Clinical Manifestations
Mrs. J. is a patient with an exhaustive history of cardiorespiratory issues, and the abandonment of treatment and consistent medication intake has eventually led to a significant worsening of her diagnosis. Considering the presence of chronic heart failure, the patient has been admitted to the hospital with acute decompensated heart failure manifested by dyspnea or shortness of breath. Moreover, the patient experiences premature beats, as she claims to feel her heart “running away.” Such a condition is predetermined by her chronic heart failure and excessive nicotine intake. Another significant clinical manifestation present in the patient is the emergence of flu-like symptoms and rapid muscle weakness, which indicates deterioration of chronic obstructive pulmonary disease (COPD). The presence of S3 heart sound, also known as ventricular gallop, is yet another manifestation of heart failure.
Nursing Interventions
Given the acute decompensated heart failure (ADHF), the administration of furosemide as a loop diuretic is the most reasonable choice, as Lasix aims at relieving congestive symptoms in ADHF. Another important intervention to consider in ADHF treatment is ACE inhibitor, as it relieves the symptoms by preventing the narrowing of blood vessels. ACE inhibitor prescription, in this case, Vasotec (Enalapril), is also vital in combination with administering loop diuretics. However, considering the low BP present in the patient, it is of paramount importance to track the dosage and the patient’s BP in order to avoid a heart attack, shock, and kidney failure (Cautela et al., 2020).
Considering the irregularity and a slight increase in the patient’s heart rate, the administration of such receptor blocker as Lopressor is also justified, as it aims at relieving chest pain and lowering heart rate (Cautela et al., 2020). Morphine, being a major painkiller, is frequently administered in acute heart failure and COPD due to severe chest pain, so nurses’ decision to prescribe this medication in a small dose is justified in this scenario.
As far as breath shortness and acute COPD manifestation are concerned, the administration of inhaled bronchodilators and corticosteroids is vital. They tend to improve lung function and breathing patterns (Crisafulli et al., 2018). Finally, the delivery of oxygen is also vital for the patient’s condition. Hence, it may be concluded that the medication prescription is justified by the patient’s clinical manifestations, but it is necessary to draw attention to the medication dosage in regard to Mrs. J.’s low BP.
Conditions Causing Heart Failure
The occurrence of heart failure in older patients is highly correlated with coronary artery disease (CAD), which, for its part, is catalyzed by hypertension. In order to prevent hypertension, it is of paramount importance to maintain a healthy diet, be physically active, and quit hazardous habits like smoking (Centers for Disease Control and Prevention [CDC], 2020). Another risk factor of heart failure in older people is diabetes mellitus, which can be prevented with the help of maintaining a proper diet, daily physical activity, and managing mental health problems and stress (CDC, 2021). Another risk factor, anemia, which is characterized by iron deficiency, may also be prevented by maintaining a diet with enough iron and B12 vitamins and promoting regular physical activity (“Anemia,” n.d.). Finally, an infection may also serve as a catalyst for heart failure decompensation (Zeru, 2018).
The promotion of hand hygiene and social distancing is the most common means of prevention. Hence, it may be concluded that the most relevant nursing intervention in terms of preventing heart failure is patient education on the matter of balanced nutrition and physical activity.
Multiple Drug Interactions in Older Patients
There are many issues related to medical drug interactions in elderly patients. The first issue that may be addressed by the nurses is the avoidance of hazardous drug-drug interactions. It can be achieved by implementing a computerized decision support system, an electronic tool to check the compatibility of medications (Ranklin et al., 2018). Another intervention is a regular patient prescription review, as the introduction of new medications may severely disrupt the initial treatment implications (Ranklin et al., 2018).
It is also imperative to promote a team approach to polypharmacy, encouraging multidisciplinary teams to develop an appropriate set of medications regarding the peculiarities of patients’ health conditions (Mangin et al., 2021). Finally, it may be beneficial to promote medication organization patterns for elderly patients, with nurses promoting daily boxes for medications for the patients not to confuse them (Saljoughian, 2019).
Health Promotion, Restoration, and Education
The first recommendation for Mrs. J. should be to give up smoking and promote daily physical activity after rehabilitation. Thus, talking to her GP might help in terms of providing the patient with options for quitting smoking, such as enrolling in nicotine replacement therapy. Moreover, the restoration should also include cardiac rehabilitation, which encompasses counseling on nutrition, physical training optimization, and physical activity promotion (Chun & Kang, 2021).
Another specialist considered in a multidisciplinary team is a physiotherapist who might help the patient gradually gain independence in performing ADLs. As far as the education is concerned, the nurse should conduct an educational session for Mrs. J., during which they would outline the risks of abandoning treatment once again and going through the list of medications once again in order to make sure she is aware of why she needs each of them.
COPD Trigger Management
The triggers for COPD exacerbation include cigarette smoke, air pollution, extremely hot and humid weather, and fumes. In order to avoid these triggers, Mrs. J. should monitor weather conditions and pollution levels in the area prior to going outside. Moreover, she should proceed with nicotine replacement therapy as a means of quitting smoking. Finally, it is of utmost importance to avoid respiratory infections and, if possible, get vaccinated.
References
Anemia. (n.d.). MedlinePlus. Web.
Cautela, J., Tartiere, J. M., Cohen-Solal, A., Bellemain‐Appaix, A., Theron, A., Tibi, T., Januzzi, Jr., J. L., Roubille, F., & Girerd, N. (2020). Management of low blood pressure in ambulatory heart failure with reduced ejection fraction patients. European Journal of Heart Failure, 22(8), 1357-1365. Web.
Centers for Disease Control and Prevention [CDC]. (2020). Prevent high blood pressure. Web.
Centers for Disease Control and Prevention [CDC]. (2021). Prevent type 2 diabetes. Web.
Chun, K. H., & Kang, S. M. (2021). Cardiac rehabilitation in heart failure. International Journal of Heart Failure, 3(1), 1-14. Web.
Crisafulli, E., Barbeta, E., Ielpo, A., & Torres, A. (2018). Management of severe acute exacerbations of COPD: an updated narrative review. Multidisciplinary Respiratory Medicine, 13(1), 1-15. Web.
Mangin, D., Lamarche, L., Agarwal, G., Banh, H. L., Dore Brown, N., Cassels, A., Colwill, K., Dolovich, L., Farrell, B., Garrison, S., Gillett, J., Griffith, L. E., Holbrook, A., Jurcic-Vrataric, J., McCormack, J., O’Reilly, D., Raina, P., Richardson, J., Risdon, C., Savelli, M., … Thabane, L. (2021). Team approach to polypharmacy evaluation and reduction: study protocol for a randomized controlled trial. Trials, 22(1), 746. Web.
Rankin, A., Cadogan, C. A., Patterson, S. M., Kerse, N., Cardwell, C. R., Bradley, M. C., Ryan, C., & Hughes, C. (2018). Interventions to improve the appropriate use of polypharmacy for older people. The Cochrane Database of Systematic Reviews, 9(9). Web.
Saljoughian, M. (2019). Polypharmacy and drug adherence in elderly patients. US Pharmacist, 44(7), 33-36.
Zeru, M. A. (2018). Assessment of major causes of heart failure and its pharmacologic management among patients at Felege Hiwot referral hospital in Bahir Dar, Ethiopia. Journal of Public Health and Epidemiology, 10(9), 326-331. Web.