NRS 410 Case Study: Mrs. J

Sample Answer for NRS 410 Case Study: Mrs. J Included After Question

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

  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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

A Sample Answer For the Assignment: NRS 410 Case Study: Mrs. J

Title: NRS 410 Case Study: Mrs. J 

Case Study: Mrs. J

The case scenario discussed is of 63-year-old Mrs. J who has been in care for chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) and is now admitted due to their exacerbations. She reports a history of cigarette smoking, hypertension, poor compliance to medication, and a recent upper airway tract infection. This discussion aims to describe how she was managed, the reasons for exacerbation, and patient management plans.

Question 1

COPD that Mrs. J is characterized by an inflamed airway that impairs expiration of gases thus presenting with dyspnea. The limited expiration results in the accumulation of carbon (IV) oxide in the body which triggers anxiety (Choi & Rhee, 2020). On the other hand, CHF reduces the heart’s ability to pump blood thus irregular heartbeat occurs described as the heart running away (Schwinger, 2021). It also presents with fatigue due to impaired blood supply to the body tissues (Hajar, 2019).

Question 2

Medications that have been administered to manage Mrs. J can be justified due to their effects. Furosemide and enalapril work through a different mechanisms of action to reduce the decompensation of the heart in CHF (Hajar, 2019). Although furosemide encourages diuresis by inhibiting the reabsorption of sodium in kidney tubules whereas enalapril inhibits the renin-angiotensin-aldosterone system (RAAS), they both lead to a decrease in preload and afterload (Lee et al., 2019). This reduces pressure against the heart and also corrects the reported edema especially due to furosemide use.

Metoprolol that was prescribed regulates the sympathetic system activation in heart failure thereby reducing the cardiac contractility and heart rate (Hajar, 2019). As such, it corrects the reported palpitations. Further, the inhaled bronchodilators and corticosteroids correct the bronchoconstriction due to COPD thus promoting expiration whereas morphine helped in reducing anxiety symptoms (Lief & McSparron, 2020). Due to Mrs. J’s low oxygen saturation, oxygen supplementation was also necessary to reverse the hypercapnia and promote oxygen delivery to tissues (Choi & Rhee, 2020). The prescribed drugs were therefore justified and appropriate for managing the exacerbations.

Question 3

CHF results from most heart conditions whether they affect the valves, heart muscles, or the electrical conduction pathways. Some of these conditions include cardiomyopathy, valvular defects, coronary artery disease (CAD), and arrhythmias. Cardiomyopathy is where there is damage to the myocardium due to a myriad of factors including alcohol use and it consequently impairs the heart’s ability to pump blood (Hajar, 2019). Valvular defects whether resulting from infection of the valves, stenosis, or regurgitation are also implicated (Lee et al., 2019). CAD where there are narrowed coronary artery vessels with consequential cardiac ischemia as well as arrhythmias where the is uncoordinated heart beating such as atrial fibrillation are other risk factors for CHF (Schwinger, 2021). Most of these conditions can be prevented from resulting in CHF.

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Different nursing interventions can help in preventing CHF from these cardiac conditions. Such measures include the adoption of physical exercise and dietary modification for CAD, reduced alcohol consumption for cardiomyopathy, and aggressive antibiotic therapy to prevent the advancement of valvular infection into CHF (Lee et al., 2019). Non-pharmacological vagal maneuvers may be applied to correct arrhythmias.

Question 4

Nurses play important roles in preventing adverse reactions to polypharmacy. They achieve this through education, instruction, information, and organization. Education involves highlighting the presentation of adverse reactions and warning the patient about drugs or food that possibly interact with their prescribed medications (Zabihi et al., 2018). By instruction, adherence to therapy is emphasized to prevent incidences of overdose which is an adverse reaction. During instruction, the nurse directs the patient to reliable sources of medicine to ensure continuity of therapy (Lief & McSparron, 2020). On the other hand, the organization is done by arranging the drug into daily pill packs that promote adherence and discourages overdose.

