The clinical manifestations for Mrs. J
Mrs. J manifests clinical signs and symptoms that show that she is suffering from acute decompensated heart failure as well as acute exacerbation of COPD. The symptoms that demonstrate the presence of acute decompensated heart include elevated jugular venous pressure. According to Ritchie et al. (2021) patients with acute decompensated heart failure show abnormal right heart dynamics as a result of jugular venous pressure. Another symptom that Mrs. J manifests is dyspnea present with pulmonary rales as well as orthopnea. Due to accumulation of fluid in the lungs Mrs J present with coughing up frothy blood tinged sputum, crackles, and decreased breath sounds.
Mrs J also displays symptoms of cardiac gallops which measure S3 and hepatomegaly which is below the costal margin of 4 centimeters. According to Vu et al. (2020), the right costal margin should be below 3.5 cm for one to confirm hepatomegaly. Mrs. J also manifests symptoms that are indicative of acute exacerbation of COPD. Some of the symptoms include strained physical activities and inability to conduct activities of daily living like eating, drinking, walking and always asking for support. The patient also experiences constant fatigue and shortness of breath due to compromised lung function. According to Ritchie et al. (2021), patients suffering from reduced lung function may regularly experience shortness of breath which affects their quality of life. The patient also manifests exhaustion and anxiety which according to Ritchie et al. (2021), patients suffering from hypoxia suffer increased ventricular drive. Mrs. J also presents a Spo2 of 82% which can be attributed to insufficient oxygen rich blood from the lungs. Additionally, the patient has decreased blood pressure which may occur when the cardiac function is restricted. She also manifests jugular vein distention with a heart rate of 132, which according to Vu et al. (2020), may be due to backing up of fluid in the lungs. This may result from backing up of fluid in the vein resulting in atrial fibrillation. Moreover, Mrs. J presents third heart sound (S3) is due to mitral valve regurgitation, low ejection fraction as well as restrictive diastolic filling. According to (Halpin et al., 2021), the third heart sound is actually produced by the large amount of blood striking a very compliant left ventricle.
The nursing interventions offered to Mrs. J during her admission were suitable since the medications were intended to alleviate the symptoms. For instance, the nurse administered intravenous Furosemide in order to manage heart failure symptoms. According to Ritchie et al. (2021), furosemide targets the Na+ and K+ channels in order to reduce fluids caused by heart failure. The same author reveals that heart failure causes accumulation of fluids due to poor pumping of blood. As a result, administration of furosemide to Mrs. J was appropriate as it helped in management of heart failure through removal of excess fluids.
Secondly, the nurse administered enalapril to manage Mrs. J’s blood pressure to act as an ACE inhibitor which blocks angiotensin II formation (Halpin et al., 2021). According to Vu et al. (2020), angiotensin II results in clogging of blood arteries which results in hypertension. Administration of Metoprolol was suitable as it managed rapid heart rate as it helps to relax the blood arteries. Additionally, administration of morphine was appropriate to calm the patient and helps in pain reduction by binding to pain receptors. The Administration of ProAir HFA also addressed the issue of shortness of breath. According to Ritchie et al. (2021), the drug acts on the lung muscles by enabling lung muscle relaxation which unblocks the airways. Flovent HFA was also appropriate as it addressed the issue of recurrent shortness of breath through treatment of inflammation on the lung muscles hence, easing breathing. Additionally, immediate administration of oxygen at a delivery rate of 2L/ NC was appropriate as it addressed breathlessness through a constant supply of oxygen.
There are several cardiovascular conditions, which may cause heart failure. Examples of such conditions include coronary artery disease, cardiomyopathy, hypertension as well as myocarditis. According to Ritchie et al. (2021), nursing interventions are necessary in the mentioned cardiovascular conditions in order to prevent heart failure. In case of coronary artery disease, the medical interventions include statins which function to reduce the fatty deposits from the walls of the coronary arteries. An additional intervention includes beta blockers which reduce the heart rate, thus lowering oxygen demand. Calcium channel blockers may also be administered as they help the beta blockers in lowering the heart, which in turn reduces the risk of heart failure (Halpin et al., 2021).
In case of cardiomyopathy, the nursing interventions include administration of vasotec which prevents clogging of blood arteries. Additionally, the nurse may also administer IV furosemide to prevent buildup of fluids and metoprolol which acts to maintain a regular heart rate. In case of hypertension, the nursing interventions include administration of diuretics to help in elimination of water and sodium from the body. Other interventions include calcium channel blockers and ACE inhibitors which act to prevent heart failure. In case of myocarditis, the nurse may administer beta blockers, ACE inhibitors like Lisinopril and diuretics like furosemide (Halpin et al., 2021).
Prevention of Multiple Drug Interactions
There are various nursing interventions that can be implemented to prevent drug interactions in elderly patients. For instance, nurses may encourage the elderly patients to maintain records of all their medication. Nurses may achieve this by educating the elderly patients on the importance of keeping such records. In turn, this enables the nurses to identify the medicines that may cause interactions to the patients (Halpin et al., 2021). Secondly, the nurses may recommend use of medication organizers by the elderly patients. This ensures that the elderly patients adhere to the right dosage and frequency which avoids multiple drug interactions.
