Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.
Case Scenario
Mrs. J. is a 63-year-old woman who has a history of hypertension,
chronic heart failure, and sleep apnea. She has been smoking two packs
of cigarettes a day for 40 years and has refused to quit. Three days
ago, she had an onset of flu with fever, pharyngitis, and malaise. She
has not taken her antihypertensive medications or her medications to
control her heart failure for 4 days. Today, she has been admitted to
the hospital ICU with acute decompensated heart failure.
Subjective Data
- Is very anxious and asks whether she is going to die.
- Denies pain but says she feels like she cannot get enough air.
- Says her heart feels like it is “running away.”
- Reports that she is so exhausted she cannot eat or drink by herself.
Objective Data
- Height 175 cm; Weight 95.5 kg
- Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
- 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 - Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%
- Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin
Critical Thinking Questions
What nursing interventions are appropriate for Mrs. J. at the time of
her admission? Drug therapy is started for Mrs. J. to control her
symptoms. What is the rationale for the administration of each of the
following medications?
- IV furosemide (Lasix)
- Enalapril (Vasotec)
- Metoprolol (Lopressor)
- IV morphine sulphate (Morphine)
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.
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 rationale for each of the interventions you
recommend.
How to solve
Case Scenario Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure Nursing Assignment Help
Introduction:
Upon admission to the hospital ICU, Mrs. J., a 63-year-old woman with a history of hypertension, chronic heart failure, and sleep apnea, presents with acute decompensated heart failure. She has not taken her antihypertensive and heart failure medications for 4 days and displays symptoms of anxiety, dyspnea, and exhaustion. This case scenario presents an opportunity to discuss appropriate nursing interventions for Mrs. J. upon admission, as well as the rationale for drug therapy. Additionally, it allows us to explore cardiovascular conditions that may lead to heart failure and potential medical/nursing interventions to prevent its development. Lastly, we will discuss nursing interventions to prevent problems caused by multiple drug interactions in older patients.
Critical Thinking Questions:
1. What nursing interventions are appropriate for Mrs. J. at the time of her admission?
Upon Mrs. J.’s admission, the following nursing interventions are appropriate:
– Assess and monitor vital signs, including temperature, heart rate, respiratory rate, and blood pressure, to identify any abnormalities or changes in her condition.
– Administer supplemental oxygen to improve oxygenation and alleviate dyspnea.
– Auscultate lung sounds regularly to monitor for changes in respiratory status.
– Administer prescribed medications promptly to manage symptoms and stabilize her condition.
– Observe for signs of fluid overload, such as edema, by measuring daily weights and monitoring peripheral pulses.
– Position Mrs. J. in an upright or semi-Fowler’s position to improve breathing comfort and reduce pulmonary congestion.
– Educate the patient and family about the importance of medication adherence and the potential consequences of not taking antihypertensive and heart failure medications.
2. Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?
a) IV furosemide (Lasix): Furosemide is a loop diuretic that promotes diuresis and eliminates excess fluid volume to relieve pulmonary congestion and peripheral edema. It reduces preload and decreases fluid overload, relieving strain on the heart and improving cardiac output.
b) Enalapril (Vasotec): Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that dilates blood vessels, reducing systemic vascular resistance and afterload. By decreasing afterload, enalapril improves cardiac output and reduces the workload on the heart.
c) Metoprolol (Lopressor): Metoprolol is a beta-blocker that blocks the effects of adrenaline on the heart, reducing heart rate and blood pressure. This medication helps to stabilize Mrs. J.’s heart rate, improve cardiac contractility, and reduce myocardial oxygen demand.
d) IV morphine sulphate (Morphine): Morphine is administered to relieve dyspnea and reduce anxiety associated with acute heart failure. It also acts as a vasodilator, decreasing preload and afterload, thereby reducing myocardial workload and improving cardiac function.
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.
a) Coronary artery disease (CAD): CAD can lead to heart failure due to impaired blood flow to the heart muscle. Medical interventions include lifestyle modifications (e.g., smoking cessation, exercise, healthy diet), medications to control blood pressure, cholesterol, and blood sugar levels, and interventions such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
b) Hypertension: Uncontrolled high blood pressure can cause the heart to work harder, leading to heart failure. Nursing interventions involve patient education on lifestyle modifications (e.g., low-sodium diet, regular exercise, stress management), adherence to antihypertensive medication regimen, and regular blood pressure monitoring.
c) Valvular heart disease: Diseased or dysfunctional heart valves can alter blood flow and increase cardiac workload, eventually resulting in heart failure. Medical interventions include medication management, surgical repair, or replacement of the affected valve.
d) Cardiomyopathy: Cardiomyopathy refers to diseases of the heart muscle that can weaken the heart and lead to heart failure. Medical and nursing interventions focus on managing symptoms, improving cardiac function, and treating underlying causes. These may include medication therapy, lifestyle modifications (e.g., sodium restriction, fluid management), cardiac rehabilitation, and potentially heart transplantation.
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 rationale for each of the interventions you recommend.
a) Medication reconciliation: Ensure a comprehensive review of all medications the patient is taking, including prescription, over-the-counter, and herbal supplements. This helps identify potential drug interactions or duplications and allows for appropriate adjustments or discontinuations.
b) Patient education: Provide thorough medication education, including proper administration techniques, potential side effects, and symptoms of adverse reactions. Encourage patients to ask questions and report concerns promptly. This empowers patients to take an active role in their medication management and alert healthcare professionals to any issues.
c) Regular medication reviews: Conduct periodic medication reviews and assessments, involving interdisciplinary collaboration among healthcare providers. This ensures that the patient’s medication regimen is continuously evaluated and adjusted as needed to optimize therapy and minimize the risk of drug interactions.
d) Use of medication reconciliation tools and technology: Implement electronic health records and medication reconciliation software to streamline and improve medication management. These tools help healthcare professionals accurately document and monitor medication regimens, flag potential interactions, and facilitate communication between different care settings.
Conclusion:
In conclusion, appropriate nursing interventions for Mrs. J. at the time of her admission include assessing vital signs, administering oxygen and medications promptly, and educating the patient and family. The rationale for the administration of specific medications, such as IV furosemide, enalapril, metoprolol, and IV morphine sulphate, involves their respective effects on addressing fluid overload, improving cardiac function, and relieving symptoms. Furthermore, it is essential to consider cardiovascular conditions that may lead to heart failure and implement preventative medical and nursing interventions accordingly. Lastly, proactive nursing interventions to prevent problems caused by multiple drug interactions in older patients can include medication reconciliation, patient education, regular reviews, and the use of technology and tools.
