NRS 410 Case Study: Mrs. J. Assignment

Case Study: Mrs. J. Assignment

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The case scenario discussed is of 63-year-old Mrs. J who has been in care for chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) and is now admitted due to their exacerbations. She reports a history of cigarette smoking, hypertension, poor compliance to medication, and a recent upper airway tract infection. This discussion aims to describe how she was managed, the reasons for exacerbation, and patient management plans.

Question 1

COPD that Mrs. J is characterized by an inflamed airway that impairs expiration of gases thus presenting with dyspnea. The limited expiration results in the accumulation of carbon (IV) oxide in the body which triggers anxiety (Choi & Rhee, 2020). On the other hand, CHF reduces the heart’s ability to pump blood thus irregular heartbeat occurs described as the heart running away (Schwinger, 2021). It also presents with fatigue due to impaired blood supply to the body tissues (Hajar, 2019).

Question 2

            Medications that have been administered to manage Mrs. J can be justified due to their effects. Furosemide and enalapril work through a different mechanisms of action to reduce the decompensation of the heart in CHF (Hajar, 2019). Although furosemide encourages diuresis by inhibiting the reabsorption of sodium in kidney tubules whereas enalapril inhibits the renin-angiotensin-aldosterone system (RAAS), they both lead to a decrease in preload and afterload (Lee et al., 2019). This reduces pressure against the heart and also corrects the reported edema especially due to furosemide use.

Cardiorespiratory complexities include a wide range of disorders affecting the cardiovascular and respiratory systems. They commonly occur in elderly patients due to cardiac and lung physiologic functioning (Riley & Masters, 2016). Common cardiorespiratory conditions include chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, emphysema, congestive cardiac failure (CCF), pneumonia, hypertension, and myocardial infarction. This paper will discuss Mrs. J, a patient with cardiorespiratory conditions, and analyze the nursing interventions provided. I will also outline a health promotion teaching plan and options for smoking cessation for Mrs. J.

Clinical Manifestations Present In Mrs. J

Mrs. J has a history of hypertension, chronic heart failure, and COPD. She presents with a sudden onset of flu-like symptoms such as fever, nausea, productive cough, and malaise and could not perform ADLs. On physical exam, she has a BMI of 31.2, categorized as obesity. She has a low-grade fever of 37.6C, tachycardia with an irregular rhythm, tachypnea, and hypotension. The cardiovascular exam reveals S gallop, with faint PMI at 6^th ICS, which points to left ventricular hypertrophy. The patient also has bilateral jugular vein distention, which points to congestive heart failure, a ventricular rate of 132, and atrial fibrillation. On respiratory exam, there were pulmonary crackles, decreased breath sounds on the right lower lobe, frothy blood-tinged sputum cough, and SpO2 82%. This suggests excessive airway secretions, fluid in the lungs with limited perfusion of the lungs, and inadequate body tissue perfusion. GI examination reveals hepatomegaly of 4cm below the costal margin.

Nursing Interventions

The nursing intervention implemented include administration of Oxygen 2L through a nasal cannula. The intervention was appropriate because the patient had low oxygen saturation levels of 82%, and it would enhance tissue perfusion. In addition to oxygen therapy, other nursing interventions included administration of IV furosemide, Enalapril, Metoprolol, IV morphine, ProAir HFA, and Flovent HFA. Furosemide was appropriate for this patient since it is a loop diuretic that acts by inhibiting reabsorption of sodium and chloride at the proximal tubules. This results in the elimination of water and sodium, thus lowering blood volume and preload as well as correcting congestive heart failure (Aronow, 2018). Enalapril inhibits angiotensin-converting enzyme, which facilitates the conversion of angiotensin I into angiotensin II. Angiotensin II is a potent vasoconstrictor and thus lowers blood pressure (Aronow, 2018). Administering Enalapril was inappropriate because the patient had a low blood pressure of 90/58.

