Case Study: Mrs. J. Assignment

NRS 410 Case Study: Mrs. J. Assignment

The case scenario concerns Mrs. J., a 63-year-old female with hypertension, chronic heart failure, and COPD. She usually uses 2L of oxygen at home during activity but has persisted in smoking cigarettes 2PPD for the last 40 years. The purpose of this paper is to analyze the patient’s condition.

Clinical Manifestations of Patient

The patient’s subjective findings include fever, nausea, productive cough, malaise, inability to perform ADLs, anxiety, palpitations, dyspnea, and fatigue. Objective findings include obesity (BMI-31.2), mild fever, low blood pressure, tachypnea, and tachycardia with irregular heart rhythm. In addition, the patient has jugular vein distention, distant heart sounds, S gallop, faint PMI at sixth ICS, and atrial fibrillation. Respiratory findings include frothy blood-tinged sputum, reduced breath sounds, pulmonary crackles, and SpO2 82%. GI findings include hepatomegaly.

Cardiovascular Conditions in Which Mrs. J Is At Risk

            The patient’s obesity increases the risk of Coronary Artery Disease (CAD), which causes heart failure (HF) when cholesterol and fat deposits accumulate along the arteries obstructing myocardial blood flow. HF can be prevented in patients with CAD by administering lipid-lowering agents and lifestyle modification to lower cholesterol levels. Atrial fibrillation (AF) causes increased resting heart rate and an exaggerated heart rate response to exercise, causing a reduced diastolic filling time and eventually reduced cardiac output that causes HF (Schwinger, 2021). Lifestyle modification and maintaining optimal blood pressure can prevent the progression of AF to HF. Stroke induces cardiac damage like ventricular wall motion defects that increase the risk of HF. Cardiac damage can be prevented by controlling BP through antihypertensives and lifestyle modification. Myocardial infarction (MI) causes myocardial damage, stunning, and necrosis that impairs the heart’s contractility resulting in heart failure (Schwinger, 2021). HF in patients with MI can be mitigated by administering ACE inhibitors to decrease cardiac output and avoiding high-intense activities that increase oxygen demand.

Evaluation of Nursing Interventions at Admissions

The interventions during the admission of Mrs. J. included the administration of IV Lasix, Vasotec, Lopressor, IV Morphine, inhaled ProAir HFA, Flovent HFA, and oxygen via nasal cannula. The appropriate interventions included IV Lasix, ProAir HFA, and oxygen therapy. Lasix was appropriate because it alleviates symptoms of pulmonary congestion like cough, frothy sputum, palpitations, pulmonary crackles, and jugular vein distention (Oparil et al., 2019). ProAir HFA was also appropriate because it relieves COPD exacerbations, which would increase perfusion and alleviate dyspnea.

Oxygen therapy was ideal for improving the oxygen saturation levels to above 95%. Vasotec and Lopressor were inappropriate because they lower BP, which would worsen the patient’s low BP (Oparil et al., 2019). Furthermore, Morphine was unsuitable because it causes respiratory depression, which would worsen the patient’s breathing difficulties. Flovent HFA was inappropriate during admission since it is indicated for long-term COP maintenance to prevent exacerbations.

Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions

Lasix is a loop diuretic that facilitates water and sodium excretion by interfering with the chloride-binding cotransport system. This hinders the reabsorption of sodium and chloride in the ascending loop of Henle, and distal renal tubule, and lower preload in CHF (Oparil et al., 2019). Vasotec hinders the conversion of angiotensin I to angiotensin II, causing elevated plasma renin levels and reduced aldosterone secretion. This lowers blood pressure and improves HF symptoms. Lopressor is a selective beta-1-adrenergic blocker that competitively blocks beta1-receptors at low doses and blocks beta2-receptors at higher doses (Oparil et al., 2019). It is used in HF because it lowers cardiac output through negative inotropic and chronotropic effects.

