Case Study-Critical Thinking Essay Assessment Paper

Mrs. J has a known history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). She presents with a three-day history of fever, nausea, productive cough with frothy blood-tinged sputum, and malaise. Both heart failure and COPD will manifest with a productive cough. In heart failure, there is failure of the heart muscles to contract sufficiently and pump blood out of the heart. This leads to fluid build-up in the heart (congestive heart failure) and subsequent backflow of blood into the lungs causing pulmonary edema. This triggers the cough reflex to clear the excess fluid, leading to a productive cough, which may contain blood (Malik et al., 2022). Congestion due to backflow of blood can also cause congestion in the liver leading to hepatomegaly. The pulmonary edema also leads to shortness of breath, difficulty breathing, and chest pains. Other symptoms are associated with poor oxygenation due to poor blood flow to tissues and include fatigue, palpitations, and anorexia (Malik et al., 2022). Case Study-Critical Thinking Essay Assessment Paper

Acute decompensated heart failure may also present with jugular venous distension and peripheral edema on physical examination. The patient also presented with fever and nausea, which could be due to the heart failure or acute exacerbation of COPD.

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Nursing interventions and treatments at admission

After initial evaluation and history taking, the patient was admitted for management of acute decompensated heart failure and acute exacerbation of COPD. The nursing interventions administered were appropriate for her condition. The management of acute exacerbation of COPD includes oxygen administration in hypoxemic patients and inhaled bronchodilators. Short-acting beta agonists like albuterol have also been used to provide quick acting bronchodilation effect. On admission, the patient was put on 2L of oxygen via nasal cannula and an inhaled short-acting bronchodilator. Studies have shown that short-acting bronchodilators have a health benefit when used as first line treatment of acute exacerbation of COPD. Bronchodilators open the airways by reducing bronchial obstruction and airflow limitation through bronchial dilatation. The patient was also given an inhaled corticosteroid, which has been shown to be effective in COPD exacerbation (Torres et al., 2018). Strong evidence supports the use of systemic steroids in acute exacerbations of COPD, which improves patient outcomes and reduces oxygen demand and hospital stay. Corticosteroids control inflammation and reduce airway swelling thus improving oxygenation. Case Study-Critical Thinking Essay Assessment Paper

The administration on furosemide provides fast diuresis which in necessary to relieve fluid overload in heart failure. This is helpful in relieving the symptoms of acute decompensated heart failure. Enalapril is an angiotensin converting enzyme inhibitor used in the management of congestive heart failure and hypertension (Njoroge & Teerlink, 2021). It has an effect of decreasing mortality and morbidity. Metoprolol is a beta blocker used in treatment of patients with heart failure and has been proven to be effective in decreasing mortality and improving clinical outcomes in patients with chronic heart failure. Morphine sulphate is an opioid given to relieve breathlessness and anxiety in these patients.

Cardiovascular conditions that lead to heart failure and their preventive interventions

The cardiovascular conditions that cause heart failure are due to structural and functional abnormalities of the heart. This includes conditions like coronary artery disease, myocardial infarction, hypertension, and valvular heart disease. Coronary artery disease causes narrowing of the arteries that supply blood to the heart muscles and block blood flow to the heart (Crea, 2021). This leads to weakening of the heart muscles and can cause heart failure with time. The most significant risk factor for CAD is high levels of cholesterol and triglycerides in blood. Nursing interventions to prevent heart failure due to CAD include education on cessation of smoking, controlling hypertension, dietary changes to exclude excess cholesterol and physical exercise.

Hypertension can also cause heart failure through damage to blood vessels and stress on the heart muscles and valves. Prevention incudes antihypertensive medications to control blood pressure and dietary modifications like avoiding excess salt and water. Diseases that affect the functioning of the heart valves lead to stress on the heart to pump harder to prevent backflow of blood into the heart chambers. This can lead to structural heart failure (Malik et al., 2022). Prevention of heart failure caused by valvular disease is surgical intervention to replace damaged valves and improve function. Case Study-Critical Thinking Essay Assessment Paper

Interventions to prevent multiple drug interactions in older patients

Older patients tend to have multiple health problems, which increases polypharmacy and multiple drug interaction problems. The nursing interventions that can be applied to prevent problems caused by multiple drug interaction include information, instruction, and proper organization. Information involves keeping a list of all the patient medications and dosages to prevent confusion to the patient (Rieckert et al., 2018). The patient also needs to be instructed on how to take each medication and the potential adverse effects. They should also be instructed on proper storage of medications and which foods to take or avoid when taking certain medications to avoid adverse food-drug reactions.

Health promotion and Restoration plan for Mrs. J

The rehabilitation process will involve education on healthy practices for the patient to prevent future exacerbations of the symptoms. This will include education on medication compliance and involving the family on care for the patient on the same. Cessation of smoking should be emphasized to control pulmonary symptoms and increase pulmonary function. The patient should be educated on how to keep a clear record of all her medication through charting to help ensure compliance. This can also involve the relatives and close caregivers who will assist.

The COPD triggers that increase exacerbation especially on this patient is continued cigarette smoking despite the symptoms and diagnosis. It can also be triggered by adverse weather conditions lie extreme hot or cold temperatures, air pollution, and respiratory tract infections. Prevention includes risk factor modification such as prevention air pollution, cessation of smoking and keeping warm. Case Study-Critical Thinking Essay Assessment Paper

Options for smoking cessation for the patient

Pharmacologic options such as nicotine replacement therapy are used to enable smoking cessation for Mrs. J. This has been shown to have a great impact on smoking cessation for patients who cannot stop smoking on their own (Giulietti et al., 2020).  It involves the use of nicotine patches or chewable gums to help smokers cut down on smoking.

References

Crea, F. (2021). Mechanisms of heart failure with preserved ejection fraction, risk stratification of heart failure with reduced ejection fraction, and new light on resistance to diuretics in acute decompensated heart failure. European Heart Journal, 42(43), 4405-4409. https://doi.org/10.1093/eurheartj/ehab791

Giulietti, F., Filipponi, A., Rosettani, G., Giordano, P., Iacoacci, C., Spannella, F., & Sarzani, R. (2020). Pharmacological approach to smoking cessation: An updated review for daily clinical practice. High Blood Pressure & Cardiovascular Prevention, 27(5), 349-362. https://doi.org/10.1007/s40292-020-00396-9

Malik A., Brito D., Vaqar S., & Chhabra L. (2022). Congestive Heart Failure. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK430873/

Njoroge, J. N., & Teerlink, J. R. (2021). Pathophysiology and therapeutic approaches to acute decompensated heart failure. Circulation Research, 128(10), 1468-1486. https://doi.org/10.1161/circresaha.121.318186

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

Rieckert, A., Trampisch, U. S., Klaaßen-Mielke, R., Drewelow, E., Esmail, A., Johansson, T., Keller, S., Kunnamo, I., Löffler, C., Mäkinen, J., Piccoliori, G., Vögele, A., & Sönnichsen, A. (2018). Polypharmacy in older patients with chronic diseases: A cross-sectional analysis of factors associated with excessive polypharmacy. BMC Family Practice, 19(1). https://doi.org/10.1186/s12875-018-0795-5

Čerlinskaitė K., Javanainen T., Cinotti R., & Mebazaa A. (2018). Acute Heart Failure Management. NCBI- Korean Circ J. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986746/

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-Critical Thinking Essay Assessment Paper

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

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. Case Study-Critical Thinking Essay Assessment Paper
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:

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. Case Study-Critical Thinking Essay Assessment Paper

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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. Case Study-Critical Thinking Essay Assessment Paper