NRS 410 Case Study: Mrs. J. Assignment
Case Study Mrs. J.
Mrs. J. was admitted to the intensive care unit (ICU) due to breathing difficulties. Mrs. J, who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease, is the subject of this case (COPD). On the other hand, she smokes and has done so for 40 years, increasing her chance of developing COPD.
The Presentation of the Patient
Due to the decreased performance of the patient’s breathing system, the patient requires two liters of oxygen at home during activities. The patient presented with flu-like symptoms including fever, nausea, persistent cough, and malaise. Additionally, she is unable to execute ADLs and is unable to walk comfortably alone. Acute decompensated heart failure and an acute aggravation of chronic obstructive pulmonary disease were the reasons for the patient’s admission to the intensive care unit. Mrs. J. appears apprehensive and concerned about whether she will make it or not. She is dyspneic yet claims not to be in discomfort. She is exhausted and unable to eat or drink.
The Nursing Intervention Is Appropriate
Because the patient was dyspneic, the primary action would be to improve respiratory function and perfusion. As a result, the patient was admitted to the intensive care unit due to her inability to breathe normally. To alleviate the symptoms, a number of drugs was administered. Nursing interventions were necessary. To improve the respiratory system’s function and address COPD, the patient was given an inhaled short-acting bronchodilator (ProAir HFA) and an inhalation corticosteroid (Flovent HFA) (Torres et al., 2018). The two medications would alleviate airway irritation. Additionally, she was initiated on oxygen supplied at a rate of 2L/NC to satisfy the body’s oxygen demand, as she was unable to meet it spontaneously. Oxygen was administered because the patient’s SpO2 level was only 82 percent, which is considered poor. Mrs. J. Case Study – NRS 410
Due to the patient’s signs of heart failure, IV furosemide was administered (Lasix). Furosemide is a diuretic medication used to treat edema in congestive heart failure patients (Vardeny et al., 2019). Patients with heart failure have impaired perfusion, which means that fluids are likely to accumulate in their lungs and extremities. The circulatory system is critical for tissue bathing; a failing heart prevents blood from being circulated to all regions of the body, jeopardizing the tissue bathing function (Lang et al., 2020). Eliminating extra fluid from the body improves the heart’s perfusion and function.
Additionally, the patient was prescribed Enalapril to assist with blood pressure control. She had skipped three days of hypertension
medication and her blood pressure was 90/58. Enalapril is an ACE inhibitor, which means it prevents the synthesis of angiotensin II, which clogs the blood vessels, resulting in higher blood pressure (Vardeny et al., 2019). Following that, the patient was given metoprolol to assist in managing the patient’s elevated heart rate; the patient’s heart rate was 118 beats per minute. Additionally, IV morphine was administered, which was required given the patient’s anxiety. Additionally, the medication is utilized to manage pain. Mrs. J. Case Study – NRS 410
Four Cardiovascular Conditions That May Lead To Heart Failure
The common factor causing heart failure include hypertension, rheumatic heart disease, coronary artery disease, and cardiomyopathy. The conditions require different nursing interventions. People with cardiomyopathy require administration of furosemide and metoprolol to maintain a regular heart rhythm. On the other hand, hypertension requires the administration of diuretics and beta or alpha-acting adrenergic antagonists (Ruan et al., 2018). For rheumatic heart disease, the patients are given antibiotics to treat streptococcal infections and manage the possibly damaged heart valves. Finally, coronary heart disease requires the administration of Angiotensin-converting enzyme inhibitors. Addressing the four factors in time reduces the risk of developing heart failure.
NRS 410 Case Study: Mrs. J. Assignment Four Nursing Interventions that Can Help Prevent Problems Caused by Multiple Drug Interactions
The first intervention involves educating the patients on the role of the various medications given to them to improve adherence. Secondly, the nurses should assess the patients for any mental health problem and address them accordingly. Patients with mental problems are likely to have poor adherence. Thirdly, the nurses have to assess the medication history of the patients and eliminate any drug that could have adverse outcomes in them. The fourth intervention involves reviewing the patient’s medication for deprescription and prescriptions regularly.
Health Promotion and Restoration Teaching Plan for Mrs. J.
