Patient with Chronic Heart Failure and COPD
Assessment Description
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.
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.
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 clinical manifestations present in Mrs. J.
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.
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 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. Explain how the rehabilitation resources and modifications will assist the patients' transition to independence.
Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
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.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
28 07:43 Clinical Manifestations of Mrs. J.
12 points
Criteria Description
Clinical Manifestations of Mrs. J.
5. Excellent
12 points
Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.
4. Good
10.68 points
Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms.
3. Satisfactory
9.48 points
Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete.
2. Less Than Satisfactory
9 points
Clinical manifestations are partially presented. There are major omissions and inaccuracies.
1. Unsatisfactory
0 points
Clinical manifestations are omitted.
Evaluation of Nursing Interventions at Admissions
12 points
Criteria Description
Evaluation of Nursing Interventions at Admissions
5. Excellent
12 points
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.
4. Good
10.68 points
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.
3. Satisfactory
9.48 points
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.
2. Less Than Satisfactory
9 points
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.
1. Unsatisfactory
0 points
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.
Cardiovascular Conditions Leading to Heart Failure and Interventions
12 points
Criteria Description
Cardiovascular Conditions Leading to Heart Failure and Interventions
5. Excellent
12 points
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.
4. Good
10.68 points
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.
3. Satisfactory
9.48 points
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.
2. Less Than Satisfactory
9 points
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.
1. Unsatisfactory
0 points
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.
Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions
12 points
Criteria Description
Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions
5. Excellent
12 points
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.
4. Good
10.68 points
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.
3. Satisfactory
9.48 points
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.
2. Less Than Satisfactory
9 points
Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are partially presented.
1. Unsatisfactory
0 points
Fewer than three nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are presented.
Health Promotion and Restoration Teaching Plan
18 points
Criteria Description
Health Promotion and Restoration Teaching Plan
5. Excellent
18 points
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.
4. Good
16.02 points
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.
3. Satisfactory
14.22 points
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.
2. Less Than Satisfactory
13.5 points
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.
1. Unsatisfactory
0 points
A health promotion and restoration teaching plan for the patient is omitted.
Method for Providing education to Prevent Hospital Readmissions
18 points
Criteria Description
Method for Providing education to Prevent Hospital Readmissions
5. Excellent
18 points
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.
4. Good
16.02 points
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.
3. Satisfactory
14.22 points
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.
2. Less Than Satisfactory
13.5 points
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.
1. Unsatisfactory
0 points
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.
COPD Triggers and Options for Smoking Cessation
12 points
Criteria Description
COPD Triggers and Options for Smoking Cessation
5. Excellent
12 points
All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.
4. Good
10.68 points
Key COPD triggers exacerbating return visits are outlined. General options for smoking cessation relevant to the patient are summarized.
3. Satisfactory
9.48 points
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.
2. Less Than Satisfactory
9 points
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.
1. Unsatisfactory
0 points
COPD triggers exacerbating return visits and options for smoking cessation are omitted.
Thesis Development and Purpose
6 points
Criteria Description
Thesis Development and Purpose
5. Excellent
6 points
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
4. Good
5.34 points
Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.
3. Satisfactory
4.74 points
Thesis is apparent and appropriate to purpose.
2. Less Than Satisfactory
4.5 points
Thesis is insufficiently developed or vague. Purpose is not clear.
1. Unsatisfactory
0 points
Paper lacks any discernible overall purpose or organizing claim.
Argument Logic and Construction
6 points
Criteria Description
Argument Logic and Construction
5. Excellent
6 points
Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
4. Good
5.34 points
Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.
3. Satisfactory
4.74 points
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.
2. Less Than Satisfactory
4.5 points
Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.
1. Unsatisfactory
0 points
Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.
Mechanics of Writing (includes spelling, punctuation, grammar, language use)
6 points
Criteria Description
Mechanics of Writing (includes spelling, punctuation, grammar, language use)
5. Excellent
6 points
Writer is clearly in command of standard, written, academic English.
