Case Study Assignment: 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

Case Study Assignment: 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

Case Study Assignment: 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

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.
Include this reference
Andrea R. Johnson (2018). Cardiorespiratory Complexities. Pathophysiology: Clinical applications for client health. Retrieved from https://lc.gcumedia.com/nrs410v/pathophysiology-clinical-applications-for-client-health/v1.1/

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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

Cardiorespiratory Complexities

Clinical manifestations present in Mrs. J

Mrs. J’s temperature of 37.60C indicates that she is suffering from mild fever. Her temperature is a little higher than the typical range of 36.8 to 37.2 degrees Celsius. This is considered a low-grade fever. The patient’s respiratory rate of 34 is also much higher than normal. Additionally, at 118, her pulse rate is much higher than the average of 60–100. Mrs. J’s blood pressure is just 90/58, which is much lower than the typical range of 120/80. This client exhibits symptoms consistent with having a respiratory ailment. Symptoms like this comprise a cough that is bloody, cracking sounds coming from the lungs and a reduced degree of oxygen saturation.

ORDER A CUSTOMIZED, PLAGIARISM-FREE HERE ON: Case Study Assignment: 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

Nursing Interventions at the time of her Admissions

In light of Mrs. J.’s current state of health, the drugs that were prescribed to her were suitable. Her elevated pulse rate and difficulty breathing suggest that her airway is partially or completely blocked. The patient is now taking a number of drugs, including IV furosemide, as part of one of those prescriptions. Because it helps lessen symptoms of decompensated heart failure and general malaise, this medication is useful for COPD patients (Bollmeier & Hartmann, 2020). Furthermore, Enalapril is a good choice since it reduces the person’s blood pressure by causing the blood vessels to constrict more effectively. Individuals who have had a heart attack really need to take metoprolol since it lessens the severity of their chest discomfort and boosts their chances of surviving the incident. Since morphine is an analgesic, which means that it may reduce or eliminate pain, the recommendation that it be given to Mrs. J. is correct. Individuals who have trouble breathing are treated with an inhaled short-acting bronchodilator. As a result, this medication is appropriate for the patient. In addition, because inhaled corticosteroid is a treatment for asthma, Mr. J. is a good candidate for this drug. Finally, the client’s breathing is improved by the 2L/NC oxygen therapy.

Cardiovascular Conditions that May lead to Heart Failure

Abnormal heart valves are a disorder that may be a contributing factor in the development of heart failure. Medication management, including the administration of an anticoagulant, is the nursing approach that is used for this illness. Heart valve surgery may also be performed in certain cases. High blood pressure is another possible cause of heart failure. Reduced substance use and an increase in the consumption of whole, plant-based foods, including those found in fruits and vegetables, have been linked to improvements in this disease. Heart muscle disease is the third illness that may cause heart failure (Vukoja et al., 2019). Medications including antiplatelet medicines and beta blockers can be used to help address this illness. Finally, coronary artery disease is a possible cause of heart failure. Positive lifestyle modifications, including regular exercise and giving up tobacco, have been shown to alleviate the symptoms of this disease.

Nursing Interventions associated with Multiple Drug Interactions

Regular medication review is among the nursing interventions that may be used to address the difficulties that are caused by multiple drug interactions. Reviewing one’s medications on a consistent basis eliminates the risk of undesired interactions between medications, which is especially important when one is taking a number of different medications. The utilization of CMS as a means of finding drugs that might be clinically unsuitable is the second approach. Considering the client’s current state of health, this approach may help determine which medications are suitable for her and which are not, as well as which medications should be avoided. The use of the Hamdy questions is yet another strategy. These questions provide assistance in determining which drugs should be stopped. Finally, continuous patient monitoring is essential, particularly for individuals who are using psychiatric medications. Because these medicines are only prescribed in certain circumstances, they need to be carefully supervised.

Health Promotion and Restoration Teaching Plan

As part of a strategy to improve Mrs. J’s health, she has to commit to a regular exercise routine and a diet of healthy foods in order to keep her weight stable. In addition, it is important for the patient to abstain from engaging in harmful habits like drug abuse. COPD patients may benefit from the input of multidisciplinary resources, such as different kinds of medical experts, including physiotherapists, dietitians, nurses specializing in COPD, and other specialists.

Method for Providing Education for Mrs. J

Mrs. J. needs individualized, hands-on instruction that combines presentations, analogies, and illustrations to help her understand the information being delivered. Educational displays with concepts that are given one-on-one to patients would assist patients in connecting to what is being shown to promote their health.

COPD Triggers that can increase Exacerbation Frequency

COPD may be brought on by a number of different factors. Indoor air pollution, pungent scents, and cigarette smoke are a few examples of them (Moraros et al., 2017). Mrs. J.’s need to return to the hospital more often may be exacerbated by these factors. Nicotine replacement therapy and the use of Varenicline are two methods that have proven successful in helping people quit smoking.

References

Bollmeier, S. G., & Hartmann, A. P. (2020). Management of chronic obstructive pulmonary disease: A review focusing on exacerbations. American Journal of Health-System Pharmacy, 77(4), 259-268. https://doi.org/10.1093/ajhp/zxz306

Moraros, J., Osman, S., Ziegler, C., Gibson, R., & Mahmood, R. (2017). The association between risk factors and chronic obstructive pulmonary disease in Canada: A cross-sectional study using the 2014 Canadian community health survey. International Journal of Preventive Medicine, 8(1), 86. https://doi.org/10.4103/ijpvm.ijpvm_330_17

Vukoja, M., Kopitovic, I., Lazic, Z., Milenkovic, B., Stankovic, I., Zvezdin, B., Dudvarski Ilic, A., Cekerevac, I., Vukcevic, M., Zugic, V., & Hromis, S. (2019). <p>Diagnosis and management of chronic obstructive pulmonary disease in Serbia: An expert group position statement</p>. International Journal of Chronic Obstructive Pulmonary Disease, 14, 1993-2002. https://doi.org/10.2147/copd.s214690