NRS 410 GCU Pathophysiology Case Clinical Manifestations Essay – Description
ASSESSMENT DESCRIPTION
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 INFORMATIN
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 (activities of daily living) 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 (subjective data is what the patient says is feeling)
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 (Objective data is what the nurse can measure)
Height 175 cm; Weight 95.5kg.
Vital signs: Temperature 37.6C, Heart Rate 118 and irregular, Respiratory Rate34, Blood Pressure 90/58.
Cardiovascular: Distant S1, S2, S3 present; Point of Maximal Impulse (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/ Nasal Cannula
CRITICAL THINKING ESSAY
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.
These are the meds classification, action, and rationale that will help you answer question #4
Classification, action, and rationale for each medicine
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/ Nasal Cannula
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Furosemide (Lasix)
Classification: Loop diuretics
Action: Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. Effectiveness persists in impaired renal function.
Rational for the use for furosemide: Furosemide is used to treat fluid retention (edema) in people with congestive heart failure. Furosemide is also used to treat high blood pressure (hypertension). Furosemide causes diuresis (frequent urination), which removes excess of fluid (edema, pleural effusions) then decreases blood pressure.
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Enalapril (Vasotec)
Classification:Angiotensin-converting enzyme (ACE) inhibitor
Action: ACE inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also ? plasma renin levels and ? aldosterone levels. Net result is systemic vasodilation.
Rational for the use for Enalapril: Management of hypertension. Management of symptomatic heart failure. Slowed progression of asymptomatic left ventricular dysfunction to overt heart failure. Lowers blood pressure in patients with hypertension. Increased survival and reduction of symptoms in patients with symptomatic heart failure. Decreases development of overt heart failure.
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Metoprolol (Lopressor)
Classification: Beta blocker
Action: Blocks stimulation of beta1 (myocardial)–adrenergic receptors. Does not usually affect beta2 (pulmonary, vascular, uterine)–adrenergic receptor sites.
Rational for the use for Metoprolol: Decreased blood pressure and heart rate. Decreased frequency of attacks of angina pectoris. Decreased rate of cardiovascular mortality and hospitalization in patients with heart failure. Management of stable, symptomatic (class II or III) heart failure due to hypertensive, or cardiomyopathic origin (may be used with ACE inhibitors, diuretics).
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IV morphine sulphate (Morphine)
Classification: opioid agonists
Action: Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression.
Rational for the use of IV Morphine: Pain reliever and pain associated with Myocardial Infarction (but this patient denies pain). Morphine can be used in Pulmonary edema. Morphine has for a long time been used in patients with acute pulmonary edema due to its anticipated anxiolytic and vasodilatory properties.
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Inhaled short-acting bronchodilator (ProAir HFA)
Classification: adrenergic bronchodilator
Action: Binds to beta2-adrenergic receptors in airway smooth muscle, leading to activation of adenyl cyclase and increased levels of cyclic-3,?,5,? adenosine monophosphate (cAMP). Increases in cAMP activate kinases, which inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased intracellular calcium relaxes smooth muscle airways. Relaxation of airway smooth muscle with subsequent bronchodilation.
Rational for the use of ProAir HFA: Used as a bronchodilator to control and prevent reversible airway obstruction caused by COPD. Quick-relief agent for acute bronchospasm.
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Inhaled corticosteroid (Flovent HFA)
Classification: corticosteroid
Action: Potent, locally acting anti-inflammatory and immune modifier.
Rational for the use of Flovent HFA: It helps keep lung inflammation low and the airways open.
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Oxygen delivered at 2L/ Nasal Cannula
Classification: Medical gas
Action: Nasal cannulas are medical devices used when people are unable to get sufficient oxygen to keep their body functioning optimally, whether that’s due to a condition like chronic obstructive pulmonary disease (COPD). Nasal cannulas are less invasive than other oxygen delivery systems. Nasal cannulas generally don’t prohibit regular eating and talking. Once the oxygen is delivered through the nasal cannula and enters the lungs, it is transported by red blood cells to the body’s cells where it is used for energy production.
Rational for the use of Oxygen 2L/ Nasal cannula: In acute and chronic ventilatory failure, oxygen supplementation is essential to maintain adequate delivery of oxyhemoglobin to organs such as the heart, kidneys, and brain. During an exacerbation of COPD, oxygen via a nasal cannula is used to maintain an oxygen saturation > 90%. (This patient SpO2 is 82%). Increased oxygen levels can increase energy and reduce fatigue causing patients to breathe easier.
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