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NRS 410 : Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission.

Assessment Description
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
1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is "running away."
4. Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.

3. 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.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe;
coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. 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.
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.
Rubric Criteria
Total120 points
Criterion 1. Unsatisfactory 2. Less Than Satisfactory 3. Satisfactory 4. Good 5. Excellent
COPD Triggers
and Options for
Smoking
Cessation
COPD Triggers
and Options for
Smoking
Cessation

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