4. Good
5.34 points
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.
3. Satisfactory
4.74 points
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.
2. Less Than Satisfactory
4.5 points
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.
1. Unsatisfactory
0 points
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.
Paper Format (use of appropriate style for the major and assignment)
2.4 points
Criteria Description
Paper Format (use of appropriate style for the major and assignment)
5. Excellent
2.4 points
All format elements are correct.
4. Good
2.14 points
Appropriate template is fully used. There are virtually no errors in formatting style.
3. Satisfactory
1.9 points
Appropriate template is used. Formatting is correct, although some minor errors may be present.
2. Less Than Satisfactory
1.8 points
Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.
1. Unsatisfactory
0 points
Template is not used appropriately, or documentation format is rarely followed correctly.
Documentation of Sources
3.6 points
Criteria Description
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
5. Excellent
3.6 points
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
4. Good
3.2 points
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
3. Satisfactory
2.84 points
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
2. Less Than Satisfactory
2.7 points
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.
1. Unsatisfactory
0 points
Sources are not documented.
Total120 po
Patient with Chronic Heart Failure and COPD
Mrs. J. was admitted to arriving at the health facility complaining of flu-like symptoms, reduced ability to perform ADLs, and needed assistance walking short distances. She was admitted to the ICU with acute decompensated heart failure and acute exacerbation of COPD. Based on Mrs. J's medical history, current medication, and perceived illness, the purpose of the current paper is to provide a critical analysis of her condition based on clinical manifestations, the efficacy of the current treatment plan, potential cardiovascular conditions leading to heart failure, and approaches to health education for the patient.
Clinical Manifestations
Clinical manifestation refers to the physical results of some infection or illness. The term designates findings that are apparent in the physical examination and history of the patient and does not involve imaging studies or esoteric laboratory outcomes. The patient history indicates she has hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Though the patient depends on 2L of oxygen/ nasal cannula when involved in activities, she smokes two packets of cigarettes per day; a habit she has practiced for almost 40 years. On arrival, the patient showed flu-like symptoms, including productive cough, fever, nausea, and malaise. She cannot perform ADLs, requires assistance walking over short distances, and experiences persistent exhaustion. The patient is also experiencing increased breathlessness and a racing heartbeat. According to Cuthbert et al. (2019), these signs and symptoms form part of the clinical manifestation of COPD coupled with chronic congestive heart failure.
Interventions
After admission, Mrs. J was placed on the following medications: IV furosemide, Enalapril, Metoprolol, IV morphine sulfate, an inhaled short-acting bronchodilator, inhaled corticosteroid, and oxygen delivered at 2L per NC. The relevance of IV furosemide is to treat swelling associated with congestive heart failure and is administered at a rate of 4mg per minute intravenously. On the other hand, Enalapril is administered to manage and treat the patient's hypertension and heart failure, while Metoprolol is a beta-blocker necessary for controlling high blood pressure. Since there is no know interaction between these two medications, they can be taken together. Aside from addressing pain, IV morphine sulfate is also ideal for managing discomfort associated with acute heart failure (Caspi & Aronson, 2020). Since the patient is experiencing breathlessness, there is a need for the oxygen delivered at 2L per NC to supplement the body's intake of oxygen. The patient is also in ProAir HFA, an albuterol inhaler that relaxes the muscles around the airways to enhance breathing. Inhaled corticosteroid, on the other hand, is vital in treating asthma. Though Mrs. J is not diagnosed with asthma, some of her asthma-like symptoms (like breathlessness) are managed by this medication. Thus, Mrs. J is so far receiving appropriate intervention for her condition.
Types of Cardiovascular Conditions
Heart failure is often a result of another disease or condition. In terms of cardiovascular diseases, four conditions can result in this outcome: coronary heart disease, high blood pressure, cardiomyopathy, and irregular heartbeat. Coronary heart disease results from the build-up of plaques in the walls of the arteries that supply blood to the hea...