Clinical Manifestations Present in Mrs. J
Clinical manifestations present in Mrs. J include fever, productive coughing, nausea, and malaise. In the past three days, she also experienced limited mobility, unable to perform daily living activities. Finally, she experienced a decompensated heart failure and acute exacerbation of COPD. Additional manifestations include irregular heart rate, jugular vein distension, and atrial fibrillation. Lung-related manifestations include pulmonary crackles, decreased breathing sounds, frothy blood-tinged sputum, and a reduced peripheral oxygen saturation level at 82%.
Appropriateness of the Initial Nursing Intervention
When Mrs. J was brought into the hospital, she was administered with 7 different treatments, including IV furosemide (Lasix), Enalapril (Vasotec), Metoprolol (Lopressor), IV morphine sulphate (Morphine), inhaled short-acting bronchodilator (ProAir HFA), inhaled corticosteroid (Flovent HFA) and oxygen delivered at 2L/ NC. These treatments were aimed to address the major symptoms and clinical manifestations found in the patient at the time of arrival. Lasix was used to deal with the liquid buildup associated with heart failure (Opie & Gersh, 2014). Vasotec was used to reduce the patient’s increased blood pressure (Opie & Gersh, 2014). Lopressor was used for the same purposes, only using a different action mechanism, with the former being an ACE inhibitor, and the latter – a beta-blocker (Opie & Gersh, 2014). The choice to use morphine is strange, as the report does not mention the patient experiencing severe pain, which would justify the use of the drug (Opie & Gersh, 2014). Short-acting bronchodilator and corticosteroids were used to allow the patient to breathe by expanding the breathing canals (Opie & Gersh, 2014). Finally, the oxygen delivery system served to improve the SpO2 levels of the patient. Overall, the prescribed treatment was adequate, minus the morphine, which should be removed.
Cardiovascular Conditions that May Lead to Heart Failure
Cardiovascular pertinent to Mrs. J’s case that may lead to a heart attack include the following (Mozaffarian et al., 2016):
- Past heart attack. The patient was already administered to the intensive care unit (ICU) with a decompensated heart failure. When that occurs, the overall structure of the heart’s muscle becomes weak, increasing the chances of a repeated incident in the future. ACE inhibitors and beta-blockers would be appropriate to prevent another incident (Mozaffarian et al., 2016).
- Heart muscle disease. Mrs. J is known to smoke and has various irregularities with her heart rate. It may indicate a heart muscle disease that can increase the chances of heart failure. Metoprolol, carvedilol, and other drugs that strengthen the heart muscle would be appropriate interventions against heart muscle disease (Mozaffarian et al., 2016).
- Severe lung disease. Mrs. J has a chronic obstructive pulmonary heart disease as a result of her smoking habit for the past 40 years. As a result, her lungs are not working as well as they should. A shortage of oxygen increases the chances of heart failure, as the heart muscle does not receive enough oxygen. Nursing interventions against the conditions would include corticosteroids, bronchodilators, and a firm ban on smoking (Mozaffarian et al., 2016).
- High blood pressure. When the blood pressure is high, the heart is forced to exert more force to push the blood through the vessels and keep them circulating. From a long-term perspective, it makes the chambers larger and weaker. Nursing interventions for the condition would include medicine that keeps the blood pressure below 130/80 mm Hg (Mozaffarian et al., 2016).
Interventions Against Polypharmacy
In order to guard the patient against the adverse effects potentially caused by polypharmacy, the following interventions are suggested (Cooper et al., 2015):
- Reduce drug interactions to a minimum. This intervention would help alleviate the negative effects of various drugs interacting with one another by finding harmless alternatives. (Cooper et al., 2015).
- Space out drug reception. Drugs have different activation and performance times. It is possible to space out the reception of drugs in order to reduce or even eliminate their interactions with one another in the bloodstream (Cooper et al., 2015).
- Controlling food intake. Some drugs have adverse interactions with certain foods, such as alcohol, juices, milk, and other products. The patient should be made aware of these interactions and remove the specified foods from their diet (Cooper et al., 2015).
- Management of negative symptoms. The patient should be made aware of symptoms of polypharmacy following the intake of certain drugs. They should be instructed on what to do in order to avoid potential injuries.
These interventions could be included in Mrs. J’s rehabilitation program (Cooper et al., 2015).
Health Promotion and Restoration Plan
The patient has issues with taking their medicine, avoiding negative health habits, such as smoking, and expresses visible signs of fear of death, resulting in stress. All of these issues are potentially threatening to her health. The intervention should be aimed at counteracting these negative conditions. The proposed solutions include the following (Edelman, Mandle, & Kudzma, 2017):
- Hospital-based patient education. It will inform the patient about the possible dangers of her existing lifestyle. It would also provide strategies for counteracting these conditions (Edelman et al., 2017).
- Psychological assistance. While in the hospital, Mrs. J should be instructed by a qualified therapist on how to manage her fear of death. It is critical to ensure her that everything will be alright, so long she stays on course with her treatment (Edelman et al., 2017).
- Home visits. Once Mrs. J is released from the hospital, a nurse or a social worker should be tasked with visiting her on a regular basis in order to provide instructions and ensure she follows the prescribed health plan (Edelman et al., 2017).
- Health-related channels and sources. Mrs. J should be forwarded to a collection of materials available on the Internet in order to learn more about managing her conditions. Any relatives living with her should be forwarded to these materials as well (Edelman et al., 2017).
The proposed health promotion and restoration plan promise a steady recovery.
Chosen Patient Education Method
Since Mrs. J expressed elements of forgetfulness in her medical history, the most appropriate method would involve teach-back techniques along with visual aids placed in appropriate locations around her home to ensure remembrance and compliance (Bastable, 2016). The teach-back method allows to assess the current levels of patient knowledge and allows the patient to accept the techniques learned as their own through repetition of the lecture to the nurse in question (Bastable, 2016). The visual aids will provide the needed reminders and impetus for maintaining discipline during the restoration course. For fears and other psychological issues, behavioral therapy may be appropriate.
COPD Triggers
Major COPD triggers include tobacco smoke, chemical fumes, dust, and indoor pollution (Sama, Kriebel, Gore, DeVries, & Rosiello, 2017). Due to Mrs. J’s low mobility and predisposition towards tobacco, all four of these triggers could potentially occur within the household. In order to avoid smoking, it is recommended for Mrs. J to have someone around to prevent her from doing so. Fully quitting smoking after 40 years may be difficult. Additional recommendations involve staying busy, drinking water and juice, avoiding alcohol, and reading motivational information to keep oneself on track (Sama et al., 2017).
References
Bastable, S. B. (2016). Essentials of patient education. New York, NY: Jones & Bartlett Learning.
Cooper, J. A., Cadogan, C. A., Patterson, S. M., Kerse, N., Bradley, M. C., Ryan, C., & Hughes, C. M. (2015). Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review. BMJ Open, 5(12), e009235.
Edelman, C. L., Mandle, C. L., & Kudzma, E. C. (2017). Health promotion throughout the life span-e-book. New York, NY: Elsevier Health Sciences.
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M. & Howard, V. J. (2016). Heart disease and stroke statistics-2016 update a report from the American Heart Association. Circulation, 133(4), e38-e48.
Opie, L. H. & Gersh, B. J. (2014). Drugs for the heart e-book (2nd ed.). New York, NY: Elsevier Health Sciences.
Sama, S. R., Kriebel, D., Gore, R. J., DeVries, R., & Rosiello, R. (2017). Environmental triggers of COPD symptoms: a case cross-over study. BMJ Open Respiratory Research, 4(1), e000179.