Health History and Medical Information

Health History and Medical Information. It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathop…

Health History

Introduction

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

Pathophysiology and Nursing Management of Client’s Health

Introduction

A comprehensive comprehension of a disease’s pathophysiological mechanisms and clinical symptoms, treatment protocols, and disease effects across a patient’s lifespan is crucial for a registered nurse. This paper evaluates and formulates a conclusion from a patient’s health history and medical history.

Clinical Manifestations

Mrs. J presents acute decompensated heart failure and exacerbation of chronic obstructive pulmonary disease (COPD). In addition, she has hypertension and present flu-like symptoms, including fever, cough with sputum, nausea, and malaise. Consequently, Mrs. J cannot carry out activities of daily living (ADL’s), such as eating, or drinking and needs assistance walking short distances.

Appropriateness of the Medications

The interventions given to Mrs. J during admission were all appropriate. According to Dixit et al. (2016), furosemide is crucial in removing excessive sodium in the body to assist the kidney to eliminate excess body fluid through urine, equally relieving heart congestion and enhancing heart rate. Enalapril is a vital pharmacological intervention for high blood pressure and treatment for heart failure. 

According to Rayner (2019), Enalapril is effective in managing elevated BP and variability. Equally, Metoprolol is a vital medication for managing hypertension to prevent heart failure (Mittal). Therefore, Metoprolol was crucial in regulating Mrs. J’s rapid heart rate.  IV morphine sulphate was the ideal medication for Mrs. J’s short breath. IV morphine sulphate is crucial in dyspnea among patients diagnosed with COPD (Soffler et al., 2017).

Equally, inhaled short-acting bronchodilator intervention was crucial for controlling Mrs. J’s breath. The intervention is recommended for emergency severe exacerbation among patients diagnosed with COPD to clear constricting airways – bronchoconstriction (Kopsaftis et al., 2018) as exemplified by Mrs. J’s inability to get enough air.

Equally, inhaled corticosteroid was a vital medical intervention for preventing recurrence of shortness of breath and resolving airway inflammation to ease breathing (Daley‐Yates, 2015). Lastly, oxygen delivered at 2L/ NC was an appropriate intervention for Mrs. J since she was severe breathless and needed immediate supplemental oxygen to aid her breathing. Supplemental oxygen is a crucial intervention for a patient with hypoxemia complications and chronic pulmonary diseases (Hardavella et al., 2019).

Cardiovascular Conditions that cause heart failure and their medical interventions.

Cardiovascular conditions that can cause heart failure include hypertension, coronary artery disease (CAD), myocarditis, and cardiomyopathy. Hypertension causes the heart to pump faster, leading to the thickening of the heart’s left ventricle. This makes it hard to pump blood, leading to heart failure (Magyar et al., 2015).

Hypertension can be managed through lifestyle changes, including increased physical activity, maintaining a healthy weight, eating healthy, and limiting alcohol intake. Equally, the condition can be pharmacologically managed through diuretics, e.g., Aldactone, ACE inhibitors such as benazepril, ARBs such as candesartan, or calcium channel blockers such as amlodipine.

CAD refers to a condition resulting from damaged or diseased blood vessels, leading to their inability to supply enough oxygenated blood to the heart and a consequent predisposition to heart failure (Malakar et al., 2019). Like hypertension, CAD interventions involve lifestyle changes. Similarly, the condition can be pharmacologically managed using ACE inhibitors, ranolazine, nitroglycerin, calcium channel blockers, beta-blockers, or cholesterol-modifying medications.

On the other hand, myocarditis refers to inflammation of the myocardium, leading to abnormal heart rhythms, inability to pump blood, and intermittent heart failure (Tschöpe et al., 2020). Myocarditis often improves on its own but can be managed through ACE inhibitors, ARBs, beta-blockers, or diuretics. Severe cases can be managed through extracorporeal membrane oxygenation machines, assistive devices, balloon pumps (intra-aorta), or intravenous (IV) medications.

Lastly, cardiomyopathy is a heart muscle disease that limits the heart’s ability to pump enough oxygenated blood into the heart, leading to heart failure (Tschöpe et al., 2020). Cardiomyopathy can be managed by reducing risks of complications, pharmacological interventions, therapies (septal ablation and radiofrequency ablation), or medical devices such as a pacemaker or implantable cardioverter-defibrillator.

Nursing interventions for multiple drug interactions in older patients

Appropriate nursing interventions for multiple drug interactions include reviews of patients’ prescriptions, educational programs for practitioners, prescribing incentive schemes, and regulatory interventions.  Practitioners should review medical prescriptions with the patient and caregiver, providing changes, and discontinuing unnecessary medications (Varghese et al., 2020).

Equally, medical practitioners should be engaged in educational programs on managing and minimizing polypharmacy (Saljoughian, 2019). These programs include training on appropriate prescription techniques and the effects of polypharmacy. Moreover, incentive schemes are also crucial in changing prescribing practice, improving quality, and cost-effectiveness in prescribing (Rankin et al., 2018).

Lastly, regulatory interventions such as government policies regulating prescriptions provide nursing frameworks for minimizing risks associated with polypharmacy in the elderly population (Soler & Barreto, 2019).

