Critical Evaluation of the Mrs. J Case Study

Critical Evaluation of the Mrs. J Case Study

Typically, for effective and efficient healthcare delivery, it is important that BSN-RN-prepared nurses show an advanced understanding of medical histories, clinical symptoms, pathophysiological processes, and treatment procedures of diseases, as well as how they impact the well-being and livelihoods of patients. This knowledge can help nurses determine the right type of drugs or medical interventions to apply to a patient, especially based on current evidence-based outcomes. This case study, therefore, primarily aims to evaluate the various aspects of Mrs. J’s condition, including the clinical manifestations, appropriateness of the nursing interventions administered during admission, cardiovascular conditions, nursing interventions for elderly patients to avert problems with multiple drug interactions, health promotion, and rehabilitation education plan, how to avoid readmissions, and COPD options and alternatives for smoking cessation.

Clinical Manifestations of Mrs. J

Mrs. J is an older adult (63 years) with a history of COPD, chronic heart failure, as well as hypertension. At home, she needs about 2 liters of oxygen/nasal cannula during an activity, even though she smokes 2 packets of cigarettes. She reported feeling flu-like clinical manifestations for three days, including malaise, nausea, productive cough, and fever. She has been unable to carry out her ADLs and has since needed help to cover short distances. She has been admitted today with acute exacerbation of COPD, as well as decompressed heart failure. She is very anxious and keeps questioning whether she is going to die. She also mentions that she cannot get enough air but denies feeling pain. She can also not drink or eat by herself and reports feeling exhausted. Clinical assessments indicate that the patient has a So0₂ of 82 percent, reduced breath sounds at the right lower lobe, and pulmonary crackles. Her sputum is frothy and blood-tinged. Hepatomegaly is also present approximately 4 cm beneath the costal margin.

Assessment Of Nursing Interventions At Admission

All the nursing interventions administered during admissions were appropriate for Mrs. J, considering that she has clinical manifestations of acute exacerbation of COPD and decompressed heart failure. The first drug, Lasix, was specifically administered to treat hepatomegaly (liver enlargement due to fluid accumulation). Lasix is an antidiuretic and anthranilic acid derivative. On the other hand, Enalapril and Metoprolol were specifically used to treat hypertension and lower heart rate levels. Inhaled bronchodilators (short-acting) and corticosteroids were needed to alleviate asthma and flu-like symptoms, including breathing difficulties. Delivery of oxygen (non-invasive ventilation) was also necessary to stabilize the respiratory rate (which is 34) as well as the oxygen saturation (which is 82 percent instead of the normal 94-100%). The only drug that might be considered unnecessary, perhaps because the patient reports no pain, is morphine sulfate. Regardless, studies indicate that all these interventions are necessary to treat COPD exacerbation and heart failure symptoms (Celutkiene et al., 2017).

Cardiovascular Conditions Resulting In Heart Failure And Interventions

Some of the four cardiovascular diseases that can lead to heart failure include heart attack, coronary artery disease, hypertension, and congenital heart valve disease (Lawson et al, 2020). Coronary heart disease comes about when arteries narrow due to the accumulation of fat deposits, increasing blood pressure. Treatment of coronary heart disease includes a combination of surgery, angioplasty, chemotherapy, and lifestyle changes. A heart attack, on the other hand, is caused by a blocked artery due to coronary heart disease or other causes, disrupting blood flow to the heart. Treatment includes lifestyle changes, bypass surgery, medication, and cardiac rehabilitation. The third cause of heart failure, hypertension, occurs when the force exerted by blood against arteries is higher than normal (above 140/90 mm Hg). Interventions to control hypertension range from lifestyle changes (smoking cessation, physical exercise, eating low sodium) and medications (such as ACE inhibitors). Finally, congenital heart valve disease (which is aortic or pulmonary valves that do not function properly) can be corrected through surgery.

Nursing Interventions For Senior Patients To Avert Issues Brought On By Multiple Drug Interactions

Typically, older patients are susceptible to multiple drug reactions because they often take more than one type of medication at any point in their lives. Some of the strategies that can be used to reduce these interactions (especially polypharmacy) include reviewing dosages, evaluating drug-drug interactions, avoiding duplicate therapies, and carrying out medical reconciliations during care transitions (Rankin et al., 2018).

Health Promotion And Rehabilitation Teaching Plan

The first rehabilitation and health promotion teaching program will focus on educating patients on independently carrying out peripheral muscle and dyspnea training. In particular, patients should be taught how to carry out pulmonary workouts to improve exercise tolerances and physical activity. The goal is to help patients cope with ADL (activities of daily living), thus helping them transition to independence. Patients should be taught how to carry out pulmonary muscle training, body flexibility, muscle strength, and cardiorespiratory endurance (Vitacca & Paneroni, 2018). To effectively understand these resources, educators must offer brochures, posters, etc.

Techniques For Offering Education To Prevent Hospital Readmissions

Because Mrs. J is old (63 years), a one-on-one session with the nurse educator is one of the most appropriate and effective teaching techniques required to make her remember the drugs needed to avoid hospital admission in the future. The nurse educator should also maintain eye contact, and the environment must be away from any distractions. In addition, the patient should be given printed material (such as charts, prescription descriptions, posters, brochures, graphics, charts, or analogies) to take home as a reminder.

COPD Alternatives And Triggers For Smoking Ending

Some of the COPD triggers that can increase and call for future visits include cigarette smoking, dust and fumes, respiratory infections, air pollution, and extreme weather changes (humid, hot, or cold). Considering Mr. J’s smoking history, the alternatives for cessation include counseling, self-help, nicotine replacement therapy, and therapy (such as Bupropion, Varenicline, or a combination of therapies).

References

Celetkiene, J., et al. (2017). Challenges of treating acute heart failure in patients with chronic obstructive pulmonary disease. Cardiac Failure Review, 3(1), 56-61. doi: 10.15420/cfr.2016:23:2

Lawson, C. A., et al. (2020). Risk factor for heart failure – 20-year population-based trends by sex, socioeconomic status, and ethnicity. Circulation: Heart Failure, 13(2). https://doi.org/10.1161/CIRCHEARTFAILURE.119.006472

Rankin, A., et al. (2018). Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Library, 9, CDOO8165. doi: 10.1002/14651858.CD008165.pub4

Vitacca, M., & Paneroni, M. (2018). Rehabilitation of patients with coexisting COPD and heart failure. COPD, 15(3), 231-237. DOI: 10.1080/15412555.2018.1468427

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Critical Evaluation of the 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; 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:

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 a 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.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

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• Maximum Points: 120.0