Another intervention involves advocating for the elderly patient to have a single primary care giver in order to prevent confusion that might lead to multiple drug interactions. The fourth intervention involves helping the elderly patients to track all the medicines used since the onset of the disease including herbal medicine. According to Ritchie et al. (2021), herbal medicine may also result in drug interactions which affects the patient outcomes.
Health Promotion Teaching Plan
The teaching plan would entail convincing Mrs. J to adopt a different approach in order to manage her condition and attain independence. The approach involves resource allocation towards acquisition of the support systems that may promote and restore her health. The health promotion plan would include modifications such as home medical equipment and multidisciplinary resources such as nutritionist, a home care nurse as well as physiotherapist. For instance, the home medical equipment will enhance her independence as it will comprise of the oxygen support system to alleviate the shortness of breath issue. Additionally, the home care nurse will offer the intravenous drug injections as well as appropriate prescriptions.
Moreover, the nutritionists will prescribe proper diet in order to ensure health promotion and independence of the patient. For instance, the nutritionist may recommend no more than 1500mg of sodium in her diet. According to Halpin et al. (2021), intake of high levels of sodium ions may cause fluid accumulation in her tissues which may in turn exacerbate edema. The physiotherapist will enhance her movement by encouraging her to exercise safely. This might require a cardiac rehabilitation program to assist with safe body exercise. According to Ritchie et al. (2021), effective exercise enhances cardiac function as it allows for smooth blood flow to the heart and other body parts. The same author reveals that proper exercise helps the patient to transition to independence as they can eventually walk without assistance. However, since Mrs. J has difficulties walking, she should be encouraged to use a walker and cane until the patient is able to walk on her own, thus achieving independence (Halpin et al., 2021).
Mrs. J has a weight of 95.5kgs and a height of 175cm. Upon calculation of body mass index (BMI), Mrs J is considered overweight. Therefore, she should be encouraged to enroll in a weight management program. Vu et al. (2020) confirm that being overweight subjects a patient to impaired cardiac function due to accumulation of cholesterol in the coronary arteries. Additionally, Mrs. J should be subjected to a skill training facility to build her strength as she cannot walk on her own. According to Ritchie et al. (2021), strength-building activities such as knee extension exercise add strength to the quadriceps and hamstrings. As a result, Mrs. J should take advantage of such activities to regain independence. Mrs. J is strongly advised to undergo smoking cessation since smoking is associated with COPD and cardiovascular diseases. Smoking cessation will lead to better cardiovascular and pulmonary outcomes.
Method for Patient Education
The best teaching strategy for Mrs. J’s medication maintenance includes a face to face session between the patient and the clinicians. The face to face session would enable the nurses to educate Mrs. J on how best to store the medicine, how to organize the drugs in terms of dosage and frequency. According to Vu et al. (2020), patients may adopt color-coded tins to organize their drugs in terms of frequency and dosage to avoid confusion. The same author reveals that confusing medicines uptake may increase the rate of hospital readmissions. Notably, the face to face sessions will allow Mrs. J to ask questions and receive immediate feedback from the clinicians. The clinicians may also demonstrate to Mrs. J on the best way to store the drugs.
There are several triggers for chronic obstructive pulmonary disease that might result in recurrent hospital visits as well as exacerbation. In the case of Mrs. J, smoking cigarettes may exacerbate her condition resulting in hospital visits. According to Vu et al. (2020), cigarette smoke accounts for approximately 90% of all chronic obstructive pulmonary disease cases. Therefore, if the patient goes back to smoking, her condition may worsen and become hospitalized.
The second COPD trigger includes cold weather which is a common agent for COPD exacerbation. A study by Ritchie et al. (2021) revealed that most COPD patients who are subjected to weather extremities suffer exacerbation which results to hospital revisits. Another trigger includes dust and fumes which irritate the respiratory tract and may worsen Mrs. J’s condition. The smoking cessation options for Mrs. J would include non-nicotine drugs like varenicline and bupropion. According to Ritchie et al. (2021), these options have proven to be effective for long term smokers.
Halpin, D. M., Criner, G. J., Papi, A., Singh, D., Anzueto, A., Martinez, F. J., & Vogelmeier, C. F. (2021). Global initiative for the diagnosis, management, and prevention of chronic obstructive lung disease. The 2020 GOLD science committee report on COVID-19 and chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine, 203(1), 24-36.
Ritchie, A. I., Baker, J. R., Parekh, T. M., Allinson, J. P., Bhatt, S. P., Donnelly, L. E., & Donaldson, G. C. (2021). Update in chronic obstructive pulmonary disease 2020. American Journal of Respiratory and Critical Care Medicine, 204(1), 14-22.
Vu, G. V., Ha, G. H., Nguyen, C. T., Vu, G. T., Pham, H. Q., Latkin, C. A., & Ho, C. S. (2020). Interventions to improve the quality of life of patients with chronic obstructive pulmonary disease: A global mapping during 1990–2018. International journal of environmental research and public health, 17(9), 3089.