NRS 410 Bowie State University Older Patients Health History Questions

Expert Solution Preview

Introduction:
The case study presents the health history and medical information of Mrs. J, a 63-year-old woman with a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease. Mrs. J has been admitted to the hospital ICU due to acute decompensated heart failure and acute exacerbation of COPD. In this critical thinking essay, various aspects of Mrs. J’s situation will be discussed, including clinical manifestations, nursing interventions, cardiovascular conditions, drug interactions, health promotion and restoration, medication education, COPD triggers, and smoking cessation options.

1. Describe the clinical manifestations present in Mrs. J.
Mrs. J presented with sudden flu-like symptoms, including fever, productive cough, nausea, and malaise. She reported feeling anxious and having difficulty in breathing, chest pain, exhaustion, and inability to eat or drink without assistance. Her vital signs revealed an irregular heart rate, tachypnea, decreased oxygen saturation, pulmonary crackles, and blood-tinged sputum. Additionally, she had peripheral edema, elevated jugular venous pressure, and hepatomegaly.

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.
The nursing interventions at the time of Mrs. J’s admission were appropriate. The medications administered to control her symptoms included IV furosemide, Enalapril, Metoprolol, IV morphine sulphate, inhaled short-acting bronchodilator, inhaled corticosteroid, and oxygen. Furosemide is a loop diuretic that helps reduce edema and fluid overload, Enalapril and Metoprolol are antihypertensive and heart failure medications that decrease blood pressure and improve heart function. Morphine is an analgesic used for pain management, while short-acting bronchodilators and corticosteroids improve airflow in patients with COPD. Oxygen is vital in improving oxygen saturation and reversing hypoxemia.

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.
Four cardiovascular conditions that may lead to heart failure are coronary artery disease, hypertension, myocarditis, and valve abnormalities. Preventive measures for CAD include regular exercise, healthy diet, and control of risk factors such as smoking, diabetes, and hyperlipidemia. Hypertension can be prevented by maintaining a healthy weight, reducing salt intake, regular physical activity, and stress management. Myocarditis prevention involves vaccination against viral myocarditis, prompt treatment and management of viral infections, and proper screening of blood or organ donors. Valve abnormalities prevention may include prompt treatment of endocarditis, early intervention for valvular disease and regular monitoring of patients with known valve abnormalities.

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.
Nursing interventions that can prevent problems caused by multiple drug interactions in older patients include: medication reconciliation, education, monitoring, and collaboration. Medication reconciliation involves reviewing the patient’s medications regularly and identifying any interactions or discrepancies. Education can be provided on the importance of taking medications as prescribed, possible side effects, drug interactions, and when to seek medical help. Monitoring of patients’ medication regimen is vital, including vital signs, laboratory values, and adverse drug reactions. Collaboration among healthcare providers can help prevent medication errors and adverse effects.

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.
The health promotion and restoration teaching plan for Mrs. J should include self-care management strategies, such as regular exercise, healthy diet, smoking cessation, regular medication adherence, stress management, and regular medical follow-up. She should receive multidisciplinary resources such as respiratory therapy, physical therapy, and occupational therapy to improve respiratory function, physical endurance and daily living activities. Home modifications such as installing grab bars, raised toilet seats, and shower chairs will help Mrs. J’s 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.
The method of providing education for Mrs. J. regarding medications should involve verbal and written instructions. The nurse can explain the importance of taking medications as prescribed, possible side effects, interactions, and when to seek medical assistance. The nurse can also provide written instructions about the medications, including the name, dose, frequency, and the reason for taking each medication. The rationale for this is to ensure that Mrs. J understands her medications and can take them properly, thus preventing future hospital admissions.

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.
COPD triggers that can increase exacerbation frequency include tobacco smoke, infections, air pollution, temperature changes, and stress. Given Mrs. J’s current and long-term tobacco use, smoking cessation options that can be offered include nicotine replacement therapy, prescription medications such as bupropion and varenicline, and cessation counseling. The nurse can also provide coping mechanisms for Mrs. J to manage stress and avoid triggers that can exacerbate COPD symptoms.

In conclusion, Mrs. J’s situation presents multiple challenges that require a comprehensive approach to her care. Nursing interventions such as drug therapy, health promotion, rehabilitation, education, and smoking cessation can improve her health outcomes and prevent future hospital admissions.