NRS 455 Case Study Mrs. R.

A Sample Answer NRS 455 Case Study Mrs. R. For the Assignment:

Title: NRS 455 Case Study Mrs. R.

Critical Thinking Table

Clinical Manifestations Describe the clinical manifestations present in Mrs. R., focusing on the normal and abnormal findings and how this relates to his current condition.
Subjective	Mrs. R’s abnormal subjective manifestations include anxiety, complaints of not getting enough air, feeling as if her heart is running away, and being exhausted and not being able to drink by herself. These manifestations are attributed to inadequate body tissue perfusion. She is experiencing anxiety because of brain tissue hypoxia, which makes her feel an impending doom. She is not getting enough air because of the hyper-inflated alveoli and fluid collection in the lungs due to heart failure. She cannot drink by herself because of inadequate tissue perfusion, which leads to a low nutrient supply to most body parts.
Objective	The abnormal objective manifestations in Mrs. R’s case study include irregular heartbeat, low blood pressure, decreased peripheral pulses, presence of S3 heart sound, PMI at sixth ICS, and distant and bilateral jugular vein distention. It also includes atrial fibrillation and a ventricular fibrillation rate of 132. These manifestations develop from altered cardiac functioning secondary to uncontrolled hypertension and chronic heart failure. Mrs. R has respiratory crackles, decreased breath sounds in the right lower lobe, and coughing bloodstained sputum. These symptoms develop because of fluid collection in the lungs and bronchitis, which is a complication of COPD.
NRS 455 Case Study Mrs. R. Cardiovascular Conditions Leading to Heart Failure Describe cardiovascular conditions in which Mrs. R. is at risk.
Describe four cardiovascular conditions in which Mrs. R. is at risk and that may lead to heart failure.	Mrs. R. is at risk of several cardiovascular conditions. They include heart valve disease, coronary artery disease, myocarditis, and uncontrolled hypertension. Uncontrolled hypertension causes cardiomegaly, which predisposes to heart failure from uncontrolled heart filling and emptying. Mrs. R is at risk of coronary artery disease because of her history of smoking. She is also overweight, which increases the risk of fat deposits, coronary artery disease, and heart failure. Mrs. R is also at risk of heart valve disease because of the strained heart valves from hypertension and heart disease. She is also at risk of myocarditis, which would develop from cardiac muscle tissue hypertrophy (Triposkiadis et al., 2022). The hypertrophy develops from prolonged straining of the heart muscles.
Discuss any comorbidities Mrs. R. displays.	Mrs. R displays comorbidities that include bronchitis, obesity, smoking, and hepatomegaly. Bronchitis is a common comorbidity that is seen among patients with COPD. COPD exacerbation causes bronchial tube inflammation and mucus accumulation to impede the normal gaseous exchange in the lungs. Patients experience symptoms such as a cough, fever, dyspnea, and fatigue. Mrs. R. has these symptoms, hence, bronchitis is among the comorbidities that she has. Mrs. R is obese. Her BMI is 31.2. Obesity predisposes her to worsened cardiovascular status and health problems such as diabetes and coronary artery disease. Mrs. R also has hepatomegaly. The case study shows that she has hepatomegaly 4 cm below the costal margin. Hepatomegaly develops because of blood pooling up in the liver in patients with hepatomegaly. Mrs. R has a 40-year history of smoking. Smoking predisposes patients to respiratory conditions such as COPD and cardiovascular problems such as coronary artery disease. Mrs. R also has uncontrolled hypertension, which is a risk factor for heart disease (Triposkiadis et al., 2022). Uncontrolled hypertension causes heart muscle thickening, which impairs normal cardiac function.
How do these conditions increase her chance of heart failure?	The above comorbidities predispose Mrs. R to heart failure. Obesity is associated with increased levels of fatty deposits in the lumen of the blood vessels. The deposition causes the narrowing of the arteries, resulting in complications such as hypertension, coronary artery disease, and heart failure. Smoking also increases the risk of heart disease. Smoke particles stimulate inflammatory response mechanisms in the thickened blood vessels, hence, cardiovascular complications, including heart failure. Cigarette also has chemicals that stimulate blood clot formation and thickening of blood in the blood vessels (Kubicki et al., 2020). Uncontrolled hypertension damages heart valves and causes cardiac muscle hypertrophy, which plays a role in the development of heart failure.
What can be done by way of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions.	One of the things that can be done to prevent the development of heart failure is encouraging Mrs. R to stop smoking. Smoking cessation will prevent and reduce the risk of heart failure due to effect of cigarette chemicals. Mrs. R should also be educated on the importance of treatment adherence to prevent the development of heart failure. Poor treatment adherence leads to uncontrolled hypertension and increases the risk of cardiac dysrhythmias, which causes heart failure. Health education on lifestyle and behavioral modifications should also be offered. This includes educating Mrs. R on the importance of a healthy diet, engaging in active physical activity, avoiding too much salt in food, and self-monitoring of blood pressure (Li et al., 2020). Self-monitoring of blood pressure will ensure early detection and management of unresponsive hypertension to the current treatment.
Evaluation of Nursing Interventions at Admissions Discuss the initial assessments and interventions provided to Mrs. R.
According to the nursing process, were the initial assessments and interventions at the time of admission beneficial for Mrs. R?	The initial nursing assessments were beneficial to Mrs. R. Obtaining information about Mrs. R’s chief complaint and history of the health problem provided insights into the severity of her health problem. The subjective data increased understanding of Mrs. R’s experiences with her health problems. Her medical history helped the nurse understand the pathophysiology of Mrs. R’s health problem and the interaction between different factors in the development of the disease. The objective data was appropriate in validating the subjective information. The subjective and objective data-informed interventions such as the administration of oxygen and prescription of diuretics to help reduce fluid volume level.