Morphine is an opioid analgesic that blocks the ascending pain pathways altering pain response. It produces analgesia, sedation, and respiratory depression. ProAir HFA is a Beta 2 Agonist that relaxes bronchial smooth muscles and is indicated to alleviate acute bronchospasms (Nici et al., 2020). Flovent HFA is an inhalant corticosteroid with an anti-inflammatory effect on eosinophils, neutrophils, macrophages, lymphocytes, mast cells, and mediators

Older adults are significantly affected by multiple drug interactions due to polypharmacy since they have comorbid health conditions. Nursing interventions to prevent drug interactions include medication reconciliation, which entails identifying and documenting all drugs a patient takes and comparing the list with the physician’s orders (Kurczewska-Michalak et al., 2021). The nurse can also note a patient’s coexisting conditions and medications and assess the possibility of resulting in adverse drug effects. In addition, the nurse should educate the patient on how to take the medications, including the medications, generic and brand names, indications, and potential side effects, and explain how long the medication will likely be taken (Kurczewska-Michalak et al., 2021). Furthermore, the nurse can regularly reevaluate the patient for the need to continue prescribed medications and inform the physician to stop those that are no longer necessary or medications with higher possible risks than benefits.

Health Promotion and Restoration Teaching Plan

The health promotion and restoration education plan for Mrs. J will focus on lifestyle modification to control BP, maintain a healthy weight, delay COPD progression, and prevent COPD exacerbations. Regarding COPD, Mrs. J will be educated on the benefits of smoking cessation and avoiding environmental pollutants to delay disease progression and prevent exacerbations. Physical exercises will further be emphasized to improve lung function (Burge et al., 2020). Health education to control BP will include engaging in moderate aerobic exercises at least 40 minutes daily to improve cardiovascular functioning, lower BP, and promote weight loss. In addition, she will be educated on a healthy diet and reducing caloric intake for weight loss and to lower BP.

A multidisciplinary approach will be needed for rehabilitation and will include pulmonary rehabilitation, nutritional counseling, education, and self-management. Pulmonary rehabilitation is a multidisciplinary intervention for COPD established to improve exercise tolerance, dyspnea, and health-related QoL (Young et al., 2021). Nutritional counseling by a dietitian is vital for COPD patients who are underweight or overweight. Education and self-management are vital aspects of the multidisciplinary approach. They involve educational sessions educating patients on the nature and course of COPD and how to live with the impact of the disease.

COPD Triggers and Options for Smoking Cessation

Mrs. J can be provided individual psychotherapy to help with smoking cessation and group-based behavioral counseling. Pharmacotherapy intervention for smoking cessation includes Nicotine replacement therapy (NRT). The patient can be administered nicotine transdermal patches, gum, lozenges, inhalers, or nasal spray (Krist et al., 2021). COPD triggers that can cause exacerbations and readmission include tobacco smoke, exposure to dust, and environmental pollutants like carbon monoxide, which cause bronchoconstriction.

Conclusion

Mrs. J has a risk of cardiovascular conditions like Coronary Artery Disease, Atrial fibrillation, Stroke, and Myocardial infarction. IV Lasix, ProAir HFA, and oxygen therapy were appropriate since they improve symptoms of pulmonary congestion and COPD exacerbations. However, Vasotec and Lopressor lower BP, which is unsuitable for the patient due to the low BP. Morphine would have caused respiratory depression, while Flovent HFA is indicated for long-term COPD maintenance and thus was inappropriate. The health education plan for Mrs. J focuses on lifestyle modification to control BP, promote weight loss, delay COPD progression, and prevent COPD exacerbations.

 

 

References

Burge, A. T., Cox, N. S., Abramson, M. J., & Holland, A. E. (2020). Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). The Cochrane database of systematic reviews, 4(4), CD012626. https://doi.org/10.1002/14651858.CD012626.pub2

Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., … & US Preventive Services Task Force. (2021). Interventions for tobacco smoking cessation in adults, including pregnant persons: US Preventive Services Task Force recommendation statement. Jama, 325(3), 265-279. doi:10.1001/jama.2020.25019

Kurczewska-Michalak, M., Lewek, P., Jankowska-Polańska, B., Giardini, A., Granata, N., Maffoni, M., Costa, E., Midão, L., & Kardas, P. (2021). Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions. Frontiers in pharmacology, 12, 734045. https://doi.org/10.3389/fphar.2021.734045

Nici, L., Mammen, M. J., Charbek, E., Alexander, P. E., Au, D. H., Boyd, C. M., … & Aaron, S. D. (2020). Pharmacologic management of chronic obstructive pulmonary disease. An official American Thoracic Society clinical practice guideline. American journal of respiratory and critical care medicine, 201(9), e56-e69. DOI: 10.1164/rccm.202003-0625ST

Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2019). Hypertension. Nature reviews. Disease primers, p. 4, 18014. https://doi.org/10.1038/nrdp.2018.14