Metoprolol was not an appropriate medication since it lowers cardiac output through negative inotropic and chronotropic effects. It is also contraindicated in decompensated heart failure and hypotension, present in Mrs. J (Aronow, 2018). Morphine was not an appropriate medication since the patient denied having pain, and morphine depresses the brain’s respiratory centers and increases the risk of respiratory depression. A safer sedative such as nonbenzodiazepines should have been administered. ProAir HFA was an appropriate drug to relieve COPD exacerbations. It relaxes bronchial smooth muscles and relieves acute bronchospasms (Rosenberg & Kalhan, 2017). Flovent HFA is an anti-inflammatory corticosteroid and is used for long-term maintenance prevention of bronchospasms caused by COPD (Rosenberg & Kalhan, 2017). It should not have been administered to relieve acute COPD exacerbations but rather be prescribed as a long-term therapy.

Cardiovascular Conditions That May Lead To Heart Failure

Coronary Artery Disease (CAD)

CAD results in limited blood flow to the myocardium due to the accumulation of cholesterol and fatty deposits in the arteries. The heart is forced to pump harder to promote adequate tissue perfusion, which results in hypertrophy and eventually, heart failure (Inamdar & Inamdar, 2016). Medical interventions to prevent progression to heart failure include administering lipid-lowering agents to lower cholesterol levels and increasing blood supply to the myocardium (Inamdar & Inamdar, 2016). Nursing interventions can entail patient education on lifestyle modification to reduce blood cholesterol levels and promote heart functioning.

Aortic Stenosis

Aortic stenosis results in obstruction of left ventricular outflow, which causes increased pressure on the left ventricle. The ventricular wall hypertrophies, and the heart begins to fail (Thomas, 2019). Medical interventions that can prevent progression to heart failure include surgical replacement of the aortic valve and percutaneous balloon valvuloplasty.

Hypertension

 Hypertension causes increased heart contractility to promote circulation. This results in hypertrophy, and the myocardium weakens over time, resulting in the heart’s inability to pump enough blood to meet the body’s requirements (Thomas, 2019). Medical interventions to prevent heart failure include administering antihypertensive that causes vasodilation and decreases cardiac output (Inamdar & Inamdar, 2016). Nursing interventions include patient education on lifestyle modification to lower blood pressure and improve cardiac functioning.

Cardiomyopathy

Cardiomyopathy results in impaired cardiac output. A decrease in stroke volume stimulates the sympathetic nervous system and the renin-angiotensin-aldosterone response, causing increased systemic vascular resistance and increased sodium and fluid retention, which places an increased workload on the heart (Thomas, 2019). These alterations can lead to congestive heart failure. Medical interventions include prescribing Beta-blockers and anticoagulants.

Nursing Interventions to Prevent Problems Caused by Multiple Drug Interactions

Nursing interventions may include conducting a patient assessment to identify the drug side effects a patient reports and identifying the drug interaction that could be causing the side effects (Cantlay, Glyn & Barton, 2016). The nurse can document the reported side effects and recommend the drugs that should be stopped to the prescribing clinician to help lower the severity of side effects. Additional nursing interventions include conducting a comprehensive drug evaluation of every drug prescribed to a patient (Cantlay, Glyn & Barton, 2016). This can help identify the drugs that may have multiple drug interactions and recommend for modification of the treatment plan. Furthermore, the nurse can recommend alternative non-pharmacological measures to manage chronic illnesses and symptoms such as chronic pain (Cantlay, Glyn & Barton, 2016). For example, heat and cold massages and physiotherapy can be used to manage pain, while lifestyle interventions can be recommended for lifestyle diseases.

Health Promotion and Restoration Teaching Plan for Mrs. J

The health promotion plan for Mrs. J will focus on lifestyle modification to promote better self-management of chronic conditions and prevent disease progression. The first lifestyle intervention will be on cessation of smoking to avoid exacerbation of bronchospasms secondary to COPD and slow the advancement of COPD (Rosenberg & Kalhan, 2017). The second intervention will be to increase physical activity by engaging in moderate exercises such as brisk walking and jogging that the patient can tolerate. This will promote weight loss, improve lung function, maintain blood pressure within a normal range, and boost heart functioning (Thomas, 2019). Besides, the patient will be recommended on healthy dieting such as the DASH diet to help manage blood pressure and promote weight loss.

