NRS 410 Pathophysiology and Nursing Management in Client Health Essay

NRS 410 Pathophysiology and Nursing Management in Client Health Essay

NRS 410 Pathophysiology and Nursing Management in Client Health Essay

NRS 410 Case Study Mrs. J

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.

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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

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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.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Rubric Criteria
Total

120 points

Criterion

1. Unsatisfactory

2. Insufficient

3. Approaching

4. Acceptable

5. Target

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.