Case Study: Mrs. J. NRS 410

Case Study: Mrs. J. NRS 410

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.

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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. Case Study: Mrs. J. NRS 41

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. 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.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

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

1. Describe the clinical manifestations present in Mrs. J.
2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
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.
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 a rationale for each of the interventions you recommend.
5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. Case Study: Mrs. J. NRS 410

Topic 1 DQ 1

Identify a cardiac or respiratory issue and outline the key steps necessary to include for prevention and health promotion.

Cardiovascular Conditions That Lead To Heart Failure

Hypertension: Elevated blood pressure in the blood vessels causes the heart to pump harder to facilitate blood circulation. This overwhelms the myocardium, which becomes weaker over time and unable to supply enough blood to meet the body’s requirements (Inamdar & Inamdar, 2016). Lifestyle interventions should be emphasized, such as a healthy diet and physical exercises to promote healthy heart and functioning and lower blood pressure. Medical intervention includes prescribing antihypertensive to lower blood pressure.

Coronary Artery Disease (CAD): CAD is characterized by cholesterol and fatty deposits accumulation in the arteries of the heart. This limits blood supply to the myocardium, and the heart is unable to pump enough blood to body tissues (Horwich & Fonarow, 2017).  It also results in angina and hypertension, which also causes heart failure. Medical intervention to prevent Heart failure in CAD patients should include prescribing lipid-lowering agents to promote adequate supply to the myocardium. Nursing intervention includes educating patients on lifestyle modification to boost heart health.

History of Myocardial Infarction (MI): MI damages the myocardial tissue resulting in the inability of the heart to pump blood to meet the body’s demand. The damaged myocardial tissue fails to adequately contract, which decreases the heart’s ability to pump blood (Horwich & Fonarow, 2017). Medical interventions to prevent heart failure in a patient with a history of MI include prescribing drugs that lower cardiac output and anticoagulants. Nursing intervention includes educating the patient to avoid intense exercises that increase body tissue demand for oxygen.

Valvular disorders: Such as Mitral valve prolapse and mitral regurgitation result in inadequate valve opening or closure during systole and diastole. The heart is thus forced to pump harder to meet the body’s demand (Inamdar & Inamdar, 2016). The increased workload results in hypertrophy of the ventricles and eventually, heart failure. Medical interventions in vulvar disorders that can prevent heart failure include administering drugs that reduce afterload, such as ACE inhibitors (Inamdar & Inamdar, 2016). Surgical repair of the valves or valve replacement can correct the valve defects. Nursing intervention includes educating the patient to avoid strenuous exercises that increase the heart’s workload.

You are required to cite to a minimum of two 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.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Course Code Class Code Assignment Title Total Points
NRS-410V NRS-410V-O500 Case Study: Mrs. J. 120.0

Criteria Percentage Unsatisfactory (0.00%) Less Than Satisfactory (75.00%) Satisfactory (79.00%) Good (89.00%) Excellent (100.00%)
Content 80.0%
Clinical Manifestations of Mrs. J. 10.0% Clinical manifestations are omitted. Clinical manifestations are partially presented. There are major omissions and inaccuracies. Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete. Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms. Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms. Case Study: Mrs. J. NRS 410

Evaluation of Nursing Interventions at Admissions 10.0% Evaluation of appropriateness of nursing interventions at the time of admission and explanation of the rationale for each of the medications listed are not discussed. Evaluation of appropriateness of nursing interventions at the time of admission is partially presented. An incomplete explanation for each of the medications listed is presented. The discussion contains significant inaccuracies. Evaluation of appropriateness of nursing interventions at the time of admission is summarized. A general explanation and some rationale for each of the medications listed are presented. There are minor inaccuracies. Evaluation of appropriateness of nursing interventions at the time of admission is discussed. An explanation and general rationale for each of the medications listed are presented. Some information is required for accuracy or clarity. Evaluation of appropriateness of nursing interventions at the time of admission is thoroughly discussed. A well-supported explanation for each of the medications listed is presented. Strong and compelling rationale is provided.

Cardiovascular Conditions Leading to Heart Failure and Interventions 10.0% Fewer than three cardiovascular conditions that may lead to heart failure, and medical or nursing interventions to prevent the development of heart failure in each condition, are described. Four cardiovascular conditions that may lead to heart failure are partially described. Medical or nursing interventions to prevent the development of heart failure in each condition are incomplete. There are significant inaccuracies. Four cardiovascular conditions that may lead to heart failure are summarized. Medical or nursing interventions to prevent the development of heart failure in each condition are generally discussed. There are some inaccuracies. Four cardiovascular conditions that may lead to heart failure are described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. There are minor inaccuracies, or information is needed for clarity. Four cardiovascular conditions that may lead to heart failure are clearly described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. Overall, the discussion demonstrates insight into medical and nursing interventions used to prevent heart failure. Case Study: Mrs. J. NRS 410

Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions 10.0% Fewer than three nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are presented. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are partially presented. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are summarized. Overall, the discussion meets assignment criteria but requires more rationale for the interventions. There are minor inaccuracies. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. Overall, the discussion meets assignment criteria and general rationale for the interventions is provided. Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. The discussion fulfills the assignment criteria and strong rationale for the interventions is provided.

Health Promotion and Restoration Teaching Plan 15.0% A health promotion and restoration teaching plan for the patient is omitted. A health promotion and restoration teaching plan for the patient is partially presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are omitted or incomplete. An explanation for how rehabilitation resources and modifications assist patient transition to independence is omitted or incomplete. A health promotion and restoration teaching plan for the patient is summarized. Multidisciplinary resources for rehabilitation and any modifications that may be needed are generally presented. A summary for how rehabilitation resources and modifications assist patient transition to independence is presented. There are minor inaccuracies. A health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are discussed. An explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. A well-developed health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are clearly discussed. An strong explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. The overall discussion is well-supported.

Method for Providing Education to Prevent Hospital Readmissions 15.0% A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is omitted. The method is not appropriate for the client or health status. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is partially summarized. The method may not be relevant to for this situation. More information is needed. There are major inaccuracies. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is summarized. The method is generally appropriate. Some rationale is provided for support. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is described. Overall, the method is appropriate. General rationale is provided for support. A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is thoroughly described. The method is clearly appropriate for the client and prevents readmission. Strong rationale is provided for support.

COPD Triggers and Options for Smoking Cessation 10.0% COPD triggers exacerbating return visits and options for smoking cessation are omitted. Some COPD triggers exacerbating return visits are partially presented. Options for smoking cessation are incomplete; it is unclear if the options are relevant to the patient. General COPD triggers exacerbating return visits are generally presented. Some options for smoking cessation relevant to the patient are summarized. Some support or information is needed. Key COPD triggers exacerbating return visits are outlined. General options for smoking cessation relevant to the patient are summarized. All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.

Organization, Effectiveness, and Format 20.0%
Thesis Development and Purpose 5.0% Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction 5.0% Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.

Paper Format (use of appropriate style for the major and assignment) 2.0% Template is not used appropriately, or documentation format is rarely followed correctly. Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. Appropriate template is used. Formatting is correct, although some minor errors may be present. Appropriate template is fully used. There are virtually no errors in formatting style. All format elements are correct.