Case Study Of Chronic Heart Failure And Hypertension Paper

Case Study Of Chronic Heart Failure And Hypertension Paper

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It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below. Case Study Of Chronic Heart Failure And Hypertension Paper

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Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

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 exhausted and cannot eat or drink by herself.

Objective Data

Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, 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 4cm below costal margin. Case Study Of Chronic Heart Failure And Hypertension Paper
Intervention

The following medications administered through drug therapy control her symptoms:

IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

Describe the subjective and objective clinical manifestations present in Mrs. J.
Describe four cardiovascular conditions in which Mrs. J is at risk, and that may lead to heart failure. What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions?
By following the nursing process, were the interventions at the time of admissions beneficial for Mrs. J? Would you change any of the interventions to ensure patient independence and prevent readmission?
Explain each of the seven medications listed in the scenario above. Include the classification, the action, and the rationale for each of these. Discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence and prevent readmission.
Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits.
You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice. Case Study Of Chronic Heart Failure And Hypertension Paper

Introduction

This paper analyzes a case study that involves Mrs. J., a 63-year-old female patient with a history of chronic heart failure, hypertension, and chronic obstructive pulmonary disease (COPD). The paper discusses appropriate nursing interventions, clinical manifestations, cardiovascular conditions potential to cause heart failure, possible triggers of COPD, and health promotion and restoration teaching plans. The sections are discussed in the following sections.

Clinical Manifestations Present in Mrs. J.

            The clinial manifestaions of Mrs. J. include several symptoms, such as; an acute exacerbation of COPD and acute decompensated heart failure. The latter has signs and symptoms including, elevated jugular venous pressure, dyspnea, pulmonary rales, and orthopnea. Other symptoms include hepatomegaly, which is supported by her measures, such that she is 4 cm below the costal border (Velazquez et al., 2019). On contrary, the patient’s acute COPD exacerbation is exhibited by a number of signs and symptoms, such as difficulty performing ADLs like eating, walking, and drinking, as well as decreased physical activity,and a continual need for assistance. Mrs. J’s acute exacerbation of COPD is further demonstrated by her persistent exhaustion and diminished lung function, which causes her to always feel as though she is not breathing enough (DeVore et al., 2020)Case Study Of Chronic Heart Failure And Hypertension Paper.

Nursing Interventions during Admission and Rationale

            Mrs. J. was given a multiple of medications upon admission in order to manage her condition. The nurse gave her several drugs including; Furosemide, a loop diuretic effective in fluid retention. Notably, furosemide helps in increasing urine discharge of slats and extra fluid. Also, the patient received Vasotec, it act by blocking the production of angiotensin II and ACE, hence known as ACE inhibitor (Velazquez et al., 2019). Also, metoprolol (Lopressor) was given to the patient to reduce cardiac output by inducing relaxation of blood vessels, during activity and at rest, which ameliorated chest discomfort.

An appropriate nursing action for Mrs. J would have been to administer IV morphine sulphate (Morphine). This opioid would help to manage any instances of extreme pain that might arise during her therapy. Additionally, Mrs. J required ProAir HFA, which would ease her breathing difficulties by relaxing her lungs’ muscles and opening her airways (DeVore et al., 2020)Case Study Of Chronic Heart Failure And Hypertension Paper. Flovent HFA, was also good for the patient  to inhibit any further episodic shortness of breath. Therefore, the medication would play a significant role in reducing any potential airway inflammation in Mrs. J’s lungs, enabling smooth breathing. Also, Mrs. J needed immediate oxygen delivery at a rate of 2L/NC since she had acute symptoms of breathlessness at the time of admission.

