Case Study Assignment: Mr. C. RN-BSN-prepared Nurse

Case Study Assignment: Mr. C. RN-BSN-prepared Nurse

Case Study: Mrs. J

This essay examines Mrs. J’s case study. She has been admitted with a diagnosis of acute decompensated heart failure. The patient has a significant history of hypertension, chronic obstructive pulmonary disease, and chronic heart failure. The essay focuses on topics that include clinical manifestations, cardiovascular risk, nursing interventions, and health promotion interventions to promote recovery and independence.

Subjective and Objective Clinical Manifestations

Subjective clinical manifestations are the problems that brought the client to the hospital.  As seen from the case study, they include sudden onset of flu-like symptoms such as fever, nausea, productive cough, malaise, and nausea. Her report of being unable to perform activities of daily living for the last three days, denying pain, feeling like her heart is running away, and feeling exhausted and being unable to drink or eat by herself also form the subjective data. Healthcare providers obtain objective data through physical assessment techniques. The objective data in Mrs. J’s case include height 175 cm, weight 95.5 kg, and vital signs. It also includes the cardiovascular assessment findings such as presence of adventitious heart sounds, bilateral jugular venous distention, atrial fibrillation, and ventricular heart rate of 132. The additional objective data includes pulmonary crackles, decreased breath sounds, and coughing frothy blood-tinge sputum.

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Cardiovascular Conditions

Mrs. J is at a risk of several cardiovascular conditions that may result in heart failure. They include endocarditis, hypertension, atherosclerosis, and cardiac dysrhythmias. Atherosclerosis may develop from the thickening and formation of clogs in the arteries. Increased cardiac activity and workload may result in hypertension. Uncontrolled hypertension and arteriosclerosis may lead to the development of fatal cardiac arrythmias. The correction of heart valves through surgery may predispose the patient to develop endocarditis (Kwong et al., 2022). Cumulatively, these cardiovascular risks can be prevented using interventions such as encouraging Mrs. J to engage in active physical exercises, weight management, treatment adherence, and avoiding alcohol intake and smoking.

Appropriateness of the Interventions

The interventions at the time of admission were beneficial for Mrs. J. There was the utilization of the steps of nursing process such as assessment, planning, and implementation. The prescribed medications are also appropriate. For example, medications such as IV furosemide are appropriate to reduce fluid volume overload. Enalapril and metoprolol are also appropriate in regulating the blood pressure and reducing cardiac workload. Oxygen also helps improve body tissue perfusion since the patient cannot tolerate activity. I would administer morphine cautiously since it is a central nervous system depressant (Adams et al., 2019). Mrs. J currently experiences respiratory problems, which may be depressed further with morphine overdose.

Medications

The first drug prescribed for Mrs. J is IV furosemide, which is a diuretic. The drug works by increasing the renal excretion of sodium and water, which lowers the body fluid volume level. It was prescribed to reduce cardiac workload by eliminating excess body fluids (Adams et al., 2019). The other drug is enalapril, which is an angiotensin-converting enzyme inhibitor. It works by inhibiting angiotensin-converting enzyme, which reduces the amount of circulating angiotensin II. The impact is the reduction in the overall peripheral resistance and cardiac oxygen demand. It was prescribed to ensure optimum cardiac functioning by lowering its workload and oxygen needs. The other drug is metoprolol, a beta blocker, which inhibits beta receptors in the cardiac muscles causing a decrease in cardiac output through negative chronotropic and inotropic effects. The drug also lowers cardiac workload, hence, its indication for the patient (Faruqi & Jain, 2022; Morris & Dunham, 2022). IV morphine sulphate has also been prescribed, which is an analgesic that manages pain and also lowers oxygen demand in the cardiac muscle. Inhaled short-acting bronchodilator has been prescribed to open the airways, hence, minimizing resistance. Similarly, Flovent HFA,  corticosteroid, which inhibits release of chemical mediators has been prescribed to prevent airway inflammation (Adams et al., 2019). Lastly, oxygen has been prescribed to increase tissue oxygenation due to the reduced cardiac function and respiratory involvement in the disease process.

Nursing Interventions for Multiple Drug Interactions

One of the strategies that can be adopted to prevent drug interactions is patient education and involvement in the treatment process. Patient education and involvement will increase her understanding of the right time and doses for the prescribed medications and the need to ensure treatment adherence. The second strategy is ensuring accurate documentation. Accurate documentation will prevent medication errors. Thirdly, nurses and pharmacists must ensure the use of the correct labels to prevent errors (Adams et al., 2019). Lastly, safe prescribing may be considered by avoiding drugs with narrow therapeutic index to prevent harm.