Discuss changes to any of the initial assessments or interventions you would make to ensure patient independence and prevent readmission.	One of the interventions I would make to ensure patient independence and prevent readmission is offering comprehensive, patient-centered health education to Mrs. R. I will stress the importance of treatment adherence, lifestyle, and behavioral modifications, and self-monitoring of blood pressure to prevent readmission. I will also incorporate telehealth into Mrs. R’s care to ensure care continuity and reduce the risk of adverse events and readmissions (Allida et al., 2020).
Medications and Prevention of Problems Caused by Multiple Drug Interactions Explain each of the seven medications listed in the case study and increase the incidence of polypharmacy.
Explain each of the seven medications listed in the case study. Include the classification, action, and rationale for each of these medications as they stem from pathophysiology for this patient’s condition (e.g., consider morphine use outside of pain management).	IV furosemide is a loop diuretic that inhibits sodium-potassium co-transporter. The inhibition results in sodium and fluid loss via the renal system, thereby, draining the excess body fluid volume in Mrs. R’s case. Enalapril is an angiotensin-converting enzyme inhibitor that blocks the conversation between angiotensin I to angiotensin II. The inhibition causes blood vessels the relaxation of blood vessels and increases oxygen and blood supply to the heart. Enalapril is prescribed in the case study to treat hypertension and prevent heart failure. Metoprolol is a beta-adrenergic blocker that inhibits beta-receptors to decrease cardiac output and workload in Mrs. R’s case. Morphine sulfate is an opioid, which binds with mu-opioid receptors in the peripheral and central nervous system to alleviate pain. Morphine has been prescribed for Mrs. R because it also decreases venous tone and the pooling of blood in the peripheries, which lowers cardiac workload. ProAIr HFA is a short-acting bronchodilator that binds to beta-2-adrenergic receptors to cause smooth muscle relaxation and inhibit mast cell release of hypersensitivity mediators. Mrs. R has been prescribed the drug to cause bronchial dilatation and prevent mucus production, hence, optimal air exchange in the lungs (Skidmore-Roth, 2022). Flovent HFA is a long-acting corticosteroid that inhibits the release of inflammatory cells, hence, preventing exacerbations in Mrs. R’s case.
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.	One of the interventions that can prevent problems caused by multiple drug interactions is ensuring interprofessional collaboration in the prescription and Mrs. R’s use of the prescribed drugs. Healthcare providers such as pharmacists should be involved to prevent the client’s prescription of drugs with high-profile interactions. The second strategy is deprescribing. Deprescribing entails the systematic discontinuation of drugs that have more harm than benefits to Mrs. R. The third strategy is regular assessment of the prescribed medications based on risk and benefit, lack of benefit, indications, adverse drug events, and patient or provider’s goals. The last strategy is patient education. Patients and families should receive clear instructions on the indications, side, and adverse effects of the prescribed medications and follow-ups (Ali et al., 2021; O’Mahony et al., 2020). Patient education will increase adherence, reduce adverse events, and promote empowerment.
Health Promotion and Restoration Teaching Plan Develop a multidisciplinary health promotion and restoration teaching plan for Mrs. R.
Discuss the steps needed to move the patient from acute care to subacute care, before discharging home and beginning a rehabilitation process.	Moving Mrs. R from acute to subacute care should be done following established protocols that would ensure care safety and quality outcomes. The nurse and other healthcare providers will use non-standardized to standardized assessments to assess Mrs. R’s readiness for transfer. Patient factors that would influence discharge decisions include functional mobility, pain and medication management skills, and cognitive functioning. The environmental considerations include environmental safety and social support Mrs. R will receive from her family members (Heydari et al., 2022). The patient’s family should be involved in all the discharge processes to ensure informed decision-making and optimize outcomes with the provision of patient-centered care.
Discuss alternative discharge options and qualifications to facilitate a smooth transition to the next level of care.	The alternative discharge options that might be considered include hospital at home, rapid response nursing, virtual ward, and Mrs. R’s admission to a care home (Sharma et al., 2023). The qualifications to facilitate a smooth transition to the next level of care include patient and family involvement, prioritizing risk reduction decisions, and ensuring the availability of a skilled workforce to meet Mrs. R’s needs.
Explain how the rehabilitation resources, including medication management, and modifications will assist the patient’s transition to promote independence and prevent readmission.	Medication management will ensure that Mrs. R gets the required medications at appropriate doses to ensure optimum recovery and prevention of other comorbidities. The provision of telehealth services will ensure care continuity and patient-centeredness, hence, early detection and management of health problems to prevent readmissions and enhance independence (Sharma et al., 2023).
Pathophysiological Changes Discuss the pathophysiological changes that come with Mrs. R.’s long-term tobacco use.
Cigarette smoking cause significant changes in the respiratory and cardiovascular system. The chemicals in cigarette smoke cause vasomotor dysfunction, which activates atherosclerotic changes. Smoking also reduces the levels of nitric oxide, which is involved in vasodilator functions in the blood vessels. There is also the increased release of inflammatory cells with smoking. Cigarette chemicals modify the lipid profile, which promotes atherosclerosis. Prolonged smoking also impairs respiratory functions such as ciliary functions, which increases predisposition to respiratory disorders such as COPD (Benowitz & Liakoni, 2022).
COPD Triggers and Options for Smoking Cessation Discuss options for smoking cessation education.
What options for smoking cessation should be offered to Mrs. R?	The options for smoking cessation that should be offered to Mrs. R include nicotine replacement therapy, bupropion, nicotine patch, behavioral therapy, nicotine lozenge, lozenges, gum, and varenicline (Rigotti et al., 2022).
Explain the COPD triggers that can increase exacerbation frequency, resulting in readmission.	The COPD triggers that can increase exacerbation frequency include tobacco smoking, exposure to dust and pollen, intensive physical activity, and indoor air pollution (Raby et al., 2023).