Schwinger, R. H. G. (2021). Pathophysiology of heart failure. Cardiovascular diagnosis and therapy, 11(1), 263–276. https://doi.org/10.21037/cdt-20-302

Young, M., Villgran, V., Ledgerwood, C., Schmetzer, A., & Cheema, T. (2021). Developing a Multidisciplinary Approach to the COPD Care Pathway. Critical care nursing quarterly, 44(1), 121–127. https://doi.org/10.1097/CNQ.0000000000000345

 

Cardiorespiratory complexities include a wide range of disorders affecting the cardiovascular and respiratory systems. They commonly occur in elderly patients due to cardiac and lung physiologic functioning (Riley & Masters, 2016). Common cardiorespiratory conditions include chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, emphysema, congestive cardiac failure (CCF), pneumonia, hypertension, and myocardial infarction. This paper will discuss Mrs. J, a patient with cardiorespiratory conditions, and analyze the nursing interventions provided. I will also outline a health promotion teaching plan and options for smoking cessation for Mrs. J.

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.

Clinical Manifestations Present In Mrs. J

Mrs. J has a history of hypertension, chronic heart failure, and COPD. She presents with a sudden onset of flu-like symptoms such as fever, nausea, productive cough, and malaise and could not perform ADLs. On physical exam, she has a BMI of 31.2, categorized as obesity. She has a low-grade fever of 37.6C, tachycardia with an irregular rhythm, tachypnea, and hypotension. The cardiovascular exam reveals S gallop, with faint PMI at 6^th ICS, which points to left ventricular hypertrophy. The patient also has bilateral jugular vein distention, which points to congestive heart failure, a ventricular rate of 132, and atrial fibrillation. On respiratory exam, there were pulmonary crackles, decreased breath sounds on the right lower lobe, frothy blood-tinged sputum cough, and SpO2 82%. This suggests excessive airway secretions, fluid in the lungs with limited perfusion of the lungs, and inadequate body tissue perfusion. GI examination reveals hepatomegaly of 4cm below the costal margin.

Nursing Interventions

The nursing intervention implemented include administration of Oxygen 2L through a nasal cannula. The intervention was appropriate because the patient had low oxygen saturation levels of 82%, and it would enhance tissue perfusion. In addition to oxygen therapy, other nursing interventions included administration of IV furosemide, Enalapril, Metoprolol, IV morphine, ProAir HFA, and Flovent HFA. Furosemide was appropriate for this patient since it is a loop diuretic that acts by inhibiting reabsorption of sodium and chloride at the proximal tubules. This results in the elimination of water and sodium, thus lowering blood volume and preload as well as correcting congestive heart failure (Aronow, 2018). Enalapril inhibits angiotensin-converting enzyme, which facilitates the conversion of angiotensin I into angiotensin II. Angiotensin II is a potent vasoconstrictor and thus lowers blood pressure (Aronow, 2018). Administering Enalapril was inappropriate because the patient had a low blood pressure of 90/58.

Metoprolol was not an appropriate medication since it lowers cardiac output through negative inotropic and chronotropic effects. It is also contraindicated in decompensated heart failure and hypotension, present in Mrs. J (Aronow, 2018). Morphine was not an appropriate medication since the patient denied having pain, and morphine depresses the brain’s respiratory centers and increases the risk of respiratory depression. A safer sedative such as nonbenzodiazepines should have been administered. ProAir HFA was an appropriate drug to relieve COPD exacerbations. It relaxes bronchial smooth muscles and relieves acute bronchospasms (Rosenberg & Kalhan, 2017). Flovent HFA is an anti-inflammatory corticosteroid and is used for long-term maintenance prevention of bronchospasms caused by COPD (Rosenberg & Kalhan, 2017). It should not have been administered to relieve acute COPD exacerbations but rather be prescribed as a long-term therapy.

Cardiovascular Conditions That May Lead To Heart Failure

Coronary Artery Disease (CAD)

CAD results in limited blood flow to the myocardium due to the accumulation of cholesterol and fatty deposits in the arteries. The heart is forced to pump harder to promote adequate tissue perfusion, which results in hypertrophy and eventually, heart failure (Inamdar & Inamdar, 2016). Medical interventions to prevent progression to heart failure include administering lipid-lowering agents to lower cholesterol levels and increasing blood supply to the myocardium (Inamdar & Inamdar, 2016). Nursing interventions can entail patient education on lifestyle modification to reduce blood cholesterol levels and promote heart functioning.

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Aortic Stenosis

Aortic stenosis results in obstruction of left ventricular outflow, which causes increased pressure on the left ventricle. The ventricular wall hypertrophies, and the heart begins to fail (Thomas, 2019). Medical interventions that can prevent progression to heart failure include surgical replacement of the aortic valve and percutaneous balloon valvuloplasty.

Hypertension

 Hypertension causes increased heart contractility to promote circulation. This results in hypertrophy, and the myocardium weakens over time, resulting in the heart’s inability to pump enough blood to meet the body’s requirements (Thomas, 2019). Medical interventions to prevent heart failure include administering antihypertensive that causes vasodilation and decreases cardiac output (Inamdar & Inamdar, 2016). Nursing interventions include patient education on lifestyle modification to lower blood pressure and improve cardiac functioning.

Cardiomyopathy

Cardiomyopathy results in impaired cardiac output. A decrease in stroke volume stimulates the sympathetic nervous system and the renin-angiotensin-aldosterone response, causing increased systemic vascular resistance and increased sodium and fluid retention, which places an increased workload on the heart (Thomas, 2019). These alterations can lead to congestive heart failure. Medical interventions include prescribing Beta-blockers and anticoagulants.

Nursing Interventions to Prevent Problems Caused by Multiple Drug Interactions

Nursing interventions may include conducting a patient assessment to identify the drug side effects a patient reports and identifying the drug interaction that could be causing the side effects (Cantlay, Glyn & Barton, 2016). The nurse can document the reported side effects and recommend the drugs that should be stopped to the prescribing clinician to help lower the severity of side effects. Additional nursing interventions include conducting a comprehensive drug evaluation of every drug prescribed to a patient (Cantlay, Glyn & Barton, 2016). This can help identify the drugs that may have multiple drug interactions and recommend for modification of the treatment plan. Furthermore, the nurse can recommend alternative non-pharmacological measures to manage chronic illnesses and symptoms such as chronic pain (Cantlay, Glyn & Barton, 2016). For example, heat and cold massages and physiotherapy can be used to manage pain, while lifestyle interventions can be recommended for lifestyle diseases.

Health Promotion and Restoration Teaching Plan for Mrs. J

The health promotion plan for Mrs. J will focus on lifestyle modification to promote better self-management of chronic conditions and prevent disease progression. The first lifestyle intervention will be on cessation of smoking to avoid exacerbation of bronchospasms secondary to COPD and slow the advancement of COPD (Rosenberg & Kalhan, 2017). The second intervention will be to increase physical activity by engaging in moderate exercises such as brisk walking and jogging that the patient can tolerate. This will promote weight loss, improve lung function, maintain blood pressure within a normal range, and boost heart functioning (Thomas, 2019). Besides, the patient will be recommended on healthy dieting such as the DASH diet to help manage blood pressure and promote weight loss.

Multidisciplinary resources needed to rehabilitate Mrs. J will consist of nutritional interventions, assistance in activities of daily living, energy-saving techniques, physical training, and health education on self-management (Riley & Masters, 2016). The rehabilitation resources will help Mrs. J transition to independence by helping her adopt self-management skills that will enable her to conduct daily living activities.  Besides, energy-saving techniques will help the patient perform her activities independently with minimal restrictions (Riley & Masters, 2016). Physical training will help increase lung function and enable the patient to work independently without exertional dyspnea.

Education for Mrs. J. Regarding Medications

Mrs. J should be educated on drug adherence to prevent future hospitalization due to COPD exacerbations, hypertension urgency, or worsening heart failure. The patient and the caregiver can be advised to have a list of all her drugs with their frequency, dosages, and indication for each drug (Cantlay, Glyn & Barton, 2016). They can be instructed to use the list when taking medications to ensure she has taken all the essential drugs. She can also be instructed to label each drug container according to the indication for each, to ensure she has taken drugs for each health condition (Cantlay, Glyn & Barton, 2016). Besides, she can use color-code pill containers to avoid confusion or drug overdose (Cantlay, Glyn & Barton, 2016). Mrs. J can also be recommended to store the essential drugs where she can see and use reminders to help her remember to take her drugs.

COPD Triggers That Can Increase Exacerbation Frequency

Tobacco smoke is the most common COPD trigger, which accounts for 80-90% of exacerbations due to bronchoconstriction (Rosenberg & Kalhan, 2017). Exposure to second-hand smoke, carbon monoxide, and dust may also trigger COPD exacerbations leading to hospitalization (Rosenberg & Kalhan, 2017). Mrs. J can be offered smoking cessation options such as professional counseling with education on how tobacco smoking causes COPD exacerbations and leads to the progression of hypertension and heart failure. Group counseling should be provided for the patient to interact with individuals who are in the process of tobacco smoking to increase the likelihood of complete tobacco cessation.

References

Aronow W. S. (2018). Antihypertensive drug therapy. Annals of translational medicine, 6(7), 123. https://doi.org/10.21037/atm.2018.01.26

Cantlay, A., Glyn, T., & Barton, N. (2016). Polypharmacy in the elderly. InnovAiT, 9(2), 69-77. https://doi.org/10.1177/1755738015614038

Inamdar, A. A., & Inamdar, A. C. (2016). Heart Failure: Diagnosis, Management, and Utilization. Journal of clinical medicine, 5(7), 62. https://doi.org/10.3390/jcm5070062

Riley, J. P., & Masters, J. (2016). Practical multidisciplinary approaches to heart failure management for improved patient outcomes. European Heart Journal Supplements, 18(suppl_G), G43-G52.https://doi.org/10.1093/eurheartj/suw046

Rosenberg, S. R., & Kalhan, R. (2017). Recent advances in the management of chronic obstructive pulmonary disease. F1000Research, 6, 863. https://doi.org/10.12688/f1000research.9819.1

Thomas, M. (2019). Pathophysiology and management of heart failure. Acute pain, 10, 00.

 

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. Case Study: Mrs. J. Assignment

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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. Case Study: Mrs. J. Assignment

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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:

1. Describe the clinical manifestations present in Mrs. J.
2. 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.
3. 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.
4. 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.
5. 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.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
7. 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. Case Study: Mrs. J. Assignment

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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Course Code Class Code Assignment Title Total Points
NRS-410V NRS-410V-O502 Case Study: Mrs. J. 120.0

Criteria Percentage Unsatisfactory (0.00%) Less Than Satisfactory (75.00%) Satisfactory (79.00%) Good (89.00%) Excellent (100.00%)
Content 80.0%
Clinical Manifestations of Mrs. J. 10.0% Clinical manifestations are omitted. Clinical manifestations are partially presented. There are major omissions and inaccuracies. Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete. Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms. Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.

Case Study: Mrs. J. Assignment Evaluation of Nursing Interventions at Admissions 10.0% Evaluation of appropriateness of nursing interventions at the time of admission and explanation of the rationale for each of the medications listed are not discussed. Evaluation of appropriateness of nursing interventions at the time of admission is partially presented. An incomplete explanation for each of the medications listed is presented. The discussion contains significant inaccuracies. Evaluation of appropriateness of nursing interventions at the time of admission is summarized. A general explanation and some rationale for each of the medications listed are presented. There are minor inaccuracies. Evaluation of appropriateness of nursing interventions at the time of admission is discussed. An explanation and general rationale for each of the medications listed are presented. Some information is required for accuracy or clarity. Evaluation of appropriateness of nursing interventions at the time of admission is thoroughly discussed. A well-supported explanation for each of the medications listed is presented. Strong and compelling rationale is provided.

Cardiovascular Conditions Leading to Heart Failure and Interventions 10.0% Fewer than three cardiovascular conditions that may lead to heart failure, and medical or nursing interventions to prevent the development of heart failure in each condition, are described. Four cardiovascular conditions that may lead to heart failure are partially described. Medical or nursing interventions to prevent the development of heart failure in each condition are incomplete. There are significant inaccuracies. Four cardiovascular conditions that may lead to heart failure are summarized. Medical or nursing interventions to prevent the development of heart failure in each condition are generally discussed. There are some inaccuracies. Four cardiovascular conditions that may lead to heart failure are described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. There are minor inaccuracies, or information is needed for clarity. Four cardiovascular conditions that may lead to heart failure are clearly described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. Overall, the discussion demonstrates insight into medical and nursing interventions used to prevent heart failure.

Case Study: Mrs. J. Assignment Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions 10.0% Fewer than three nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are presented. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are partially presented. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are summarized. Overall, the discussion meets assignment criteria but requires more rationale for the interventions. There are minor inaccuracies. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. Overall, the discussion meets assignment criteria and general rationale for the interventions is provided. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. The discussion fulfills the assignment criteria and strong rationale for the interventions is provided.

Health Promotion and Restoration Teaching Plan 15.0% A health promotion and restoration teaching plan for the patient is omitted. A health promotion and restoration teaching plan for the patient is partially presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are omitted or incomplete. An explanation for how rehabilitation resources and modifications assist patient transition to independence is omitted or incomplete. A health promotion and restoration teaching plan for the patient is summarized. Multidisciplinary resources for rehabilitation and any modifications that may be needed are generally presented. A summary for how rehabilitation resources and modifications assist patient transition to independence is presented. There are minor inaccuracies. A health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are discussed. An explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. A well-developed health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are clearly discussed. An strong explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. The overall discussion is well-supported.

Method for Providing Education to Prevent Hospital Readmissions 15.0% A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is omitted. The method is not appropriate for the client or health status. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is partially summarized. The method may not be relevant to for this situation. More information is needed. There are major inaccuracies. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is summarized. The method is generally appropriate. Some rationale is provided for support. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is described. Overall, the method is appropriate. General rationale is provided for support. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is thoroughly described. The method is clearly appropriate for the client and prevents readmission. Strong rationale is provided for support.

COPD Triggers and Options for Smoking Cessation 10.0% COPD triggers exacerbating return visits and options for smoking cessation are omitted. Some COPD triggers exacerbating return visits are partially presented. Options for smoking cessation are incomplete; it is unclear if the options are relevant to the patient. General COPD triggers exacerbating return visits are generally presented. Some options for smoking cessation relevant to the patient are summarized. Some support or information is needed. Key COPD triggers exacerbating return visits are outlined. General options for smoking cessation relevant to the patient are summarized. All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.

Organization, Effectiveness, and Format 20.0%
Thesis Development and Purpose 5.0% Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction 5.0% Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.

Paper Format (use of appropriate style for the major and assignment) 2.0% Template is not used appropriately, or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) 3.0% Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Topic 1 DQ 1

Identify a cardiac or respiratory issue and outline the key steps necessary to include for prevention and health promotion.

Re: Topic 1 DQ 1

According to the Center for Disease Control and Prevention [CDC] (2020), asthma is a disease that can repeatedly affect your lungs with episodes of wheezing, chest tightness, coughing, and shortness of breath. As taught by Johnson (2018) it is a chronic airway disorder that can affect anyone from infants to adults. It is caused by inflammation and bronchospasm of the airway. Triggers can be anything from allergens, exercise, or viral illness. Asthma can be managed and treated with medications as well as prevention measures. Some medications that are used for management and prevention of asthma exacerbation include rescue inhalers, antihistamines, and anti-inflammatory medications. Asthma action plans help guide patients on what medications to take and when in order to prevent an asthma attack (Johnson, 2018).

According to Castillo et al. (2017), appropriate medical therapy to critical control symptoms and reduce the risk of asthma exacerbations. Asthma exacerbations are more commonly triggered by respiratory infections such as the rhinovirus making it important to prevent and treat such infections. Other prevention methods include avoiding triggers such as mold, tobacco smoke, pollen, dust, dander, and other airway pollutants. The four essential components in prevention and management of asthma include: monitoring symptoms and lung function, avoid triggers and control comorbid conditions, pharmacologic therapy, and patient education. Asthma triggers and severity varies among individuals, so it is important to regularly monitor and properly adjust asthma control guides for effective treatment and management (Castillo et al., 2017).

References:

Castillo, J. R., Peters, S. P., & Busse, W. W. (2017). Asthma Exacerbations: Pathogenesis, Prevention, and Treatment. The Journal of Allergy and Clinical Immunology: In Practice, 5(4), 918–927. https://doi.org/10.1016/j.jaip.2017.05.001

Centers for Disease Control and Prevention [CDC]. (2019). Asthma FAQs. Centers for Disease Control and Prevention. https://www.cdc.gov/asthma/faqs.htm.

Johnson, A. (2018). Cardiorespiratory complexities. In Grand Canyon University (Eds.), Pathophysiology: Clinical applications for client health (1^st ed). https://lc.gcumedia.com/nrs410v/pathophysiology-clinical-applications-for-client-health/v1.1/

The case scenario concerns Mrs. J., a 63-year-old female with hypertension, chronic heart failure, and COPD. She usually uses 2L of oxygen at home during activity but has persisted in smoking cigarettes 2PPD for the last 40 years. The purpose of this paper is to analyze the patient’s condition.

Clinical Manifestations of Patient

The patient’s subjective findings include fever, nausea, productive cough, malaise, inability to perform ADLs, anxiety, palpitations, dyspnea, and fatigue. Objective findings include obesity (BMI-31.2), mild fever, low blood pressure, tachypnea, and tachycardia with irregular heart rhythm. In addition, the patient has jugular vein distention, distant heart sounds, S gallop, faint PMI at sixth ICS, and atrial fibrillation. Respiratory findings include frothy blood-tinged sputum, reduced breath sounds, pulmonary crackles, and SpO2 82%. GI findings include hepatomegaly.

Cardiovascular Conditions in Which Mrs. J Is At Risk

            The patient’s obesity increases the risk of Coronary Artery Disease (CAD), which causes heart failure (HF) when cholesterol and fat deposits accumulate along the arteries obstructing myocardial blood flow. HF can be prevented in patients with CAD by administering lipid-lowering agents and lifestyle modification to lower cholesterol levels. Atrial fibrillation (AF) causes increased resting heart rate and an exaggerated heart rate response to exercise, causing a reduced diastolic filling time and eventually reduced cardiac output that causes HF (Schwinger, 2021). Lifestyle modification and maintaining optimal blood pressure can prevent the progression of AF to HF. Stroke induces cardiac damage like ventricular wall motion defects that increase the risk of HF. Cardiac damage can be prevented by controlling BP through antihypertensives and lifestyle modification. Myocardial infarction (MI) causes myocardial damage, stunning, and necrosis that impairs the heart’s contractility resulting in heart failure (Schwinger, 2021). HF in patients with MI can be mitigated by administering ACE inhibitors to decrease cardiac output and avoiding high-intense activities that increase oxygen demand.

Evaluation of Nursing Interventions at Admissions

The interventions during the admission of Mrs. J. included the administration of IV Lasix, Vasotec, Lopressor, IV Morphine, inhaled ProAir HFA, Flovent HFA, and oxygen via nasal cannula. The appropriate interventions included IV Lasix, ProAir HFA, and oxygen therapy. Lasix was appropriate because it alleviates symptoms of pulmonary congestion like cough, frothy sputum, palpitations, pulmonary crackles, and jugular vein distention (Oparil et al., 2019). ProAir HFA was also appropriate because it relieves COPD exacerbations, which would increase perfusion and alleviate dyspnea.

Oxygen therapy was ideal for improving the oxygen saturation levels to above 95%. Vasotec and Lopressor were inappropriate because they lower BP, which would worsen the patient’s low BP (Oparil et al., 2019). Furthermore, Morphine was unsuitable because it causes respiratory depression, which would worsen the patient’s breathing difficulties. Flovent HFA was inappropriate during admission since it is indicated for long-term COP maintenance to prevent exacerbations.

Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions

Lasix is a loop diuretic that facilitates water and sodium excretion by interfering with the chloride-binding cotransport system. This hinders the reabsorption of sodium and chloride in the ascending loop of Henle, and distal renal tubule, and lower preload in CHF (Oparil et al., 2019). Vasotec hinders the conversion of angiotensin I to angiotensin II, causing elevated plasma renin levels and reduced aldosterone secretion. This lowers blood pressure and improves HF symptoms. Lopressor is a selective beta-1-adrenergic blocker that competitively blocks beta1-receptors at low doses and blocks beta2-receptors at higher doses (Oparil et al., 2019). It is used in HF because it lowers cardiac output through negative inotropic and chronotropic effects.

Morphine is an opioid analgesic that blocks the ascending pain pathways altering pain response. It produces analgesia, sedation, and respiratory depression. ProAir HFA is a Beta 2 Agonist that relaxes bronchial smooth muscles and is indicated to alleviate acute bronchospasms (Nici et al., 2020). Flovent HFA is an inhalant corticosteroid with an anti-inflammatory effect on eosinophils, neutrophils, macrophages, lymphocytes, mast cells, and mediators

Older adults are significantly affected by multiple drug interactions due to polypharmacy since they have comorbid health conditions. Nursing interventions to prevent drug interactions include medication reconciliation, which entails identifying and documenting all drugs a patient takes and comparing the list with the physician’s orders (Kurczewska-Michalak et al., 2021). The nurse can also note a patient’s coexisting conditions and medications and assess the possibility of resulting in adverse drug effects. In addition, the nurse should educate the patient on how to take the medications, including the medications, generic and brand names, indications, and potential side effects, and explain how long the medication will likely be taken (Kurczewska-Michalak et al., 2021). Furthermore, the nurse can regularly reevaluate the patient for the need to continue prescribed medications and inform the physician to stop those that are no longer necessary or medications with higher possible risks than benefits.