Health Promotion and Restoration Teaching Plan

An effective health promotion and restoration plan for Mrs. J is educating het about the lifestyle and behavioral modifications she should embrace for her optimal health and functioning. She should be educated about the importance of treatment adherence, healthy, balanced diets, physical activity, and smoking cessation. Mrs. J should also be linked with the existing social support services to facilitate her recovery. Interprofessional teams are also needed for the optimum management of the patient’s problems. As a result, care coordination should be incorporated into the plan for optimum outcomes (Kwong et al., 2022). Rehabilitation resources are essential in helping Mrs. J cope with her complex needs and identify resources she can utilize to promote independence and prevent readmission.

Options for Smoking Cessation and COPD Triggers

Mrs. J should be linked with smoking cessation support groups to help her overcome her smoking problem. She may also require prescription for nicotine replacement therapies as she adopts a stepdown approach to smoking cessation. Some of the COPD triggers that Mrs. J should be informed including tobacco smoking, air pollution, dust, and some detergents. Therefore, she should minimize her exposure to these trigger (Kwong et al., 2022).

Conclusion

The essay has explored Mrs. J problem. The adopted treatment is appropriate for her health needs. Health education on lifestyle and behavioral modifications needed for her health and wellbeing. Rehabilitation interventions should aim at enhancing her independence and reduce hospital readmissions.

References

Adams, M., Holland, N., & Urban, C. (2019). Pharmacology for Nurses: A Pathophysiologic Approach. Pearson.

Faruqi, A., & Jain, A. (2022). Enalapril. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK557708/

Kwong, J., Roberts, D., Hagler, D., & Reinisch, C. (2022). Lewis’s Medical-surgical Nursing: Assessment and Management of Clinical Problems. Elsevier, Incorporated.

Morris, J., & Dunham, A. (2022). Metoprolol. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK532923/

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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 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 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.

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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Rubric Criteria
Total
120 points
Criterion

1. Unsatisfactory

2. Insufficient

3. Approaching

4. Acceptable

5. Target

Health Promotion and Restoration Teaching Plan

Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications. Explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission.

0 points

Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications and/or explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are omitted.

13.5 points

Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications and/or explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are present, but lack detail or are incomplete.

14.22 points

Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications, and explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are present.

16.02 points

Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications, and explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are detailed.

18 points

Health promotion and restoration teaching plan is provided for patient including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications, and explanation of how the rehabilitation resources and modifications will assist the patient’s transition to independence and prevent readmission are thorough.

Format/Documentation

Uses appropriate style, such as APA, MLA, etc., for college, subject, and level; documents sources using citations, footnotes, references, bibliography, etc., appropriate to assignment and discipline.

0 points

Appropriate format is not used. No documentation of sources is provided.

1.8 points

Appropriate format is attempted, but some elements are missing. Frequent errors in documentation of sources are evident.

1.9 points

Appropriate format and documentation are used, although there are some obvious errors.

2.14 points

Appropriate format and documentation are used with only minor errors.

2.4 points

No errors in formatting or documentation are present.

Development, Structure, and Conclusion

Advances position or purpose throughout writing; conclusion aligns to and evolves from development.

0 points

No advancement of the thesis, position, or purpose is evident. Connections between paragraphs are missing or inappropriate. No conclusion is offered.

4.5 points

Writing lacks logical progression of the thesis, position, or purpose. Some organization is attempted, but ideas are disconnected. Conclusion is unclear and not supported by the overall development of the purpose.

4.74 points

Limited advancement of thesis, position, or purpose is discernable. There are inconsistencies in organization or the relationship of ideas. Conclusion is simplistic and not fully aligned to the development of the purpose.

5.34 points

The thesis, position, or purpose is advanced in most aspects. Ideas clearly build on each other. Conclusion aligns to the development of the purpose.

6 points

The thesis, position, or purpose is logically advanced throughout. The progression of ideas is coherent and unified. A clear and logical conclusion aligns to the development of the purpose.

Cardiovascular Conditions Leading to Heart Failure and Interventions

Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure. Explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the presented conditions.

0 points

Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure and/or explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are omitted.

13.5 points

Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure and/or explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are present, but lack detail or are incomplete.

14.22 points

Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure, and an explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are present.

16.02 points

Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure is and an explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are detailed.

18 points

Description of four cardiovascular conditions in which the patient is at risk and may lead to heart failure, and an explanation of what can be done in the form of medical/nursing interventions to prevent heart failure development in each of the conditions are thorough.

