Pathophysiology: Case Study of 63 Year-Old Mrs J. : Expert Essay Example

Pathophysiology: Case Study of 63 Year-Old Mrs J.

Elderly persons are known to suffer from a number of comorbidities as a result of the failing physiological processes due to aging. The case of Mrs. J is typical of this situation. She suffers from hypertension, heart disease, and chronic obstructive pulmonary disease (COPD). Her history of smoking however explains why she would be suffering from COPD at her age. It is also worth noting that she still smokes despite this reality. It is safe to surmise that the combination of the stress of the hypertension and the heart disease coupled with her continued smoking are what is responsible for her current presentation. This paper describes her clinical presentation, the appropriateness of the nursing interventions she received at first, the rationale for the medications she is on, and the health education she needs to stop smoking.

The Clinical Presentation of the Patient

The patient presents with a low-grade fever of 37.6°C (99.68°F). She also has nausea, feels weak, and coughs productively. She gets breathless on exertion or physical activity and that is why she cannot perform her activities of daily living or ADLs. On admission she is very dyspnoeic and shows air hunger. Her respiratory rate on admission is a high of 34 breaths per minute. Pulse oximetry also shows that her SpO₂ is a low of just 82%. The other notable observation is that she has serious palpitations as demonstrated by her heart rate that is 118 beats per minute on admission. This heart rate is also irregular. The vital signs indicate that her blood pressure on admission is 90/58 mmHg despite not having taken her antihypertensive medications for the past three days. This could potentially be a sign that she is going into shock or cardiovascular insufficiency (Hammer & McPhee, 2018; Huether & McCance, 2017).

Nursing Interventions, their Appropriateness, and Rationale for Medications

When Mrs J was admitted, the first thing done was taking her vital observations. After this a number of medications were administered to control her symptoms. Because of the dyspnea, she was also put on supplemental oxygen which was given through a nasal cannula at a rate of two liters per minute. Judging by the condition of the patient, these nursing interventions were appropriate except one. This is because most of them were justified and informed by evidence-based practice (EBP). The inappropriate nursing action in this case was the administration of furosemide, metoprolol, and enalapril for the hypertension. As has been seen above, the blood pressure of this patient on admission was quite low at 90/58 mmHg. Administering these medications may worsen the blood pressure reading and place the patient’s life in danger (Katzung, 2018).

Each of the pharmacotherapeutic agents that the patient was given on admission had a justification or rationale. Frusemide, metoprolol, and enalapril were given because of the history of hypertension and heart disease. However, the timing of their administration was wrong as has been explained above (low blood pressure). ProAir HFA and Flovent HFA administered as inhalations were given to ease bronchospasms and aid mucociliary clearance hence educing the cough. Last but not least, morphine was given to calm the patient and also help alleviate the shortness of breath.

Cardiovascular Conditions that Could Lead to Heart Failure

Four of the cardiovascular conditions that may lead to the development of heart failure are hypertension, coronary artery disease (CAD), a previous myocardial infarction that was survived and cardiac tamponade (Hammer & McPhee, 2018). Hypertension is the result of resistance of the arterial walls to the force of the blood pumped from the heart to the body. Regular isotonic aerobic exercise has been proven to improve outcomes in hypertension (MacDonald & Pescatello, 2018). This may or may not be combined with medications such as angiotensin-converting enzyme inhibitors (ACEs) or beta blockers. Coronary artery disease results from atherosclerosis derived from hyperlipidemia (Hammer & McPhee, 2018; Huether & McCance, 2017). It can be combated by medications such as the statins represented by atorvastatin that reduces cholesterol, including low-density lipoprotein (LDL) cholesterol. This medication is also useful in preventing a second myocardial infarction (MI). Nursing health education on compliance to medications is also crucial in the prevention of MI. Lastly, cardiac tamponade is a medical emergency and only quick action to drain the fluid compressing the heart can save lives. In the meantime, the most important nursing intervention will be to administer oxygen via mask or nasal cannula.

Nursing Interventions to Prevent Adverse Events Related to Polypharmacy in Older Patients

The fact that many older patients have comorbidities means that they at any given time consume a number of medications, usually exceeding five. This is the same case with Mrs J. One of the nursing interventions to prevent drug interactions, adverse effects, or drug reactions in this case is avoiding giving unnecessary medications. The best example is in this case of Mrs J where the nurses gave metoprolol, furosemide, and atenolol even though the patient’s blood pressure was low. These drugs were not necessary at this time. The other nursing intervention is avoiding duplication of medications. For instance, if the nurse decided, they would have given atenolol alone and left metoprolol for later since the blood pressure was not elevated at the time. Last but not least is drug reconciliation at the time of transition of care. This avoids including for instance medications that had already been stopped in the next current drug list.

Health Promotion and Education Restoration Plan, COPD Triggers, and Smoking Cessation Options

Mrs J will need health education on commencing a nurse-led smoking cessation behavioral change program. She will also need advice on a healthy diet and isotonic exercise (just walking) within the limits of her endurance. Referring her to the support group Smokers Anonymous may also be of great help in stopping smoking. To prevent readmission, Mrs J will have to start strict compliance to the medication regime.

Infections and irritants such as cigarette smoke are some of the known COPD triggers around. The options that this patient has for smoking cessation are narrow. Having smoked for forty years and still smoking, only gradual behavioral desensitization can work. That means the nurse-led smoking cessation program mentioned above.

Conclusion

Elderly persons suffer many pre-existing chronic conditions. Mrs J is a case in point as she has three distinct chronic conditions. She also has behavioral risk factors the most prominent of which is cigarette smoking contributing to her COPD symptoms. In this case study, a large part of the nursing interventions have been appropriate. Most of the drugs are justified, but ultimately Mrs J will benefit immensely from behavioral interventions for smoking cessation.

References

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. McGraw-Hill Education.

Huether, S.E. & McCance, K.L. (2017). Understanding pathophysiology, 6^th ed. Elsevier, Inc.

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14^th ed. McGraw-Hill Education.

MacDonald, H.V. & Pescatello, L.S. (2018). Exercise prescription for hypertension: New advances for optimizing blood pressure benefits. Lifestyle in Heart Health and Disease, 115-136. https://doi.org/10.1016/B978-0-12-811279-3.00009-4