Multidisciplinary resources needed to rehabilitate Mrs. J will consist of nutritional interventions, assistance in activities of daily living, energy-saving techniques, physical training, and health education on self-management (Riley & Masters, 2016). The rehabilitation resources will help Mrs. J transition to independence by helping her adopt self-management skills that will enable her to conduct daily living activities.  Besides, energy-saving techniques will help the patient perform her activities independently with minimal restrictions (Riley & Masters, 2016). Physical training will help increase lung function and enable the patient to work independently without exertional dyspnea.

Education for Mrs. J. Regarding Medications

Mrs. J should be educated on drug adherence to prevent future hospitalization due to COPD exacerbations, hypertension urgency, or worsening heart failure. The patient and the caregiver can be advised to have a list of all her drugs with their frequency, dosages, and indication for each drug (Cantlay, Glyn & Barton, 2016). They can be instructed to use the list when taking medications to ensure she has taken all the essential drugs. She can also be instructed to label each drug container according to the indication for each, to ensure she has taken drugs for each health condition (Cantlay, Glyn & Barton, 2016). Besides, she can use color-code pill containers to avoid confusion or drug overdose (Cantlay, Glyn & Barton, 2016). Mrs. J can also be recommended to store the essential drugs where she can see and use reminders to help her remember to take her drugs.

COPD Triggers That Can Increase Exacerbation Frequency

Tobacco smoke is the most common COPD trigger, which accounts for 80-90% of exacerbations due to bronchoconstriction (Rosenberg & Kalhan, 2017). Exposure to second-hand smoke, carbon monoxide, and dust may also trigger COPD exacerbations leading to hospitalization (Rosenberg & Kalhan, 2017). Mrs. J can be offered smoking cessation options such as professional counseling with education on how tobacco smoking causes COPD exacerbations and leads to the progression of hypertension and heart failure. Group counseling should be provided for the patient to interact with individuals who are in the process of tobacco smoking to increase the likelihood of complete tobacco cessation.

References

Aronow W. S. (2018). Antihypertensive drug therapy. Annals of translational medicine, 6(7), 123. https://doi.org/10.21037/atm.2018.01.26

Cantlay, A., Glyn, T., & Barton, N. (2016). Polypharmacy in the elderly. InnovAiT, 9(2), 69-77. https://doi.org/10.1177/1755738015614038

Inamdar, A. A., & Inamdar, A. C. (2016). Heart Failure: Diagnosis, Management, and Utilization. Journal of clinical medicine, 5(7), 62. https://doi.org/10.3390/jcm5070062

Riley, J. P., & Masters, J. (2016). Practical multidisciplinary approaches to heart failure management for improved patient outcomes. European Heart Journal Supplements, 18(suppl_G), G43-G52.https://doi.org/10.1093/eurheartj/suw046

Rosenberg, S. R., & Kalhan, R. (2017). Recent advances in the management of chronic obstructive pulmonary disease. F1000Research, 6, 863. https://doi.org/10.12688/f1000research.9819.1

Thomas, M. (2019). Pathophysiology and management of heart failure. Acute pain, 10, 00.

 

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. Case Study: Mrs. J. Assignment

Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT on Case Study: Mrs. J. Assignment

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. Case Study: Mrs. J. Assignment

Case Study: Mrs. J. Assignment

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 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. Case Study: Mrs. J. Assignment

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. 

Course Code Class Code Assignment Title Total Points
NRS-410V NRS-410V-O502 Case Study: Mrs. J. 120.0

Criteria Percentage Unsatisfactory (0.00%) Less Than Satisfactory (75.00%) Satisfactory (79.00%) Good (89.00%) Excellent (100.00%)
Content 80.0%
Clinical Manifestations of Mrs. J. 10.0% Clinical manifestations are omitted. Clinical manifestations are partially presented. There are major omissions and inaccuracies. Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete. Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms. Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.

