Posted: November 17th, 2022
Evaluate the Health History and Medical Information.
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.Evaluate the Health History and Medical Information. Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
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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. Evaluate the Health History and Medical Information.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. 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.Evaluate the Health History and Medical Information. 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.Evaluate the Health History and Medical Information. 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.Evaluate the Health History and Medical Information. 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. Refer to the LopesWrite Technical Support articles for assistance.Evaluate the Health History and Medical Information.
The Case Study of Mrs. J. With Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF), and Hypertension: Clinical Manifestations, Nursing Interventions, and Health Promotion
The clinical manifestations presented by Mrs. J in the most part show an exacerbation of her COPD. Exacerbations of COPD are normally caused by a sudden inflammation of the lungs as a result of an infection or irritants (Hammer & McPhee, 2018; Huether & McCance, 2017). In the case of Mrs. J, she smokes many cigarettes daily making her exposed to smoke irritation.Evaluate the Health History and Medical Information.
However, she has also displayed symptoms of flu which means that this may be an important trigger to the COPD exacerbation. The mild fever that she has of 37.6°C proves that she has an infection. The productive cough and malaise show that it is an exacerbation of the COPD that she is having. COPD is defined by chronic bronchitis and emphysema which make the bronchial mucous glands hypertrophy and the alveoli lose their elastic recoil.Evaluate the Health History and Medical Information. The result is a loss of mucociliary clearance and an overproduction of mucus which cannot be cleared from the airways as fast as it is produced (Singh et al., 2018). The nausea may be due to irritation of the chemoreceptor trigger zone or CTZ as a result of little oxygen reaching the medulla because of the heart failure. The CTZ then erroneously excites the vomiting centre (Hammer & McPhee, 218; Huether & McCance, 2017). Mrs. J is not able to do her activities of daily living (ADLs) herself because of the hypoxemia (SpO2 of 82%) and the dyspnea (respiratory rate of 34) she has (caused by the heart failure and the COPD).Evaluate the Health History and Medical Information.
The Nursing Interventions and Medications Administered
The nursing interventions at the time of Mrs. J’s admission were in the most part appropriate. His vital signs were taken during the objective phase of the physical examination, and this is what revealed that she had mild fever, dyspnea, and a low blood pressure of 90/58 mmHg despite not taking her medications for the last three days. She was also correctly put on oxygen at 2l/ minute by nasal prongs. The nursing intervention also involved the administration of prescribed drugs. However, given the low blood pressure of Mrs. J at the time of admission, enalapril and metoprolol could have been withheld for a while since they may worsen the hypotension.Evaluate the Health History and Medical Information. This is despite the fact that Mrs. J has not taken her hypertension medication for the last three days. Furosemide (Lasix) is a loop diuretic that helps to combat fluid retention as experienced in heart failure. It works to remove excess fluid retained in the body via the kidneys (urine). In controlling fluid, it also helps in controlling blood pressure. Enalapril (Vasotec) is an angiotensin converting enzyme inhibitor or ACEI that is used to treat both hypertension and heart failure. Metoprolol (Lopressor) is a beta-blocker that is also administered to treat both hypertension and heart failure such as Mrs. J suffers from. Morphine is an opioid that is used to help in relieving the dyspnea. The inhaled bronchodilators and corticosteroids are for the treatment of the COPD and the accompanying symptoms (Katzung, 2018).Evaluate the Health History and Medical Information.
Cardiovascular Conditions that May Lead to Heart Failure
The four cardiovascular conditions that may lead to heart failure are coronary artery disease (CAD), previous myocardial infarction (MI), hypertension (high blood pressure), and valvular heart disease (AHA, 2017). CAD is caused by the deposition of fatty atherosclerotic plaques in the tunica intima of the coronary arteries. Over time these occlude the arteries starving the heart of oxygen. The result is that the myocardium cannot function well and a part of it may die (infarction). A previous MI on its part means that a part of the myocardium has already died previously from an earlier infarction. This makes the myocardium inefficient and the heart fails in its pumping function. High blood pressure causes resistance to the pumping action of the heart. The heart has thus to pump blood harder for it to overcome the resistance brought about by the hypertension. Over time, this strain on the heart causes it to fail. Lastly, heart valve disease caused either by infection or congenital abnormalities make the heart unable to pump all the blood from its left ventricle. This causes inefficiency and heart failure in the long run (Hammer & McPhee, 2018; Huether & McCance, 2017; AHA, 2017). CAD can be prevented when nurses teach primary prevention by avoiding foods with high cholesterol content and exercising regularly. Secondary prevention of previous MI is in the form of taking statin medications such as atorvastatin (Katzung, 2018). Hypertension can be addressed by both health education and medication. Nurses can particularly advise patients to exercise frequently and avoid too much salt in their food. Lastly, valvular heart disease can be corrected by cardiothoracic surgery.Evaluate the Health History and Medical Information.
Nursing Prevention of Polypharmacy Risks
To help in lowering the risks of adverse drug reactions caused by Mrs. J taking many drugs at the same time, the nurse can do several things. First, she can educate Mrs. J to be on the lookout for some specific symptoms which may be a result of drug interactions. On noticing them, she is told by the nurse to report immediately. Second, the nurse can put each drug in a differently colored container that is well labelled to avoid confusion. Third, the nurse will teach Mrs. J secondary prevention strategies to help keep her in remission and reduce the need for some of the drugs. Fourth and last, the nurse can start home visits to Mrs. J to keep on monitoring and teaching her as a community health nurse is supposed to do. The alternative is monitoring her through a telehealth platform.Evaluate the Health History and Medical Information.
Health Promotion and Restoration Teaching Plan
The health promotion and teaching plan for Mrs. J would involve encouraging her to stop smoking or at least start reducing the amount smoked. At the same time, she should also avoid environmental irritants which may exacerbate her COPD. Maintaining a healthy weight and regular exercise within her abilities will prevent atherosclerosis, control her hypertension, and ease her heart failure. A physiotherapist may help with this measured exercise before she starts doing it herself. The same effect will be achieved by taking more fresh fruits and vegetables in the diet. These contain antioxidant molecules that help contain the rise in low density lipoproteins (cholesterol). Last but not least, reducing her intake of salt and water will help check both her blood pressure and heart failure by reducing intravascular volume.Evaluate the Health History and Medical Information.
The most effective method for providing continuing education to Mrs. J regarding medications to forestall future admissions will be through telehealth. This means the clinicians and nurses would be able to engage her through technology when she is at home. They can also monitor her weight and progress through the same platform. The rationale is that she does not need to physically come to the hospital just for monitoring, when telehealth can facilitate that.
The COPD triggers that could precipitate an exacerbation are irritants and infections that include influenza, allergens like pollen, chest infections like pneumonia, polluted environmental air, and cigarette smoke. In the case of Mrs. J., the most important precipitating factor to her COPD exacerbation is her continued smoking of 2 packs of cigarettes daily. The options for cessation of smoking that could be provided to her include gradually lowering the number of cigarettes smoked (tapering off), or starting to use nicotine patches instead of the real cigarettes. Evaluate the Health History and Medical Information.
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