Posted: March 27th, 2023

Mrs. J is a 63-year-old African American woman

NRS410V Case Study Mrs J

Assessment Description

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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. NRS410V Case Study Mrs J

Health History and Medical Information

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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

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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. NRS410V Case Study Mrs J
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

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In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

Describe the subjective and objective clinical manifestations present in Mrs. J.
Describe four cardiovascular conditions in which Mrs. J is at risk, and that may lead to heart failure. What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions?
By following the nursing process, were the interventions at the time of admissions beneficial for Mrs. J? Would you change any of the interventions to ensure patient independence and prevent readmission?
Explain each of the seven medications listed in the scenario above. Include the classification, the action, and the rationale for each of these. 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, including maintenance of medications. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence and prevent readmission.
Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. NRS410V Case Study Mrs J
You are required to cite a minimum of three 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.

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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NRS410V Case Study Mrs J Rubric

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Mrs. J is a 63-year-old African American woman admitted to the hospital with shortness of breath, ankle edema, and an increased heart rate. She has a history of hypertension, obesity, and smoking. Mrs. J also complains of indigestion and occasional chest pain. The objective clinical manifestations in Mrs. J include elevated blood pressure, tachycardia, peripheral edema, bibasilar crackles, elevated jugular venous pressure, and positive orthopnea. The subjective clinical manifestations reported by Mrs. J include shortness of breath, chest pain, and indigestion.

Four cardiovascular conditions in which Mrs. J is at risk of developing heart failure include hypertension, coronary artery disease, atrial fibrillation, and diabetes mellitus. Medical and nursing interventions to prevent heart failure in each of these conditions include:

Hypertension: The medical intervention is to prescribe antihypertensive medications to lower blood pressure, while the nursing intervention is to educate Mrs. J on lifestyle changes such as weight loss, exercise, and a low-sodium diet.

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Coronary artery disease: The medical intervention is to perform diagnostic tests such as a coronary angiogram to determine the extent of blockage, while the nursing intervention is to provide education on lifestyle changes and medication adherence.

Atrial fibrillation: The medical intervention is to prescribe anticoagulant medications to prevent blood clots, while the nursing intervention is to monitor Mrs. J for signs of bleeding and educate her on medication adherence.

Diabetes mellitus: The medical intervention is to prescribe medications to manage blood sugar levels, while the nursing intervention is to educate Mrs. J on lifestyle changes such as diet and exercise.

The nursing interventions at the time of admission were beneficial for Mrs. J. However, some modifications could be made to ensure patient independence and prevent readmission. For instance, the healthcare team could have emphasized the importance of medication adherence and provided a detailed medication list to Mrs. J before discharge.

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The seven medications listed in the scenario include lisinopril, furosemide, carvedilol, aspirin, metformin, insulin, and nitroglycerin. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to lower blood pressure. Furosemide is a loop diuretic used to reduce excess fluid in the body. Carvedilol is a beta-blocker used to lower blood pressure and heart rate. Aspirin is an antiplatelet agent used to prevent blood clots. Metformin is an oral hypoglycemic agent used to manage diabetes. Insulin is a hormone used to manage high blood sugar levels. Nitroglycerin is a vasodilator used to relieve chest pain.

Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients include:

Providing education on medication adherence and potential side effects.

Monitoring for adverse drug reactions and drug interactions.

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Encouraging the use of a single pharmacy to prevent medication duplication.

Ensuring that medication orders are clear and up-to-date.

A health promotion and restoration teaching plan for Mrs. J should focus on lifestyle changes such as weight loss, exercise, and smoking cessation. Rehabilitation resources such as physical therapy and occupational therapy can assist Mrs. J in regaining her strength and independence. Modifications that may be needed include the use of assistive devices and home modifications to ensure a safe and supportive environment. Maintaining medication adherence and regular follow-up appointments with the healthcare team can also prevent readmission.

Considering Mrs. J.'s current and long-term tobacco use, smoking cessation options that should be offered include nicotine replacement therapy, prescription medications such as bupropion and varenicline, and counseling

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