Clinical Manifestations of Patient

Description of subjective and objective clinical manifestations

0 points

Subjective and objective clinical manifestations are omitted.

9 points

Subjective and objective clinical manifestations are present but lack detail or are incomplete.

9.48 points

Subjective and objective clinical manifestations are present.

10.68 points

Subjective and objective clinical manifestations are detailed.

12 points

Subjective and objective clinical manifestations are thorough.

Thesis, Position, or Purpose

Communicates reason for writing and demonstrates awareness of audience.

0 points

The thesis, position, or purpose is not discernible. No awareness of the appropriate audience is evident.

4.5 points

The thesis, position, or purpose is unfocused or confused. There is very little awareness of the intended audience.

4.74 points

The thesis, position, or purpose is discernable in most aspects but is occasionally weak or unclear. There is limited awareness of the appropriate audience.

5.34 points

The thesis, position, or purpose is adequately presented. An awareness of the appropriate audience is demonstrated.

6 points

The thesis, position, or purpose is clearly communicated throughout and clearly directed to a specific audience.

Mechanics of Writing

Includes spelling, capitalization, punctuation, grammar, language use, sentence structure, etc.

0 points

Errors in grammar or syntax are pervasive and impede meaning. Incorrect language choice or sentence structure errors are found throughout.

2.7 points

Frequent and repetitive mechanical errors are present. Inconsistencies in language choice or sentence structure are recurrent.

2.84 points

Occasional mechanical errors are present. Language choice is generally appropriate. Varied sentence structure is attempted.

3.2 points

Few mechanical errors are present. Suitable language choice and sentence structure are used.

3.6 points

No mechanical errors are present. Appropriate language choice and sentence structure are used throughout.

Evidence

Selects and integrates evidence to support and advance position/purpose; considers other perspectives.

0 points

Evidence to support the thesis, position, or purpose is absent. The writing relies entirely on the perspective of the writer.

4.5 points

Evidence is limited or irrelevant. The interpretation of other perspectives is superficial or incorrect.

4.74 points

Evidence is used but is insufficient or of limited relevance. Simplistic explanation or integration of other perspectives is present.

5.34 points

Relevant evidence that includes other perspectives is used.

6 points

Specific and appropriate evidence is included. Relevant perspectives of others are clearly considered.

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

Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each. Discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions.

0 points

Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each, and/or discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions are omitted.

13.5 points

Explanation of seven medications listed in the scenario, including the classification, action, and rationale for and/or discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions is present, but lacks detail or are incomplete.

14.22 points

Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each and discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions are present.

16.02 points

Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each, and discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions are detailed.

18 points

Explanation of seven medications listed in the scenario, including the classification, action, and rationale for each, and discussion of four nursing interventions to prevent problems caused by multiple drug interactions in older patients, including rationale for the recommended interventions are thorough.

COPD Triggers and Options for Smoking Cessation

Discussion of options for smoking offered considering patient’s current and long-term tobacco use. Outline of COPD triggers that can increase exacerbation frequency, resulting in readmission.

0 points

Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use is omitted and/or outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are omitted.

13.5 points

Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use and/or outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are present, but lack detail or are incomplete.

14.22 points

Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use, and outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are present.

16.02 points

Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use, and outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are detailed.

18 points

Discussion of options for smoking cessation offered considering patient’s current and long-term tobacco use, and outline of COPD triggers that can increase exacerbation frequency, resulting in readmission are thorough.

Evaluation of Nursing Interventions at Admissions

Description of the benefit of the intervention at the time of admission using the nursing process. Explanation of any changes to the interventions to ensure patient independence and prevent readmission.

0 points

Description of the benefit of the intervention at the time of admission using the nursing process and/or explanation of any changes to the interventions to ensure patient independence and prevent readmission are omitted.

9 points

Description of the benefit of the intervention at the time of admission using the nursing process and/or explanation of any changes to the interventions to ensure patient independence and prevent readmission are present, but lack detail or are incomplete.

9.48 points

Description of the benefit of the intervention at the time of admission using the nursing process, and an explanation of any changes to the interventions to ensure patient independence and prevent readmission are present.

10.68 points

Description of the benefit of the intervention at the time of admission using the nursing process and an explanation of any changes to the interventions to ensure patient independence and prevent readmission are detailed.

12 points

Description of the benefit of the intervention at the time of admission using the nursing process and an explanation of any changes to the interventions to ensure patient independence and prevent readmission are thorough.