The health promotion will involve educating the patient on the need to take the prescribed medications accordingly. The patient demonstrated poor adherence from the medication history and this could negatively affect the treatment outcomes (Toukhsati et al., 2019). In addition, the patient should be enrolled in a rehabilitation program to help her overcome the smoking addiction; this will involve both psychotherapy and medical interventions to address the withdrawal symptoms. NRS 410 Case Study: Mrs. J. Assignment
Method for providing Education
The use of posters and direct interaction with the healthcare providers are the most appropriate methods for providing education to the patients. The posters can be given to the patient and will serve as a reminder of what she should do and what not to do (Hasanica et al., 2020). On the other hand, the direct interaction will help the healthcare provider address specific health needs of the patient, but also, allow the patient to seek clarification on areas of interest.
COPD Triggers that Can Increase Exacerbation Frequency
The common COPD triggers include smoking, air pollution, and extreme weather conditions. Also, dust, fumes, and respiratory diseases could exacerbate the frequency of the disease (Viniol & Vogelmeier, 2018). In this case, the possible options for smoking cessation include the prescribed nicotine spray and the use of Zyban. The interventions will help reduce the frequency of COPD.
Mrs. J. presents with multiple health conditions and so requires polypharmacy. However, lifestyle and behaviors including smoking could affect the treatment outcome negatively. Offering relevant education and rehabilitation will significantly improve her health condition.
Hasanica, N., Catak, A., Mujezinovic, A., Begagic, S., Galijasevic, K., & Oruc, M. (2020). The effectiveness of leaflets and posters as a health education method. Material Socio Medica, 32(2), 135. https://doi.org/10.5455/msm.2020.32.135-139
Lang, K., Van Iterson, E. H., & Laffin, L. J. (2020). Contemporary strategies to manage high blood pressure in patients with coexistent resistant hypertension and heart failure with reduced ejection fraction. Cardiology and Therapy. https://doi.org/10.1007/s40119-020-00203-5
Ruan, Y., Guo, Y., Zheng, Y., Huang, Z., Sun, S., Kowal, P., Shi, Y., & Wu, F. (2018). Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: Results from SAGE wave 1. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-5653-9
Torres, A., Crisafulli, E., Barbeta, E., & Ielpo, A. (2018). Management of severe acute exacerbations of COPD: An updated narrative review. Multidisciplinary Respiratory Medicine, 13. https://doi.org/10.4081/mrm.2018.188
Toukhsati, S., Jaarsma, T., Babu, A., Driscoll, A., & Hare, D. (2019). Self-care interventions that reduce hospital readmissions in patients with heart failure; Towards the identification of change agents. Clinical Medicine Insights: Cardiology, 13, 117954681985685. https://doi.org/10.1177/1179546819856855
Vardeny, O., Claggett, B., Kachadourian, J., Desai, A. S., Packer, M., Rouleau, J., Zile, M. R., Swedberg, K., Lefkowitz, M., Shi, V., McMurray, J. J., & Solomon, S. D. (2019). Reduced loop diuretic use in patients taking sacubitril/valsartan compared with enalapril: The PARADIGM‐HF trial. European Journal of Heart Failure, 21(3), 337-341. https://doi.org/10.1002/ejhf.1402
Viniol, C., & Vogelmeier, C. F. (2018). Exacerbations of COPD. European Respiratory Review, 27(147), 170103. https://doi.org/10.1183/16000617.0103-2017
As a care manager with a hospital readmission team, one disease that our patients often have is congestive heart failure (CHF). Something about CHF that scares patients are the terms “heart” and “failure” together in a sentence, but as medical professionals, we know that the heart is not stopping. CHF is when the heart is not able to pump enough blood to meet the needs of the rest of the body. This can happen when the heart muscle itself is weaker than normal or when there is a defect in the heart that prevents blood from getting out into the circulation. When the heart does not circulate blood normally, the kidneys receive less blood and filter less fluid out of the circulation into the urine. People with CHF can see fluid build-up throughout their bodies like in their legs, ankles, faces, and more (American Heart Association, n.d.).Health maintenance is a key aspect of CHF. If patients were prescribed diuretics by their physicians, they need to be compliant in order to prevent fluid build-up. Patients should weigh themselves at the same time every morning after voiding to monitor for fluid fluctuations. It is recommended that patients reach out to their providers if they notice a four-pound weight gain (Cleveland Clinic, 2019). Sodium and fluid restrictions are also factors that CHF patients need to be aware of in order to achieve health promotion. I, personally, find that psychosocial support is an important aspect of patient’s health with cardiovascular diseases like CHF. Patient’s benefit from the “little things” like phone calls and outreaches just to check on them. Peer groups may also be helpful as Sharing feelings with others who are going through similar experiences can help to improve patient mood and self-esteem (Johnson, 2018). American Heart Association. (n.d.). Congestive heart failure and congenital defects. https://www.heart.org/en/health-topics/congenital-heart-defects/the-impact-of-congenital-heart-defects/congestive-heart-failure-and-congenital-defects.Cleveland Clinic. (2019). When to call your doctor or nurse about heart failure symptoms. https://my.clevelandclinic.org/health/treatments/17640-heart-failure-when-to-call-your-doctor-or-nurse-about-symptoms.