Case Study: Mrs. J. Assignment Evaluation of Nursing Interventions at Admissions 10.0% Evaluation of appropriateness of nursing interventions at the time of admission and explanation of the rationale for each of the medications listed are not discussed. Evaluation of appropriateness of nursing interventions at the time of admission is partially presented. An incomplete explanation for each of the medications listed is presented. The discussion contains significant inaccuracies. Evaluation of appropriateness of nursing interventions at the time of admission is summarized. A general explanation and some rationale for each of the medications listed are presented. There are minor inaccuracies. Evaluation of appropriateness of nursing interventions at the time of admission is discussed. An explanation and general rationale for each of the medications listed are presented. Some information is required for accuracy or clarity. Evaluation of appropriateness of nursing interventions at the time of admission is thoroughly discussed. A well-supported explanation for each of the medications listed is presented. Strong and compelling rationale is provided.

Cardiovascular Conditions Leading to Heart Failure and Interventions 10.0% Fewer than three cardiovascular conditions that may lead to heart failure, and medical or nursing interventions to prevent the development of heart failure in each condition, are described. Four cardiovascular conditions that may lead to heart failure are partially described. Medical or nursing interventions to prevent the development of heart failure in each condition are incomplete. There are significant inaccuracies. Four cardiovascular conditions that may lead to heart failure are summarized. Medical or nursing interventions to prevent the development of heart failure in each condition are generally discussed. There are some inaccuracies. Four cardiovascular conditions that may lead to heart failure are described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. There are minor inaccuracies, or information is needed for clarity. Four cardiovascular conditions that may lead to heart failure are clearly described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. Overall, the discussion demonstrates insight into medical and nursing interventions used to prevent heart failure.

Case Study: Mrs. J. Assignment Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions 10.0% Fewer than three nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are presented. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are partially presented. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are summarized. Overall, the discussion meets assignment criteria but requires more rationale for the interventions. There are minor inaccuracies. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. Overall, the discussion meets assignment criteria and general rationale for the interventions is provided. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. The discussion fulfills the assignment criteria and strong rationale for the interventions is provided.

Health Promotion and Restoration Teaching Plan 15.0% A health promotion and restoration teaching plan for the patient is omitted. A health promotion and restoration teaching plan for the patient is partially presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are omitted or incomplete. An explanation for how rehabilitation resources and modifications assist patient transition to independence is omitted or incomplete. A health promotion and restoration teaching plan for the patient is summarized. Multidisciplinary resources for rehabilitation and any modifications that may be needed are generally presented. A summary for how rehabilitation resources and modifications assist patient transition to independence is presented. There are minor inaccuracies. A health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are discussed. An explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. A well-developed health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are clearly discussed. An strong explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. The overall discussion is well-supported.

Method for Providing Education to Prevent Hospital Readmissions 15.0% A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is omitted. The method is not appropriate for the client or health status. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is partially summarized. The method may not be relevant to for this situation. More information is needed. There are major inaccuracies. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is summarized. The method is generally appropriate. Some rationale is provided for support. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is described. Overall, the method is appropriate. General rationale is provided for support. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is thoroughly described. The method is clearly appropriate for the client and prevents readmission. Strong rationale is provided for support.

COPD Triggers and Options for Smoking Cessation 10.0% COPD triggers exacerbating return visits and options for smoking cessation are omitted. Some COPD triggers exacerbating return visits are partially presented. Options for smoking cessation are incomplete; it is unclear if the options are relevant to the patient. General COPD triggers exacerbating return visits are generally presented. Some options for smoking cessation relevant to the patient are summarized. Some support or information is needed. Key COPD triggers exacerbating return visits are outlined. General options for smoking cessation relevant to the patient are summarized. All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.

Organization, Effectiveness, and Format 20.0%
Thesis Development and Purpose 5.0% Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and