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

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 so exhausted she cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5 kg
2. Vital signs: T 37.6 C, 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 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?

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. 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.

part 1

Advance Care Planning and Analysis

Democrats’ Plans for Healthcare

I totally agree with Sarah Palin’s sentiments on the Democrats plan for healthcare. I think what the Democrats are pushing for claiming to reduce healthcare is downright discriminatory and it will do more harm than good in the long run. The truth of the matter is, some people need more care than others. For a fact, such a system will not favor vulnerable populations like those with chronic illness, the elderly and the disabled. There are currently more than half a million people in America living with various forms of disabilities. Such people continue to remain in waiting lists to receive services due to the fact that Obamacare urges states to expand Medicaid coverage to able-bodied adults instead of prioritizing the services to those who need them the most (Hilberg, 2015).

My judgment is informed by a commitment to advance care of planning. For instance, recent estimates from the Urban Institute suggest that a big percentage of the individuals eligible to Obamacare Medicaid expansion are adults without children in their prime working years. This means that Obamacare does not provide medical services to the most vulnerable. Another report published by the Foundation for Government Accountability showcases how Medicaid rolls have erupted under Obamacare and also how individuals with disabilities have suffered owing to this.

The Role of Nurses in this Plight

It is important to note that nurses are always in the frontline in boardrooms and in leading healthcare organizations. Given their high level of education and their experience, they have the intelligence to observe, validate and the network to transmit messages that advocate for healthcare reform values. Taking this into consideration, it is not right for them to endorse a legislation even when it is not perfect. If they leverage their numbers and use their influence efficiently, they will be able to support only the legislative changes that strengthen the system instead of those that weaken it (Béland, Rocco & Waddan, 2016).

The above also applies to the recently failed American Care Act. They must rigorously oppose legislation that could undermine or compromise the goals of the healthcare system. Nurses must, therefore, make an extra effort to communicate, listen and collaborate with the new congressional leaders. I believe that by putting their voices together, they can become part of the solution when it comes to directing policy through political goodwill (Béland, Rocco & Waddan, 2016).

part 2

You posed valid considerations.  What is moral agency and how does it correlate with Sara Palin’s comments?

Discussion: Cardiovascular Disorders

Veins and arteries are vital elements of the cardiovascular system. They carry the blood supply through the body and are essential for proper function. Sometimes veins and arteries malfunction, resulting in cardiovascular disorders. Malfunctions of arteries and veins are similar to malfunctions of a water hose. Consider the structure and function of a hose. A tap releases water, which then travels through the hose and comes out the other end. If the hose has been dormant for several months, dirt and rusty particles might build up inside, resulting in a restricted flow of water. Similarly, buildup of plaque inside the coronary arteries restricts blood flow and leads to disorders such as coronary heart disease. This disease is one of the most common cardiovascular disorders, and according to the National Heart, Lung and Blood Institute (2011), is the leading cause of death for men and women in the United States. In this Discussion, you examine the pathophysiology of cardiovascular disorders such as coronary heart disease.

To Prepare

• Review this week’s media presentation on alterations of cardiovascular functions, as well as Chapter 24 in the Huether and McCance text. Identify the pathophysiology of cardiovascular disorders.
• Select one patient factor: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of cardiovascular disorders.
• Select one of the following alterations of cardiovascular disorders: peripheral arterial disease, myocardial infarction, coronary artery disease, congestive heart failure, or dysrhythmia. Think about how hypertension or dyslipidemia can lead to the alteration you selected.

Post a description of the pathophysiology of cardiovascular disorders, including how the factor you selected might impact the pathophysiology. Then, explain how hypertension or dyslipidemia can lead to the alteration you selected for patients with the factor you identified.

Pick any that you want.