Case Study: Mrs. J Example Essay

Question:

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.

 

Answer:

Case Study: Mrs. J

This essay examines Mrs. J’s case study. She has been admitted with a diagnosis of acute decompensated heart failure. The patient has a significant history of hypertension, chronic obstructive pulmonary disease, and chronic heart failure. The essay focuses on topics that include clinical manifestations, cardiovascular risk, nursing interventions, and health promotion interventions to promote recovery and independence.

Subjective and Objective Clinical Manifestations

Subjective clinical manifestations are the problems that brought the client to the hospital.  As seen from the case study, they include sudden onset of flu-like symptoms such as fever, nausea, productive cough, malaise, and nausea. Her report of being unable to perform activities of daily living for the last three days, denying pain, feeling like her heart is running away, and feeling exhausted and being unable to drink or eat by herself also form the subjective data. Healthcare providers obtain objective data through physical assessment techniques. The objective data in Mrs. J’s case include height 175 cm, weight 95.5 kg, and vital signs. It also includes the cardiovascular assessment findings such as presence of adventitious heart sounds, bilateral jugular venous distention, atrial fibrillation, and ventricular heart rate of 132. The additional objective data includes pulmonary crackles, decreased breath sounds, and coughing frothy blood-tinge sputum.

Cardiovascular Conditions

Mrs. J is at a risk of several cardiovascular conditions that may result in heart failure. They include endocarditis, hypertension, atherosclerosis, and cardiac dysrhythmias. Atherosclerosis may develop from the thickening and formation of clogs in the arteries. Increased cardiac activity and workload may result in hypertension. Uncontrolled hypertension and arteriosclerosis may lead to the development of fatal cardiac arrythmias. The correction of heart valves through surgery may predispose the patient to develop endocarditis (Kwong et al., 2022). Cumulatively, these cardiovascular risks can be prevented using interventions such as encouraging Mrs. J to engage in active physical exercises, weight management, treatment adherence, and avoiding alcohol intake and smoking.

Appropriateness of the Interventions

The interventions at the time of admission were beneficial for Mrs. J. There was the utilization of the steps of nursing process such as assessment, planning, and implementation. The prescribed medications are also appropriate. For example, medications such as IV furosemide are appropriate to reduce fluid volume overload. Enalapril and metoprolol are also appropriate in regulating the blood pressure and reducing cardiac workload. Oxygen also helps improve body tissue perfusion since the patient cannot tolerate activity. I would administer morphine cautiously since it is a central nervous system depressant (Adams et al., 2019). Mrs. J currently experiences respiratory problems, which may be depressed further with morphine overdose.

Medications

The first drug prescribed for Mrs. J is IV furosemide, which is a diuretic. The drug works by increasing the renal excretion of sodium and water, which lowers the body fluid volume level. It was prescribed to reduce cardiac workload by eliminating excess body fluids (Adams et al., 2019). The other drug is enalapril, which is an angiotensin-converting enzyme inhibitor. It works by inhibiting angiotensin-converting enzyme, which reduces the amount of circulating angiotensin II. The impact is the reduction in the overall peripheral resistance and cardiac oxygen demand. It was prescribed to ensure optimum cardiac functioning by lowering its workload and oxygen needs. The other drug is metoprolol, a beta blocker, which inhibits beta receptors in the cardiac muscles causing a decrease in cardiac output through negative chronotropic and inotropic effects. The drug also lowers cardiac workload, hence, its indication for the patient (Faruqi & Jain, 2022; Morris & Dunham, 2022). IV morphine sulphate has also been prescribed, which is an analgesic that manages pain and also lowers oxygen demand in the cardiac muscle. Inhaled short-acting bronchodilator has been prescribed to open the airways, hence, minimizing resistance. Similarly, Flovent HFA,  corticosteroid, which inhibits release of chemical mediators has been prescribed to prevent airway inflammation (Adams et al., 2019). Lastly, oxygen has been prescribed to increase tissue oxygenation due to the reduced cardiac function and respiratory involvement in the disease process.

Nursing Interventions for Multiple Drug Interactions

One of the strategies that can be adopted to prevent drug interactions is patient education and involvement in the treatment process. Patient education and involvement will increase her understanding of the right time and doses for the prescribed medications and the need to ensure treatment adherence. The second strategy is ensuring accurate documentation. Accurate documentation will prevent medication errors. Thirdly, nurses and pharmacists must ensure the use of the correct labels to prevent errors (Adams et al., 2019). Lastly, safe prescribing may be considered by avoiding drugs with narrow therapeutic index to prevent harm.

Health Promotion and Restoration Teaching Plan

An effective health promotion and restoration plan for Mrs. J is educating het about the lifestyle and behavioral modifications she should embrace for her optimal health and functioning. She should be educated about the importance of treatment adherence, healthy, balanced diets, physical activity, and smoking cessation. Mrs. J should also be linked with the existing social support services to facilitate her recovery. Interprofessional teams are also needed for the optimum management of the patient’s problems. As a result, care coordination should be incorporated into the plan for optimum outcomes (Kwong et al., 2022). Rehabilitation resources are essential in helping Mrs. J cope with her complex needs and identify resources she can utilize to promote independence and prevent readmission.

Options for Smoking Cessation and COPD Triggers

Mrs. J should be linked with smoking cessation support groups to help her overcome her smoking problem. She may also require prescription for nicotine replacement therapies as she adopts a stepdown approach to smoking cessation. Some of the COPD triggers that Mrs. J should be informed including tobacco smoking, air pollution, dust, and some detergents. Therefore, she should minimize her exposure to these trigger (Kwong et al., 2022).

Conclusion

The essay has explored Mrs. J problem. The adopted treatment is appropriate for her health needs. Health education on lifestyle and behavioral modifications needed for her health and wellbeing. Rehabilitation interventions should aim at enhancing her independence and reduce hospital readmissions.

 

References

Adams, M., Holland, N., & Urban, C. (2019). Pharmacology for Nurses: A Pathophysiologic Approach. Pearson.

Faruqi, A., & Jain, A. (2022). Enalapril. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK557708/

Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2022). Lewis’s Medical-surgical Nursing: Assessment and Management of Clinical Problems. Elsevier, Incorporated.

Morris, J., & Dunham, A. (2022). Metoprolol. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK532923/