Case Study-Critical Thinking Essay Assessment
Case Study-Critical Thinking Essay Assessment
Clinical Manifestations in Mrs. J
Mrs. J has a known history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). She presents with a three-day history of fever, nausea, productive cough with frothy blood-tinged sputum, and malaise. Both heart failure and COPD will manifest with a productive cough. In heart failure, there is failure of the heart muscles to contract sufficiently and pump blood out of the heart. This leads to fluid build-up in the heart (congestive heart failure) and subsequent backflow of blood into the lungs causing pulmonary edema. This triggers the cough reflex to clear the excess fluid, leading to a productive cough, which may contain blood (Malik et al., 2022). Congestion due to backflow of blood can also cause congestion in the liver leading to hepatomegaly. The pulmonary edema also leads to shortness of breath, difficulty breathing, and chest pains. Other symptoms are associated with poor oxygenation due to poor blood flow to tissues and include fatigue, palpitations, and anorexia (Malik et al., 2022)Case Study-Critical Thinking Essay Assessment .
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Acute decompensated heart failure may also present with jugular venous distension and peripheral edema on physical examination. The patient also presented with fever and nausea, which could be due to the heart failure or acute exacerbation of COPD.
Nursing interventions and treatments at admission
After initial evaluation and history taking, the patient was admitted for management of acute decompensated heart failure and acute exacerbation of COPD. The nursing interventions administered were appropriate for her condition. The management of acute exacerbation of COPD includes oxygen administration in hypoxemic patients and inhaled bronchodilators. Short-acting beta agonists like albuterol have also been used to provide quick acting bronchodilation effect. On admission, the patient was put on 2L of oxygen via nasal cannula and an inhaled short-acting bronchodilator. Studies have shown that short-acting bronchodilators have a health benefit when used as first line treatment of acute exacerbation of COPD. Bronchodilators open the airways by reducing bronchial obstruction and airflow limitation through bronchial dilatation. The patient was also given an inhaled corticosteroid, which has been shown to be effective in COPD exacerbation (Torres et al., 2018). Strong evidence supports the use of systemic steroids in acute exacerbations of COPD, which improves patient outcomes and reduces oxygen demand and hospital stay. Corticosteroids control inflammation and reduce airway swelling thus improving oxygenation.
The administration on furosemide provides fast diuresis which in necessary to relieve fluid overload in heart failure. This is helpful in relieving the symptoms of acute decompensated heart failure. Enalapril is an angiotensin converting enzyme inhibitor used in the management of congestive heart failure and hypertension (Njoroge & Teerlink, 2021). It has an effect of decreasing mortality and morbidity. Metoprolol is a beta blocker used in treatment of patients with heart failure and has been proven to be effective in decreasing mortality and improving clinical outcomes in patients with chronic heart failure. Morphine sulphate is an opioid given to relieve breathlessness and anxiety in these patients.
Cardiovascular conditions that lead to heart failure and their preventive interventions
The cardiovascular conditions that cause heart failure are due to structural and functional abnormalities of the heart. This includes conditions like coronary artery disease, myocardial infarction, hypertension, and valvular heart disease. Coronary artery disease causes narrowing of the arteries that supply blood to the heart muscles and block blood flow to the heart (Crea, 2021). This leads to weakening of the heart muscles and can cause heart failure with time. The most significant risk factor for CAD is high levels of cholesterol and triglycerides in blood. Nursing interventions to prevent heart failure due to CAD include education on cessation of smoking, controlling hypertension, dietary changes to exclude excess cholesterol and physical exercise Case Study-Critical Thinking Essay Assessment .
Hypertension can also cause heart failure through damage to blood vessels and stress on the heart muscles and valves. Prevention incudes antihypertensive medications to control blood pressure and dietary modifications like avoiding excess salt and water. Diseases that affect the functioning of the heart valves lead to stress on the heart to pump harder to prevent backflow of blood into the heart chambers. This can lead to structural heart failure (Malik et al., 2022). Prevention of heart failure caused by valvular disease is surgical intervention to replace damaged valves and improve function.
Interventions to prevent multiple drug interactions in older patients
Older patients tend to have multiple health problems, which increases polypharmacy and multiple drug interaction problems. The nursing interventions that can be applied to prevent problems caused by multiple drug interaction include information, instruction, and proper organization. Information involves keeping a list of all the patient medications and dosages to prevent confusion to the patient (Rieckert et al., 2018). The patient also needs to be instructed on how to take each medication and the potential adverse effects. They should also be instructed on proper storage of medications and which foods to take or avoid when taking certain medications to avoid adverse food-drug reactions.
Health promotion and Restoration plan for Mrs. J
The rehabilitation process will involve education on healthy practices for the patient to prevent future exacerbations of the symptoms. This will include education on medication compliance and involving the family on care for the patient on the same. Cessation of smoking should be emphasized to control pulmonary symptoms and increase pulmonary function. The patient should be educated on how to keep a clear record of all her medication through charting to help ensure compliance. This can also involve the relatives and close caregivers who will assist.
The COPD triggers that increase exacerbation especially on this patient is continued cigarette smoking despite the symptoms and diagnosis. It can also be triggered by adverse weather conditions lie extreme hot or cold temperatures, air pollution, and respiratory tract infections. Prevention includes risk factor modification such as prevention air pollution, cessation of smoking and keeping warm.
Options for smoking cessation for the patient
Pharmacologic options such as nicotine replacement therapy are used to enable smoking cessation for Mrs. J. This has been shown to have a great impact on smoking cessation for patients who cannot stop smoking on their own (Giulietti et al., 2020). It involves the use of nicotine patches or chewable gums to help smokers cut down on smoking.
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References
Crea, F. (2021). Mechanisms of heart failure with preserved ejection fraction, risk stratification of heart failure with reduced ejection fraction, and new light on resistance to diuretics in acute decompensated heart failure. European Heart Journal, 42(43), 4405-4409. https://doi.org/10.1093/eurheartj/ehab791
Giulietti, F., Filipponi, A., Rosettani, G., Giordano, P., Iacoacci, C., Spannella, F., & Sarzani, R. (2020). Pharmacological approach to smoking cessation: An updated review for daily clinical practice. High Blood Pressure & Cardiovascular Prevention, 27(5), 349-362. https://doi.org/10.1007/s40292-020-00396-9
Malik A., Brito D., Vaqar S., & Chhabra L. (2022). Congestive Heart Failure. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK430873/
Njoroge, J. N., & Teerlink, J. R. (2021). Pathophysiology and therapeutic approaches to acute decompensated heart failure. Circulation Research, 128(10), 1468-1486. https://doi.org/10.1161/circresaha.121.318186
Torres, A., Crisafulli, E., Barbeta, E., & Ielpo, A. (2018). Management of severe acute exacerbations of COPD: An updated narrative review. Multidisciplinary Respiratory Medicine, 13. https://doi.org/10.4081/mrm.2018.188
Rieckert, A., Trampisch, U. S., Klaaßen-Mielke, R., Drewelow, E., Esmail, A., Johansson, T., Keller, S., Kunnamo, I., Löffler, C., Mäkinen, J., Piccoliori, G., Vögele, A., & Sönnichsen, A. (2018). Polypharmacy in older patients with chronic diseases: A cross-sectional analysis of factors associated with excessive polypharmacy. BMC Family Practice, 19(1). https://doi.org/10.1186/s12875-018-0795-5
Čerlinskaitė K., Javanainen T., Cinotti R., & Mebazaa A. (2018). Acute Heart Failure Management. NCBI- Korean Circ J. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986746/ Case Study-Critical Thinking Essay Assessment