Health promotion and restoration teaching plan for Mrs. J

As a practitioner, I would present Mrs. J with an appropriate nutritional plan and routine guide for physical activity. Good nutrition and appropriate physical activity will be crucial in decreasing lifestyle risks associated with heart failure mentioned above and improving her quality of life.  In this sense, the nutrition guideline will include various fruits and vegetables, sugar-free food and drinks, more water, at least 30 minutes of exercise a day, and a routine clinical evaluation.

Education Method

As a practitioner, I would have a face value conversation with Mrs. J to explain the significance of every prescribed medication, probable side effects, and the need for medication adherence. Communicating with a patient facilitates understanding clinical instructions and information relating to a given medical intervention (Bowman & Cushing, 2017). Communication would also allow Mrs. J to make sense of his condition and learn about the significance of the medical interventions in improving his/her health.  

COPD Triggers

I would discuss the triggers of COPD with the patient, including inhaled irritants, extreme weather, respiratory infections, and, most importantly, cigarette smoke (Viniol & Vogelmeier, 2018). Possible options for smoking cessation include; enrolling Mrs. J in a stop-smoking program and smoking support groups to improve cessation success. I would also provide Mrs. J with smoking cessation medication such as Varenicline 0.5 mg PO qDay.

References

Bowman, D., & Cushing, A. (2017). Ethics, law, and communication. In: Kumar P, Clark M, eds. Kumar and Clarke’s Clinical Medicine. 9th ed. Philadelphia, PA: Elsevier;

Daley‐Yates, P. T. (2015). Inhaled corticosteroids: potency, dose equivalence, and therapeutic index. British journal of clinical pharmacology, 80(3), 372-380. https://doi.org/10.1111/bcp.12637

Hardavella, G., Karampinis, I., Frille, A., Sreter, K., & Rousalova, I. (2019). Oxygen devices and delivery systems. Breathe, 15(3), e108-e116. 10.1183/20734735.0204-2019   

Kopsaftis, Z. A., Sulaiman, N. S., Mountain, O. D., Carson-Chahhoud, K. V., Phillips, P. A., & Smith, B. J. (2018). Short-acting bronchodilators for managing acute exacerbations of chronic obstructive pulmonary disease in the hospital setting: a systematic review. Systematic reviews, 7(1), 1-13. 10.1186/s13643-018-0860-0

Magyar, K., Gal, R., Riba, A., Habon, T., Halmosi, R., & Toth, K. (2015). From hypertension to heart failure. World, 2.  10.5494/wjh.v5.i2.85 

Malakar, A. K., Choudhury, D., Halder, B., Paul, P., Uddin, A., & Chakraborty, S. (2019). A review on coronary artery disease, its risk factors, and therapeutics. Journal of cellular physiology, 234(10), 16812-16823. https://doi.org/10.1002/jcp.28350

Mittal, N., Shafiq, N., Reddy, S., Malhotra, S., Kumari, S., & Varma, S. (2017). Evaluation of efficacy of Metoprolol in patients having heart failure with preserved ejection fraction: A randomized, double-blind, placebo-controlled pilot trial. Perspectives in clinical research, 8(3), 124. 10.4103/2229-3485.210449

Rayner, B. (2019). The effect of lercanidipine or lercanidipine/enalapril combination on blood pressure in treatment-naïve patients with stage 1 or 2 systolic hypertension. Pragmatic and observational research, 10, 9. https://doi.org/10.2147/POR.S186070

Saljoughian, M. (2019). Polypharmacy and drug adherence in elderly patients. US Pharm, 44(7), 33-6. https://www.uspharmacist.com/article/polypharmacy-and-drug-adherence-in-elderly-patients

Soffler, M. I., Rose, A., Hayes, M. M., Banzett, R., & Schwartzstein, R. M. (2017). Treatment of acute dyspnea with morphine to avert respiratory failure. Annals of the American Thoracic Society, 14(4), 584-588. 10.1513/AnnalsATS.201611-922CC

Soler, O., & Barreto, J. O. M. (2019). Community-level pharmaceutical interventions to reduce the risks of polypharmacy in the elderly: overview of systematic reviews and economic evaluations. Frontiers in pharmacology, 10, 302. 10.3389/fphar.2019.00302

Tschöpe, C., Ammirati, E., Bozkurt, B., Caforio, A. L., Cooper, L. T., Felix, S. B., … & Van Linthout, S. (2020). Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nature Reviews Cardiology, 1-25. https://doi.org/10.1038/s41569-020-00435-x

Varghese, D., Ishida, C., & Koya, H. H. (2020). Issues of Concern. StatPearls [Internet]. https://pubmed.ncbi.nlm.nih.gov/30422548/

Rankin, A., Cadogan, C. A., Patterson, S. M., Kerse, N., Cardwell, C. R., Bradley, M. C., … & Hughes, C. (2018). Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews, (9). 0.1002/14651858.CD008165.pub4

Viniol, C., & Vogelmeier, C. F. (2018). Exacerbations of COPD. European Respiratory Review, 27(147). 10.1183/16000617.0103-2017