Johnson, A. (2018). Cardiovascular complexities. In Grand Canyon University (Eds.), Pathophysiology: Clinical applications for client health (1st ed). https://lc.gcumedia.com/nrs410v/pathophysiology-clinical-applications-for-client-health/v1.1/
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
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.
- 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.
- 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.
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, 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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Name: Assignment Rubric
|Summarize your interpretation of the frequency data provided in the output for respondent’s age, highest school grade completed, and family income from prior month.||32 (32%) – 35 (35%)
The response accurately and clearly explains, in detail, a summary of the frequency distributions for the variables presented.
The response accurately and clearly explains, in detail, the number of times the value occurs in the data.
The response accurately and clearly explains, in detail, the appearance of the data, the range of data values, and an explanation of extreme values in describing intervals that sufficiently provides an analysis that fully supports the categorization of each variable value.
The response includes relevant, specific, and appropriate examples that fully support the explanations provided for each of the areas described.
|28 (28%) – 31 (31%)
The response accurately summarizes the frequency distributions for the variables presented.
The response accurately explains the number of times the value occurs in the data.
The response accurately explains the appearance of the data, the range of data values, and explains extreme values in describing intervals that provides an analysis which supports the categorization of each variable value.
The response includes relevant, specific, and accurate examples that support the explanations provided for each of the areas described.
|25 (25%) – 27 (27%)
The response inaccurately or vaguely summarizes the frequency distributions for the variables presented.
The response inaccurately or vaguely explains the number of times the value occurs in the data.
The response inaccurately or vaguely explains the appearance of the data, the range of data values, and inaccurately or vaguely explains extreme values.
An analysis that may support the categorization of each variable value is inaccurate or vague.
The response includes inaccurate and irrelevant examples that may support the explanations provided for each of the areas described.
|0 (0%) – 24 (24%)
The response inaccurately and vaguely summarizes the frequency distributions for the variables presented, or it is missing.
The response inaccurately and vaguely explains the number of times the value occurs in the data, or it is missing.
The response inaccurately and vaguely explains the appearance of the data, the range of data values, and an explanation of extreme values, or it is missing.
An analysis that does not support the categorization of each variable values is provided, or it is missing.
The response includes inaccurate and vague examples that do not support the explanations provided for each of the areas described, or it is missing.
|Summarize your interpretation of the descriptive statistics provided in the output for respondent’s age, highest school grade completed, race and ethnicity, currently employed, and family income from prior month.||45 (45%) – 50 (50%)
The response accurately and clearly summarizes in detail the interpretation of the descriptive statistics provided.
The response accurately and clearly evaluates in detail each of the variables presented, including an accurate and complete description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.
|40 (40%) – 44 (44%)
The response accurately summarizes the interpretation of the descriptive statistics provided.
The response accurately explains evaluates each of the variables presented, including an accurate description of the sample size, the mean, the median, standard deviation, and the size and spread of the data.
|35 (35%) – 39 (39%)
The response inaccurately or vaguely summarizes the interpretation of the descriptive statistics provided.
The response inaccurately or vaguely evaluates each of the variables presented, including an inaccurate or vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data.
|0 (0%) – 34 (34%)
The response inaccurately and vaguely summarizes the interpretation of the descriptive statistics provided, or it is missing.
The response inaccurately and vaguely evaluates each of the variables presented, including an inaccurate and vague description of the sample size, the mean, the median, the standard deviation, and the size and spread of the data, or it is missing.
|Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.
|5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.
|4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.
|3 (3%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
Purpose, introduction, and conclusion of the assignment is vague or off topic.
|0 (0%) – 2 (2%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.
No purpose statement, introduction, or conclusion was provided.
|Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
|5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
|4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
|3 (3%) – 3 (3%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
|0 (0%) – 2 (2%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
|Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.||5 (5%) – 5 (5%)
Uses correct APA format with no errors.
|4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
|3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors.
|0 (0%) – 2 (2%)
Contains many (≥ 5) APA format errors.
|Total Points: 100|
Name: Assignment Rubric