Case Study Assignment: Critical Thinking

Case Study Assignment: Critical Thinking

Case Study Assignment Critical Thinking

 

1. What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?

Based on the patient’s subjective and objective data, the nurse can start the patient on a care plan aimed at managing left-sided cardiac failure. The respiratory status of the patient indicates that she has a spao2 of 82%. She also has decreased breathing sounds on the right lower lobe, in addition to productive cough with frothy blood-tinged sputum. The nurse is required to administer oxygen therapy for the management of these symptoms. Consequently, the patient’s crackles are an indication of fluid overload and congestion in addition to jugular venous distension (JVD). These symptoms can be managed by administering diuretics intravenously (Carnagarin, Matthews, Gregory, & Schlaich, 2018). A Foley catheter could be placed potentially to ensure strict I&Os and possible fluid retention. The patient’s weight should also be monitored daily to assess the effectiveness of the treatment and the patient’s general health status. A chest x-ray is also necessary to check whether the patient’s symptoms are as a result of an underlying infection. The patient’s slight increase in body temperature can be managed by Tylenol.

2. 2. With the patient’s cardiovascular system. The patient would be on 24hr telemetry monitoring. Medications would be administered to treat the patients AFIB to control the rate and for anticoagulation therapy.

IV furosemide (Lasix)- This drug is classified under loop diuretics. It is used to manage edema as a result of heart failure. It increases urine frequency, mobilizing the excretion of excess fluids from the body, as a result of cardiac failure. It is also effective in lowering the blood pressure of the patient (Carnagarin, Matthews, Gregory, & Schlaich, 2018).

Enalapril (Vasotec)- This is an angiotensin-converting enzyme ACE inhibitor. It is used in maintaining the patient’s blood pressure within normal limits. It is also used in the management of congestive heart failure in combination with diuretics.

Metoprolol (Lopressor)- This is a selective beta1-adrenoreceptor blocking agent. It blocks the action of certain natural chemicals such as epinephrine on the blood vessels and the heart. It is effective in lowering blood pressure, heart rate, and cardiovascular strain. It is also effective in the management of atrial fibrillations.

IV morphine sulfate (Morphine)- This drug belongs to the class of narcotic analgesics. It is used in the treatment of severe pain, such as chest pain. It also helps in improving cardiac workload and reducing anxiety (Carnagarin, Matthews, Gregory, & Schlaich, 2018).

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.

• High blood pressure: Uncontrolled high blood pressure increases the patient’s risk of developing heart failure. High pressure in the blood vessels strains the heart muscles as the heart will be required to pump blood with a lot of force increase the cardiac work load. With time, the heart becomes weak leading to heart failure. The nursing intervention to prevent this is by ensuring that the patient takes appropriate medication to control blood pressure. The patient blood pressure should also be monitored regularly to ensure that it is always within the normal limits. PRN should also be ordered, or medication adjusted to meed the MD’s parameters (Screever, Meijers, Van, & De, 2017). The patient should also be educated on non-pharmacological ways of maintaining blood pressure such as cutting down on high-calorie food and regular exercise.
• Coronary artery disease: Blockage or narrowing of the coronary arteries usually leads to atherosclerosis, which can lead to heart failure as a result of the heart being overworked. The nurse needs to ensure that the risk factors are reduced, medication is taken appropriately and if necessary, see that the patient undergoes through an invasive or surgical procedure.
• Obesity: Obese individuals tend to have high-fat deposits on the walls of the blood vessels hence making them narrow. As a result, the hearing is overworked when pumping blood, and becomes week with time leading to heart failure. The nurse can help the patient take medications to lower body calories and manage obesity. The patient also needs to be educated on ways of reducing their weight, while monitoring their BMI.
• Sleep apnea: Pauses in breathing can result in fatigue, which will intern cause a number of conditions such as high blood pressure, heart failure, stroke, and diabetes. The nurse needs to ensure that the patients sleep study is completed or ordered (Carnagarin, Matthews, Gregory, & Schlaich, 2018). Appropriate medications and interventions are also required such as CPAP at night. The patient should also be educated on the relevance of adhering to CPAP, and the implications associated is not observed.

4. 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.

Educate and help the patient keep track of an accurate log and list of all the drugs in terms of their dosing and frequency, in addition to herbal medications (Williams, Malani, & Wesorick, 2014). This will help the medical practitioner review the patient’s medication to avoid interactions.

Encourage the patient to maintain only one primary care physician who can keep track of the patient’s medication and compliance to avoid any unnecessary drug interaction to promote patients health.

In case the patient transfers to another healthcare facility, educate them on the importance of providing a complete medical history,

for assessment before prescription of new drugs to avoid unnecessary interactions.

Educate the patient on the importance of completing the recommended dose as prescribed by the physician to avoid resistance and interactions in the future, for the realization of the intended therapeutic benefits.

Acknowledge the patient on the importance of reading drug inserts so that they can be aware of the indications, side effects and adverse reactions in addition to all the information about the drug they are taking to avoid any sudden unexpected effects.

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Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.

Case Scenario

Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure and sleeps apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.

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 so exhausted she cannot eat or drink by herself.
Objective Data

Height 175 cm; Weight 95.5 kg
Vital signs: T 37.6 C, 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 4 cm below costal margin
Critical Thinking Questions

1. What nursing interventions are appropriate for Mrs. J. at the time of her admission?
(B) Drug therapy is started for Mrs. J. to control her symptoms.
What is the rationale for the administration of each of the following medications?

IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)

2. Describe four cardiovascular conditions in detail that may lead to heart failure and what can be done in the form of medical/nursing interventions, along with education to prevent the development of heart failure in each condition.

3. Taking into consideration the fact that most mature adults take at least six prescription medications,

(A) discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients.

(B) Provide rationale for each of the interventions you recommend.

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource