NRS 410 Bowie State University Older Patients Health History Questions

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

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5kg.
  2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
  3. 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.
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
  5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)
  5. Inhaled short-acting bronchodilator (ProAir HFA)
  6. Inhaled corticosteroid (Flovent HFA)
  7. 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.

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.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Expert Solution Preview

Introduction:
The case study presents the health history and medical information of Mrs. J, a 63-year-old woman with a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease. Mrs. J has been admitted to the hospital ICU due to acute decompensated heart failure and acute exacerbation of COPD. In this critical thinking essay, various aspects of Mrs. J’s situation will be discussed, including clinical manifestations, nursing interventions, cardiovascular conditions, drug interactions, health promotion and restoration, medication education, COPD triggers, and smoking cessation options.

1. Describe the clinical manifestations present in Mrs. J.
Mrs. J presented with sudden flu-like symptoms, including fever, productive cough, nausea, and malaise. She reported feeling anxious and having difficulty in breathing, chest pain, exhaustion, and inability to eat or drink without assistance. Her vital signs revealed an irregular heart rate, tachypnea, decreased oxygen saturation, pulmonary crackles, and blood-tinged sputum. Additionally, she had peripheral edema, elevated jugular venous pressure, and hepatomegaly.

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.
The nursing interventions at the time of Mrs. J’s admission were appropriate. The medications administered to control her symptoms included IV furosemide, Enalapril, Metoprolol, IV morphine sulphate, inhaled short-acting bronchodilator, inhaled corticosteroid, and oxygen. Furosemide is a loop diuretic that helps reduce edema and fluid overload, Enalapril and Metoprolol are antihypertensive and heart failure medications that decrease blood pressure and improve heart function. Morphine is an analgesic used for pain management, while short-acting bronchodilators and corticosteroids improve airflow in patients with COPD. Oxygen is vital in improving oxygen saturation and reversing hypoxemia.

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.
Four cardiovascular conditions that may lead to heart failure are coronary artery disease, hypertension, myocarditis, and valve abnormalities. Preventive measures for CAD include regular exercise, healthy diet, and control of risk factors such as smoking, diabetes, and hyperlipidemia. Hypertension can be prevented by maintaining a healthy weight, reducing salt intake, regular physical activity, and stress management. Myocarditis prevention involves vaccination against viral myocarditis, prompt treatment and management of viral infections, and proper screening of blood or organ donors. Valve abnormalities prevention may include prompt treatment of endocarditis, early intervention for valvular disease and regular monitoring of patients with known valve abnormalities.

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.
Nursing interventions that can prevent problems caused by multiple drug interactions in older patients include: medication reconciliation, education, monitoring, and collaboration. Medication reconciliation involves reviewing the patient’s medications regularly and identifying any interactions or discrepancies. Education can be provided on the importance of taking medications as prescribed, possible side effects, drug interactions, and when to seek medical help. Monitoring of patients’ medication regimen is vital, including vital signs, laboratory values, and adverse drug reactions. Collaboration among healthcare providers can help prevent medication errors and adverse effects.

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.
The health promotion and restoration teaching plan for Mrs. J should include self-care management strategies, such as regular exercise, healthy diet, smoking cessation, regular medication adherence, stress management, and regular medical follow-up. She should receive multidisciplinary resources such as respiratory therapy, physical therapy, and occupational therapy to improve respiratory function, physical endurance and daily living activities. Home modifications such as installing grab bars, raised toilet seats, and shower chairs will help Mrs. J’s 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.
The method of providing education for Mrs. J. regarding medications should involve verbal and written instructions. The nurse can explain the importance of taking medications as prescribed, possible side effects, interactions, and when to seek medical assistance. The nurse can also provide written instructions about the medications, including the name, dose, frequency, and the reason for taking each medication. The rationale for this is to ensure that Mrs. J understands her medications and can take them properly, thus preventing future hospital admissions.

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.
COPD triggers that can increase exacerbation frequency include tobacco smoke, infections, air pollution, temperature changes, and stress. Given Mrs. J’s current and long-term tobacco use, smoking cessation options that can be offered include nicotine replacement therapy, prescription medications such as bupropion and varenicline, and cessation counseling. The nurse can also provide coping mechanisms for Mrs. J to manage stress and avoid triggers that can exacerbate COPD symptoms.

In conclusion, Mrs. J’s situation presents multiple challenges that require a comprehensive approach to her care. Nursing interventions such as drug therapy, health promotion, rehabilitation, education, and smoking cessation can improve her health outcomes and prevent future hospital admissions.

Share This Post

Email
WhatsApp
Facebook
Twitter
LinkedIn
Pinterest
Reddit

Order a Similar Paper and get 15% Discount on your First Order

Related Questions

Select one text from the selection below for Essay#1: Article:”China Helped Raise My American Kids, and They Turned Out Fine” by Heather Kaye  published in

Select one text from the selection below for Essay#1: Article:”China Helped Raise My American Kids, and They Turned Out Fine” by Heather Kaye  published in New York Times.   Video: “How AI is generating a revolution in entertainment” published in Youtube by The Economist   Podcast: “Beyoncé, Björk and Donald Trump: What makes divas tick ”

Description Deliverable Length: 3-5 pages Write a brief summary of an intelligence and information-sharing strategy, either by a specific agency or in

Description Deliverable Length: 3-5 pages Write a brief summary of an intelligence and information-sharing strategy, either by a specific agency or in general as it applies to intelligence and information sharing. The summary will identify the following: The strategy The agency behind the strategy The primary goals, objectives, and policies within the strategy

Select one of the topics below: Autonomic computing Grid computing Nanotechnology N-tier client/server architectures On-demand computing Service-oriented

Select one of the topics below: Autonomic computing Grid computing Nanotechnology N-tier client/server architectures On-demand computing Service-oriented architecture (SOA) Storage area networks (SANs) Virtualization Write a research paper on the real-world application of the chosen technology. Your paper should include the type of organization(s) that benefits most from this technology.