Critical Review of Mrs. J.’s Nursing Intervention

Critical Review of Mrs. J.’s Nursing Intervention

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

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.

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.

SAMPLE ANSWER

Critical Review of Mrs. J.’s Nursing Intervention

Introduction

In healthcare, critical thinking involves an intellectual process of synthesizing, analyzing, reasoning, and reflecting as guidance towards decision making. This process is essential as it helps practitioners to develop accurate and relevant decisions in difficult scenarios. The paper uses critical thinking to analyze a situation involving a 63 year old patient by the name Mrs. J. She has a health history of cardiovascular diseases and portrays symptoms of heart failure.

Clinical Manifestations

The subjective data reveals that the patient is anxious about her condition. Also, she does not feel pain and has a running heart. She feels exhausted and is unable to drink by herself. This data aligns with the practitioner’s findings about the disease. For instance, the objective data shows irregular heart rate. From another perspective, respiratory problems caused by pulmonary crackle may lead to complications.

Critical Review of Mrs. J.’s Nursing Intervention

Appropriateness of the Interventions

During admission, a patient with heart failure needs to undergo proper assessment. Other important symptoms need to be evaluated. The practitioner needs to increase the patient’s oxygen availability. Application of diuretics, ACE inhibitors, and beta blockers is essential in the control of the disease. In the scenario, the treatment upon admission includes the above measures. Therefore, it can be observed to be appropriate (Komajda et al., 2016).

Rationale for the Medication

IV furosemide is a diuretic. The drug is used to control overflow of fluid. It is also used to minimize heart workload, thereby reducing ventricular filling pressure and improvement in a patient’s condition. Enalapril is an ACE inhibitor. In the scenario, the drug is provided for vascular dilation, which results in improved blood flow and oxygenation of blood to the heart. It is also used to improve heart, kidney and nerve functioning in patients with diabetes type 1. Metrolol is a beta blocker which is applied in reducing a patient’s heart rate (Komajda et al., 2016).

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Morphine sulphate is an analgesic that is used for treating pain. It is also essential in improving vasodilation and relaxing the respiratory system. Inhaled short-acting bronchodilator is used for treatment of lung conditions and controlling effects of respiratory diseases such as chronic obstructive pulmonary disease. Inhaled corticosteroid is used for controlling respiratory conditions such as asthma. Lastly oxygen treatment is used to improve oxygen availability (Komajda et al., 2016).

Conditions Leading to Heart Failure

Arteriosclerosis: This condition involves hardening and narrowing of a body’s blood vessels. It is usually caused by conditions such as diabetes, smoking, and diet high in cholesterol. The condition can lead to poor blood flow to one’s heart, thereby overworking the heart. This feature may cause heart failure. Reduction of cholesterol intake and management of weight can reduce risk of attaining heart failure. Sleep apnea is a condition that involves breathing pauses during one’s sleep. Its obstructive version is associated with obesity Severe sleep apnea may lead to cardiovascular problems such as heart failure.  Sleep apnea can be controlled by being more active (Prabhakaran, Jeemon, & Roy, 2016).

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Hypertension is a condition where an individual experiences high blood pressure. It leads to increased risk of heart diseases due to increased pressure against the walls heading to the heart. This disease can be controlled by engaging in exercises and reducing weight. Coronary artery disease is a condition which entails formation of plaque inside an individual’s coronary arteries. The condition limits the blood flow to the heart. This condition can be controlled by engaging in exercises and reducing salt intake (Prabhakaran, Jeemon, & Roy, 2016).

Interventions in Multiple Drug Interactions

To eliminate issues caused by drug-drug interactions, a practitioner needs to review, the types of medications taken by the patient. By considering factors such as frequency, dosage, and reason for intake, a practitioner develops a proper way to control challenges caused by the interactions. Moreover, the practitioner may need to maintain an effective communication to ensure that the patient takes the right level of dosage. In addition, the practitioner may offer a warning to the patient to use the drug according to the recommendations. Creating a medication plan is also important. This strategy ensures that the drugs are kept in a safe place (Komajda et al., 2016).

Critical Review of Mrs. J.’s Nursing Intervention

Health Promotion Plan

Self-care education will be suitable in providing knowledge for the patient in both pharmacological and non-pharmacological measures. The plan needs to provide information on early planning of the hospital leave, reinforcement, improvement, and analysis of self-care abilities. Weight monitoring devices, medication monitoring devices will be essential in guiding the patient to get an effective control of her condition (Pandey et al., 2017).

Educational Method

When educating the patient, Abraham Marslow’s ABC’s theory would be applied. This method is essential in helping the patient group her needs depending on the necessity. For instance, teaching about self-care will focus much on taking medication more than engaging in exercise. The main objective of this approach is to ensure that the patient has an effective way of controlling the problem (Pandey et al., 2017).

COPD Risk and Management

Smoking and air pollution present the most common causes of COPD exuberating.  The patient needs to attend stop-smoking groups to get the motivation to reduce smoking. She should also avoid individuals who are smoking to ensure that she does not get tempted to smoke (Pandey et al., 2017).

References

Komajda, M., Anker, S. D., Cowie, M. R., Filippatos, G. S., Mengelle, B., Ponikowski, P., … &

QUALIFY Investigators. (2016). Physicians’ adherence to guideline‐recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey. European Journal of Heart Failure, 18(5), 514-522.

Pandey, A., LaMonte, M., Klein, L., Ayers, C., Psaty, B. M., Eaton, C. B., … & Berry, J. D.

(2017). Relationship between physical activity, body mass index, and risk of heart failure. Journal of the American College of Cardiology, 69(9), 1129-1142.

Prabhakaran, D., Jeemon, P., & Roy, A. (2016). Cardiovascular diseases in India: current

epidemiology and future directions. Circulation, 133(16), 1605-1620.

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