Health Promotion and Restoration Teaching Plan

The health promotion and restoration education plan for Mrs. J will focus on lifestyle modification to control BP, maintain a healthy weight, delay COPD progression, and prevent COPD exacerbations. Regarding COPD, Mrs. J will be educated on the benefits of smoking cessation and avoiding environmental pollutants to delay disease progression and prevent exacerbations. Physical exercises will further be emphasized to improve lung function (Burge et al., 2020). Health education to control BP will include engaging in moderate aerobic exercises at least 40 minutes daily to improve cardiovascular functioning, lower BP, and promote weight loss. In addition, she will be educated on a healthy diet and reducing caloric intake for weight loss and to lower BP.

A multidisciplinary approach will be needed for rehabilitation and will include pulmonary rehabilitation, nutritional counseling, education, and self-management. Pulmonary rehabilitation is a multidisciplinary intervention for COPD established to improve exercise tolerance, dyspnea, and health-related QoL (Young et al., 2021). Nutritional counseling by a dietitian is vital for COPD patients who are underweight or overweight. Education and self-management are vital aspects of the multidisciplinary approach. They involve educational sessions educating patients on the nature and course of COPD and how to live with the impact of the disease.

COPD Triggers and Options for Smoking Cessation

Mrs. J can be provided individual psychotherapy to help with smoking cessation and group-based behavioral counseling. Pharmacotherapy intervention for smoking cessation includes Nicotine replacement therapy (NRT). The patient can be administered nicotine transdermal patches, gum, lozenges, inhalers, or nasal spray (Krist et al., 2021). COPD triggers that can cause exacerbations and readmission include tobacco smoke, exposure to dust, and environmental pollutants like carbon monoxide, which cause bronchoconstriction.

Conclusion

Mrs. J has a risk of cardiovascular conditions like Coronary Artery Disease, Atrial fibrillation, Stroke, and Myocardial infarction. IV Lasix, ProAir HFA, and oxygen therapy were appropriate since they improve symptoms of pulmonary congestion and COPD exacerbations. However, Vasotec and Lopressor lower BP, which is unsuitable for the patient due to the low BP. Morphine would have caused respiratory depression, while Flovent HFA is indicated for long-term COPD maintenance and thus was inappropriate. The health education plan for Mrs. J focuses on lifestyle modification to control BP, promote weight loss, delay COPD progression, and prevent COPD exacerbations.

References

Burge, A. T., Cox, N. S., Abramson, M. J., & Holland, A. E. (2020). Interventions for promoting physical activity in people with chronic obstructive pulmonary disease (COPD). The Cochrane database of systematic reviews, 4(4), CD012626. https://doi.org/10.1002/14651858.CD012626.pub2

Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., … & US Preventive Services Task Force. (2021). Interventions for tobacco smoking cessation in adults, including pregnant persons: US Preventive Services Task Force recommendation statement. Jama, 325(3), 265-279. doi:10.1001/jama.2020.25019

Kurczewska-Michalak, M., Lewek, P., Jankowska-Polańska, B., Giardini, A., Granata, N., Maffoni, M., Costa, E., Midão, L., & Kardas, P. (2021). Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions. Frontiers in pharmacology, 12, 734045. https://doi.org/10.3389/fphar.2021.734045

Nici, L., Mammen, M. J., Charbek, E., Alexander, P. E., Au, D. H., Boyd, C. M., … & Aaron, S. D. (2020). Pharmacologic management of chronic obstructive pulmonary disease. An official American Thoracic Society clinical practice guideline. American journal of respiratory and critical care medicine, 201(9), e56-e69. DOI: 10.1164/rccm.202003-0625ST

Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2019). Hypertension. Nature reviews. Disease primers, p. 4, 18014. https://doi.org/10.1038/nrdp.2018.14

Schwinger, R. H. G. (2021). Pathophysiology of heart failure. Cardiovascular diagnosis and therapy, 11(1), 263–276. https://doi.org/10.21037/cdt-20-302

Young, M., Villgran, V., Ledgerwood, C., Schmetzer, A., & Cheema, T. (2021). Developing a Multidisciplinary Approach to the COPD Care Pathway. Critical care nursing quarterly, 44(1), 121–127. https://doi.org/10.1097/CNQ.0000000000000345

Case Study: Mrs. J. – Rubric