Cardiovascular Conditions to Cause Heart Failure

            Various cardiovascular diseases are potential in causing heart failure. According to Groenewegen et al. (2020), these include myocarditis, cardiomyopathy, hypertension, and coronary diseases. Therefore, depending on the circumstances, several nursing treatments might be used to prevent heart failure. A combination of enalapril (Vasotec), metoprolol (Lopressor) and IV furosemide (Lasix) are suitable in supporting regular heartbeat, lowering blood pressure, and preventing water retention in some body parts of the patient. This combination is considered to be  the optimum pharmacological intervention for cardiomyopathy. The administration of ACE inhibitors including, Beta-blockers (diuretics and carvedilol) and Lisinopril is regarded as he best pharmacological intervention for myocarditis. Nurses advice coronary artery diseases (CAD) patients to cease from smoking in order to minimize the chances of developing consequent heart failure and risk of atherosclerosis.  For coronary artery diseases (CAD)Case Study Of Chronic Heart Failure And Hypertension Paper, in order to reduce the risk of atherosclerosis and consequent heart failure, nurses should advise patients to stop smoking.

Nursing Interventions to Prevent Problems with Multiple Drug Interactions

            Most of  senior population have to be given multiple medications as effort to address  several comorbidities. This is evident in Mrs. J’s case, who has several chronic conditions that jeopardize her for adverse drug events and non-compliance. The 2019 American Geriatrics Society Beers Criteria® Update Expert Panel et al. (2015) suggest that healthcare practitioners should follow the Beers Criteria in order to decrease the contingency of an harmful medication event. Further, the doctor should plan follow-up appointments for Mrs.. J.  to enable medication reviews before doing away with any medications without therapeutic advantage. To prevent over- or under-dosing, education can be leveraged to strongly emphasize on the necessity of proper organization of medications.

Health Promotion and Restoration Teaching Plan

Health promotion and education program for the patient characterized by solid support to Mrs. J’s disease self-management would be beneficial to her health. According to Habibzadeh et al. (2021) cardiovascular rehabilitation have to be considered for COPD patients, while emphasizing on keeping a nutritious diet, medication compliance, and taking part in day-to-day physical activity in efforts to achieve independence. The best way Mrs. J will walk towards healthy living is by quitting smoking, lifestyle changes, nutrition, physical exercise,. Also, educating patients about medication adherence, and following the current immunization schedule, will be supportive for health promotion Case Study Of Chronic Heart Failure And Hypertension Paper.

Educating Mrs. J.

            Having a one-on-one meeting with Mrs. J would be the most efficient way to instruct her on managing her condition. The medical professionals would instruct Mrs. J on how to organize her medications and store them in color-coded containers according to the time of day they should be taken in order to prevent confusion. This would simplify drug administration for the patients and stop exacerbations in the future.

COPD Triggers Potential for Return Visits

            The potential triggers for an acute exacerbation of COPD symptoms include strong scents,  tobacco smoke, pollen, and severe temperatures. According to Habibzadeh et al. (2021), the best smoking cessation method involves a mix of nicotine replacement treatment and psychotherapy (CBT). In the Mrs. J.’s case, cigarette smoke will be responsible for COPD exacerbations. For instance, in nicotine therapy there is nicotine patches and nicotine gum; the two are significant in lessening the craving for cigarettes.

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References

2019 American Geriatrics Society Beers Criteria® Update Expert Panel, Fick, D. M., Semla, T. P.,           Steinman, M., Beizer, J., Brandt, N., … & Sandhu, S. (2019). American Geriatrics Society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older          adults. Journal of the American Geriatrics Society, 67(4), 674-694.

DeVore, A. D., Braunwald, E., Morrow, D. A., Duffy, C. I., Ambrosy, A. P., Chakraborty, H., … & PIONEER-HF Investigators. (2020). Initiation of angiotensin-neprilysin inhibition after                      acute decompensated heart failure: secondary analysis of the open-label extension of the            PIONEER-HF trial. JAMA cardiology, 5(2), 202-207.

Groenewegen, A., Rutten, F. H., Mosterd, A., & Hoes, A. W. (2020). Epidemiology of heart                      failure. European Journal of heart failure, 22(8), 1342-1356.

Velazquez, E. J., Morrow, D. A., DeVore, A. D., Duffy, C. I., Ambrosy, A. P., McCague, K., … &  Braunwald, E. (2019). Angiotensin–neprilysin inhibition in acute decompensated heart             failure. New England Journal of Medicine, 380(6), 539-548 Case Study Of Chronic Heart Failure And Hypertension Paper