Chronic Obstructive Pulmonary Disease, Hypertension, and Heart Failure: The Case Study Essay

Clinical Presentation Account

The symptom given shows that Mrs. J had hypertension, acute decompensated heart failure, and obvious COPD. The patient has acute respiratory distress as per the subjective data evidenced by feelings of impending doom, anxiety, and feelings of breathlessness. The most likely cause of the symptom is fluid accumulation and congestion in the pulmonary system due to the failed heart that reduces the kidneys’ perfusion, thus causing an increase in the production of renin. The result is an increase in the aldosterone hormone that causes water and sodium retention above the normal levels. The patient has increased respiratory rate, a saturation of 82%, frothy sputum, faint PMI, and pulmonary crackles, which confirms the acute respiratory distress resulting from fluid buildup. Hepatomegaly suggests portal hypertension while jugular distension is caused by pulmonary congestion.

Nursing Management and Rationale

The most priority intervention is to ensure the airway’s patency and administration of supplemental oxygen via a non-rebreather mask to maintain the normal levels’ saturation. Continuous monitoring of the oxygen should be done by pulse oximetry. Nevertheless, the patient should be monitored closely in case she needs a mechanical ventilator. (Baker & Fatoye, 2019). Therefore, Mrs. J. should be on a continuous cardiac monitor, and pacer pads should be available in case there is a need for cardioversion arises. She should have intravenous access, which means she should not consume food orally to avoid exhaustion during eat, or swallowing. Furthermore, Foley catheter should be inserted for input-output monitoring, especially when she starts anti diuretics. The other interventions include renal function tests and liver function tests.

Medical Management and Rationale

IV furosemide (Lasix) mobilizes the accumulated intestinal fluid to improve tissue perfusion, causes diuresis, and lowers blood pressure (Olsson et al., 2019).

Enalapril (Vasotec) – first-line treatment for hypertension in heart failure. It is an angiotensin converting enzyme (ACE) and is cardio and renal protective, thus reduces cardiovascular risk.

Metoprolol (Lose pressor) – relaxes respiratory smooth muscle relieving COPD symptoms and reduces heart rate and blood pressure. It is a cardioselective beta-blocker. (Güder & Störk, 2019).

IV morphine sulfate (Morphine) – relives severe pain and sedates patients.

Inhaled short-acting bronchodilator (ProAir HFA) – is a short-acting bronchodilator that relaxes respiratory smooth muscles hence essential in acute exacerbation of COPD.

Inhaled corticosteroid (Flovent HFA) – reduces the irritation and inflammation of the airway, easing breathing.

Oxygen 2L NC – Increases the saturation and promotes perfusion of the tissue.

Cardiovascular Conditions and Their Nursing Interventions

Coronary artery disease

Caused by accumulation of cholesterol and narrowing of the arteries, causing high blood pressure, angina, and heart attack leads to heart failure. Nursing interventions include health education on lifestyle modification and maintaining a normal weight, physical exercises, DASH diet, and administration (Kamińska & Krzemińska, 2018).

Myocardial infarction

It is the impairment of blood flow to the heart instigated by a blocked artery, resulting in ischemia that impairs the normal heart contractility, triggering heart failure. The recommended nursing education includes health education on smoking cessation, healthy eating, maintaining a normal BMI, and physical exercise.

Uncontrolled blood pressure

Uncontrolled high blood pressure weakens the myocardial muscles since it overworks the heart, causing heart failure. The recommended nursing care includes health education on routine blood pressure monitoring, lifestyle modification, and adherence to antihypertensives. (Güder & Störk, 2019).

Dilated cardiomyopathy or myocarditis

This damage of the heart muscles by either alcohol or infection results in heart failure. Nursing care includes promoting a healthy lifestyle and treating all heart infections and the most common streptococcal infections. (Kaszuba, 2018).

Nursing Interventions in Reducing Multiple Drug Interactions and the Rationale

1. Ensure that the patient takes the right dose at the right frequency through using medication organizer
2. Educate the patient on the significance of having one primary doctor to reduce polypharmacy
3. Ensure that the patient is updated on all the drug information of all the medications that they are taking to avoid drug interactions
4. Help and educate the patient to have a list of all medications prescribed to them to avoid cases of erroneous consumption of drugs that may result in interactions. (Kaszuba, 2018).

Health Restoration and Promotion Plan

The health promotion goal is to reduce the cases of hospitalization due to complications of the condition to zero in 4 months. The recommended actions include education on lifestyle modifications, physical exercise, DASH diet, maintaining a normal BMI, and self-blood pressure monitoring. The patient should also explore the options for smoking cessation (Kaszuba, 2018). Mrs. J. should be educated on the need to adhere to her medications to prevent complications and improve the quality of her life. Consequently, the multidisciplinary resources required include a walking aid, which will help the patient walk without support, resulting in more independence, medication organizer that will promote adherence by taking the right dose at the right frequency, blood pressure machine that will monitor blood pressure, and a psychologist who will help explore smoking cessation options.

Health Education Method

The preferable patient-centered method for Mrs. J. health education is teach-back. It encompasses explaining the disease process, medication information, and self-care involved in managing the condition, after which the patient teaches the nurse back the information given to ensure that they have comprehended. The method puts the patient at the center of their management, and ensures she remembers and adheres to the self-care medication methods (Centrella-Nigro & Alexander, 2017).

Triggers of COPD and Smoking Cessation Options

COPD’s commonest trigger includes airway irritants such as smoke, humid air, cold air, tobacco smoke, and pollen grains. To start with, Mrs. J. can reduce the number of daily cigarette packs to one, and start Nicotine replacement therapy such as Varenicline, which acts by binding to nicotine receptors, thus rendering smoking unpleasant. She can also start behavior therapy sessions to help in smoking cessation.

References

Baker, E., & Fatoye, F. (2019). Patient perceived impact of nurse-led self-management interventions for COPD: A systematic review of qualitative research. International journal of nursing studies, 91, 22–34. Web.

Centrella-Nigro, A. M., & Alexander, C. (2017). Using the teach-back method in patient education to improve patient satisfaction. Journal of Continuing Education in Nursing, 48(1), 47–52. Web.

Güder, G., & Störk, S. (2019). COPD and heart failure: Differential diagnosis and comorbidity. COPD und Herzinsuffizienz: Differenzialdiagnose und Komorbidität. Herz, 44(6), 502–508. Web.

Kamińska, M., & Krzemińska, S. (2018). Nursing care of patients after cardiac arrest in the course of myocardial infarction. Jinstituournal of Education, Health and Sport, 8(7), 345-356. Web.

Kaszuba, E. (2018). Heart failure in patients with a chronic obstructive pulmonary disease with special reference to primary care. Lund University. Web.

Olsson, K. M., Halank, M., Egenlauf, B., Fistera, D., Gall, H., Kaehler, C., Kortmann, K., Kramm, T., Lichtblau, M., Marra, A. M., Nagel, C., Sablotzki, A., Seyfarth, H. J., Schranz, D., Ulrich, S., Hoeper, M. M., & Lange, T. J. (2018). Decompensated right heart failure, intensive care, and perioperative management in patients with pulmonary hypertension: Updated recommendations from the Cologne Consensus Conference 2018. International journal of cardiology, 272S, 46–52. Web.