References

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Allida, S., Du, H., Xu, X., Prichard, R., Chang, S., Hickman, L. D., Davidson, P. M., & Inglis, S. C. (2020). MHealth education interventions in heart failure. Cochrane Database of Systematic Reviews, 7. https://doi.org/10.1002/14651858.CD011845.pub2

Benowitz, N. L., & Liakoni, E. (2022). Tobacco use disorder and cardiovascular health. Addiction, 117(4), 1128–1138. https://doi.org/10.1111/add.15703

Heydari, M., Lai, K. K., Fan, Y., & Li, X. (2022). A Review of Emergency and Disaster Management in the Process of Healthcare Operation Management for Improving Hospital Surgical Intake Capacity. Mathematics, 10(15), Article 15. https://doi.org/10.3390/math10152784

Kubicki, D. M., Xu, M., Akwo, E. A., Dixon, D., Mu, ñoz D., Blot, W. J., Wang, T. J., Lipworth, L., & Gupta, D. K. (2020). Race and Sex Differences in Modifiable Risk Factors and Incident Heart Failure. JACC: Heart Failure, 8(2), 122–130. https://doi.org/10.1016/j.jchf.2019.11.001

Li, H., Hastings, M. H., Rhee, J., Trager, L. E., Roh, J. D., & Rosenzweig, A. (2020). Targeting Age-Related Pathways in Heart Failure. Circulation Research, 126(4), 533–551. https://doi.org/10.1161/CIRCRESAHA.119.315889

O’Mahony, D., Gudmundsson, A., Soiza, R. L., Petrovic, M., Cruz-Jentoft, A. J., Cherubini, A., Fordham, R., Byrne, S., Dahly, D., Gallagher, P., Lavan, A., Curtin, D., Dalton, K., Cullinan, S., Flanagan, E., Shiely, F., Samuelsson, O., Sverrisdottir, A., Subbarayan, S., … Eustace, J. (2020). Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: The SENATOR* randomized controlled clinical trial. Age and Ageing, 49(4), 605–614. https://doi.org/10.1093/ageing/afaa072

Raby, K. L., Michaeloudes, C., Tonkin, J., Chung, K. F., & Bhavsar, P. K. (2023). Mechanisms of airway epithelial injury and abnormal repair in asthma and COPD. Frontiers in Immunology, 14, 1201658. https://doi.org/10.3389/fimmu.2023.1201658

Rigotti, N. A., Kruse, G. R., Livingstone-Banks, J., & Hartmann-Boyce, J. (2022). Treatment of Tobacco Smoking: A Review. JAMA, 327(6), 566–577. https://doi.org/10.1001/jama.2022.0395

Sharma, S., Salibi, D. G., & Tzenios, N. (2023). Modern approaches of rehabilitation in COPD patients. Special Journal of the Medical Academy and Other Life Sciences., 1(6), Article 6. https://doi.org/10.58676/sjmas.v1i6.39

Skidmore-Roth, L. (2022). Mosby’s 2023 Nursing Drug Reference – E-Book: Mosby’s 2023 Nursing Drug Reference – E-Book. Elsevier Health Sciences.

Triposkiadis, F., Xanthopoulos, A., Parissis, J., Butler, J., & Farmakis, D. (2022). Pathogenesis of chronic heart failure: Cardiovascular aging, risk factors, comorbidities, and disease modifiers. Heart Failure Reviews, 27(1), 337–344. https://doi.org/10.1007/s10741-020-09987-z