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NRS 410 Case Study Mrs. J
NRS 410 Case Study Mrs. J

Question 5

Health promotion in a patient with COPD and CHF will aim at reducing readmission rates and facilitating recovery. To reduce the readmissions, the risk factors of exacerbation such as unhealthy diet, cigarette smoking, and obesity should be addressed. Mrs. J will therefore be encouraged to reduce her weight, adopt the DASH diet, and also engage in physical activity (Hajar, 2019). She will also be advised against cigarette smoking which may worsen COPD. In the promotion of her recovery, the patient will benefit from a multidisciplinary team comprised of pulmonologists and cardiologists who will educate her on pulmonary physiotherapy, cardiac rehabilitation, and adherence to medication (Schwinger, 2021). Homebased care can also be adopted to promote her well-being at home. These measures will enhance recovery and reduce the risks of readmission.

Question 6

Mrs. J is a geriatric patient who will benefit from proper education on her condition. Given most geriatric patients have poor literacy that may enable the comprehension of complex medical information during education, an effective education would involve the use of diagrams and charts for illustrations (Lee et al., 2019). This not only promotes comprehension but also encourages memorability. Adoption of family education can also be encouraged to promote the involvement of family members in patient care (Toledano-Toledano & Luna, 2020).

Question 7

Some of the factors that may have exacerbated the COPD in this patient would include the history of cigarette smoking and the recent flu-like illness that is reported. These triggers cause airway hyperresponsive and worsen bronchoconstriction, especially in COPD and asthma patients (Lief & McSparron, 2020). Other possible causes of the exacerbation may include exposure to cold, air pollution, and non-adherence to medications. Smoke cessation would therefore be encouraged for patients with COPD who smoke a cigarette. The options to encourage cessation of smoking include nicotine replacement therapy, use of bupropion, as well as psychotherapy such as group therapy (Choi & Rhee, 2020). These methods help in reducing cravings for smoking thus promoting recovery.

Conclusion

Chronic illnesses such as COPD and CHF have underlying organ dysfunctions that are responsible for their presentation. Understanding these dysfunctions as well as their causes and triggers helps in the formulation of effective strategies for managing patients against these conditions. The use of medications should be aimed at addressing the dysfunction or patient symptoms. In the course of treatment, adherence to therapy should be encouraged as the incidences of adverse drug reactions are reduced. Further, the specific risk factors of the conditions should also be addressed by encouraging health promotion strategies such as a healthy diet, smoke cessation, and physical exercise. This would reduce incidences of readmission for these patients and promote patient recovery.

References

Choi, J. Y., & Rhee, C. K. (2020). Diagnosis and treatment of early chronic obstructive lung disease (COPD). Journal of Clinical Medicine9(11), 3426. https://doi.org/10.3390/jcm9113426

Hajar, R. (2019). Congestive heart failure: A history. Heart Views: The Official Journal of the Gulf Heart Association20(3), 129–132. https://doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_77_19

Lee, J. H., Kim, M. S., Yoo, B. S., Park, S. J., Park, J. J., Shin, M. S., Youn, J. C., Lee, S. E., Jang, S. Y., Choi, S., Cho, H. J., Kang, S. M., & Choi, D. J. (2019). KSHF guidelines for the management of acute heart failure: Part II. Treatment of acute heart failure. Korean Circulation Journal49(1), 22–45. https://doi.org/10.4070/kcj.2018.0349

Lief, L., & McSparron, J. (2020). Acute Exacerbation of COPD. In Evidence-Based Critical Care (pp. 169–173). Springer International Publishing.

Schwinger, R. H. G. (2021). Pathophysiology of heart failure. Cardiovascular Diagnosis and Therapy11(1), 263–276. https://doi.org/10.21037/cdt-20-302

Toledano-Toledano, F., & Luna, D. (2020). The psychosocial profile of family caregivers of children with chronic diseases: a cross-sectional study. BioPsychoSocial Medicine14(1), 29. https://doi.org/10.1186/s13030-020-00201-y

Zabihi, A., Hosseini, S., Jafarian Amiri, S., & Bijani, A. (2018). Polypharmacy among the elderly. Journal of Mid-Life Health9(2), 97. https://doi.org/10.4103/jmh.jmh_87_17