they lower cardiac output, and anticoagulants to prevent the formation of blood clots.

Whether the Nursing Interventions at the Time of Admission Were Appropriate

The patient has symptoms of congestive heart failure (CHF) and thus IV lasix was appropriate. The patient had hypotension and therefore administering Enalapril was inappropriate at this time. Metoprolol was inappropriate for this patient since it is contraindicated in cases of hypotension and decompensated heart failure (Heidenreich et al., 2022). Morphine depresses the brain’s respiratory centers, which can lead to respiratory depression. The patient had breathing difficulties, which make IV morphine inappropriate since it would have deteriorated her respiratory symptoms. ProAir HFA is recommended in treating acute bronchospasms in COPD patients, and thus was appropriate for COPD exacerbation (Singh et al., 2019).  However, Flovent HFA was inappropriate during admission since it is used for long-term maintenance of COPD. Lastly, oxygen therapy was appropriate to increase oxygen saturation levels and improve associated dyspnea and limitations in activity.

Medications Listed In the Scenario

IV furosemide is a loop diuretic that acts on the proximal tubules causing the excretion of water and sodium. This decreases blood volume and preload and thus alleviates symptoms of CHF. Enalapril is an angiotensin-converting enzyme inhibitor (ACEI) that inhibits the conversion of angiotensin into angiotensin II. In the absence of angiotensin II, the BP decreases and the kidneys excrete sodium and fluid, decreasing the oxygen demand of the heart (Heidenreich et al., 2022). Metoprolol is a bête blocker that has negative inotropic and chronotropic action, which lowers cardiac output. Morphine is an opioid analgesic that acts as an analgesic and sedative. It is administered until a patient is free from chest pain and to relieve pulmonary congestion.  ProAir HFA is a Beta 2 Agonist that acts on beta-2 adrenergic receptors relaxing the bronchial smooth muscles (Singh et al., 2019). Flovent HFA is an anti-inflammatory corticosteroid that inhibits inflammatory cells thus reducing airway inflammation.

Strategies to reduce problems related to multiple drug interactions in elderly patients include medication reconciliation on admission. This helps to identify unintentional discrepancies between prescribed medications on admission and the patient’s usual medications before admission (Chiu et al., 2019). In addition, medication review on admission and at discharge can help ensure the appropriateness of medications prescribed to elderly persons. The third intervention is pharmacist counseling on admission and at discharge, which can increase patients’ drug knowledge thus ensuring proper use of medications to prevent drug-related problems. Lastly, clinicians can incorporate non-pharmacological treatments as alternatives to medications to reduce polypharmacy.

Health Promotion and Restoration Teaching Plan

The teaching plan for Mrs. J will focus on lifestyle interventions to slow the progression of COPD, Chronic HF, and hypertension and prevent complications. The lifestyle interventions include a healthy diet, physical exercises, and smoking cessation.  Mrs. J should be educated on healthy dietary habits like reducing caloric intake and consumption of processed foods and sugared drinks (Heidenreich et al., 2022). This will promote weight loss since she is obese and reduce the risk of developing obesity-related diseases like diabetes, CAD, and heart failure.  She will be advised to engage in moderate aerobic exercises for 15-300 minutes/week and muscle-strengthening exercises at least twice a week to improve cardiovascular and respiratory health, prevent COPD exacerbations, and promote weight loss. Smoking cessation will be emphasized since smoking is the primary risk factor for COPD.

Multidisciplinary resources that will facilitate the rehabilitation will include physical training, nutrition counseling, smoking cessation education, and physiotherapy. These resources are vital in helping Mrs. J to modify her diet and engage in physical exercises that align with her physical ability (Heidenreich et al., 2022). Smoking cessation education is crucial in helping the patient successfully quit smoking without relapse. Besides, physiotherapy will be crucial for chest exercises and mobilizing chest secretions from COPD.

Options for Smoking Cessation

Options for smoking cessation for this patient include Nicotine replacement therapy (NRT), E-cigarettes, and psychotherapy. NRT comes in various forms, like chewing gum, cutaneous patches, or inhaled/nasal delivery. These forms temporarily replace much of tobacco’s nicotine, reducing motivation to smoke tobacco and nicotine withdrawal symptoms (Handschin et al., 2019). This can ease the patient’s transition from cigarette smoking to complete abstinence. E-cigarettes are also effective in promoting smoking cessation. Psychotherapy is a great option to help Mrs. J with nicotine addiction since it helps an individual identify the factors causing the addiction and effective measures to eliminate them. COPD triggers for COP exacerbation include smoke, dust, and carbon monoxide.

Conclusion

The patient is at risk of CAD, atrial fibrillation, cardiomyopathy, and MI, which are associated with heart failure. Cardiovascular medications and lifestyle interventions can prevent these conditions from progressing to heart failure. The patient should be educated on lifestyle interventions like a healthy diet, physical exercises, and smoking cessation to prevent the deterioration of her condition.  

References

Handschin, J., Hitsman, B., Blazekovic, S., Veluz-Wilkins, A., Wileyto, E. P., Leone, F. T., & Schnoll, R. A. (2019). Factors Associated with Adherence to Transdermal Nicotine Patches within a Smoking Cessation Effectiveness Trial. Journal of smoking cessation, 13(1), 33–43. https://doi.org/10.1017/jsc.2017.2

Chiu, K. C., Lee, W. K., See, Y. W., & Chan, H. W. (2019). Outcomes of a pharmacist-led medication review program] for hospitalized elderly patients. Hong Kong medical journal = Xianggang yi xue za zhi, 24(2), 98–106. https://doi.org/10.12809/hkmj176871

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., … & Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 79(17), e263-e421. https://doi.org/10.1161/CIR.0000000000001063

Singh, D., Agusti, A., Anzueto, A., Barnes, P. J., Bourbeau, J., Celli, B. R.,Criner, G.J., Frith, P., Halpin, D.M., Han, M.,& Varela, M. V. L. (2019). Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019. European Respiratory Journal, 53(5), 1900164.

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