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.
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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. Hide
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