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.
Based on this information, formulate a conclusion based on your
evaluation, and complete the Critical Thinking Essay assignment, as
instructed below.
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.
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.
- 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.
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