Critical Thinking Essay

Critical Thinking Essay

Critical Thinking Essay

Critical Thinking Essay
Heart failure is a chronic condition in which the heart cannot sufficiently pump blood to maintain tissue oxygenation and remove metabolic wastes. It requires continuous monitoring to improve symptoms. This paper aims to assess a patient with heart failure and discuss pharmacological management and nursing intervention to improve the patient’s quality of life.

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Subjective and Objective Clinical Manifestations
Subjectively, Mrs J. has anxiety and fears about her condition, explicitly asking if she will die. She also describes a sensation of not getting enough air and feeling like her heart is “running away.” Additionally, she reports exhaustion and an inability to eat or drink independently. These subjective symptoms suggest a significant deterioration in her health status.Objectively, Mrs J.’s vital signs reveal a body temperature of 37.6°C, a HR of 118 b/m (irregular), a RR of 34 breaths per minute, and a BP of 90/58 mmHg. Cardiovascular examination findings include distant S1 and S2, an S3 sound, and a faint PMI at the sixth ICS. Peripheral pulses are weak, with a strength of 1+. Cardiac monitoring shows atrial fibrillation with a ventricular rate of 132. Respiratory examination reveals pulmonary crackles, decreased breath sounds in the right lower lobe, and frothy blood-tinged sputum. Mrs J.’s oxygen saturation is low at 82%.
Cardiovascular conditions
Mrs J. has several cardiovascular conditions that put her at risk for the development of heart failure. These conditions include hypertension, chronic heart failure, atrial fibrillation, and hypotension (Arrigo et al., 2020). Mrs J. has a history of hypertension, which increases the workload on the heart. Medications like enalapril and metoprolol can be administered to reduce blood pressure and improve cardiac function. Management of heart failure involves optimizing cardiac function and reducing symptoms. Medications like furosemide can be administered to control fluid overload. Other interventions include lifestyle modifications, such as sodium restriction, fluid restriction, and regular exercise. Monitoring of weight, symptoms, and adherence to medication is essential.
Mrs J’s vitals show that she is hypotensive with a BP of 90/58. It may be due to inadequate pumping of the blood by the heart as the heart is strained (Arrigo et al., 2020). As a result, the heart may try to increase its contractility to push the blood to the tissues, which puts a lot of stress on the heart in the long run, thus predisposing Mrs J to heart failure. Medications such as adrenaline are essential in the management of hypotension.
Atrial fibrillation increases the risk of heart failure due to irregular and rapid heart rates. Medical interventions such as warfarin or direct oral anticoagulants may include anticoagulant therapy to prevent blood clots (Carlisle et al., 2019). Control of heart rate and rhythm with medications like beta-blockers. Nursing interventions include patient education on medication compliance, self-monitoring blood pressure and Smoking cessation.
Nursing Interventions
Some of the interventions given to Mrs J were of no benefit. For instance, administration of metoprolol and enalapril would only worsen the hypotensive condition.Therefore, I would withhold these drugs and maintain the patient with Furosemide until her symptoms improve and her BP stabilizes. I would change morphine to another class ofanalgesics such as NSAID since morphine causes respiratory depression, worsening the patient’s respiratory function a. Flovent HFA is also not indicated in COPD exacerbation as it is used in the long-term management of COPD.
Mechanism of Action Of Drugs
I.V. furosemide is a loop diuretic used to promote diuresis and reduce fluid overload by inhibiting the reabsorption of sodium and chloride in the ascending loop of Henle. The rationale for its use in Mrs J is to alleviate symptoms of congestion associated with acute decompensated heart failure(Abraham et al., 2020). Inhaled corticosteroid (Flovent HFA) is an anti-inflammatory agent which inhibits the release of mediators such as histamine. It decreases bronchial secretions and lung functions, relieving COPD symptoms.
Enalapril is an ACE inhibitor that helps to lower blood pressure and reduce the workload on the heart. In Mrs J’s case, it controls hypertension and manages heart failure by inhibiting the conversion of angiotensin I to angiotensin II. Inhaled short-acting bronchodilator (ProAir HFA) acts on beta-2-adrenergic receptors at bronchial smooth muscles and causes relaxation of the muscles. It relieves the symptoms of COPD.
Metoprolol is a beta-blocker that reduces heart rate and blood pressure, thereby decreasing the workload on the heart (Alabed et al., 2020). It is used to manage hypertension and heart failure. In Mrs J’s case, it helps to control her irregular heart rate and decrease the risk of arrhythmias.IV morphine sulfate (Morphine) is an opioid analgesic that relieves pain and alleviates dyspnea in patients with acute COPD and heart failure exacerbation. Oxygen was provided to improve lung function.
Prevention Of Drug Interactions
The nurse should review all the medications prescribed for Mrs J and their dosages for the possibility of interactions which would lead to adverse reactions. For example, the nurse should ensure that macrolide antibiotics are not prescribed with furosemide. Nurses can also educate their patients on nonpharmacological therapies that can help minimize the drugs taken (Hoel et al., 2021). In Mrs J’s case, the nurses can encourage her to reduce her salt intake. Such interventions may reduce her risk of developing heart failure, thus decreasing her risk of adverse drug reactions caused by multiple drugs interaction.
Moreover, nurses are tasked to ensure that the patients take the correct dosage of the drug at the correct time to prevent mixing of different drugs simultaneously. The nurses should also stress any dietary restrictions to the patients. Some food preventsthe metabolism of certain medications,which increases their levels in circulation, predisposingto toxicity (Hoel et al., 2021). Finally, nurses should look keenly at the prescription list of all medication taken by the patient, including OTC drugs. Certain drugs may exacerbate heart failure because they either inhibit or decrease the metabolism of some drugs (Hoel et al., 2021). In the case of MrsJ, the administration of NSAIDs will blunt the effect of furosemide by causing the retention of sodium and water due to the inhibition of prostaglandins.
Health Promotion
A multidisciplinary approach involving various healthcare professionals is necessary to provide a health promotion for Mrs J. The goal is to assist her transition to independence and prevent readmission. Mrs J needs services from nurses on self-care techniques and medication compliance. She also needs a respiratory therapist and dietitian to address her nutritional status and provide dietary modifications for a healthy heart.By engaging in this multidisciplinary approach, Mrs J. can receive comprehensive care addressing her physical, emotional, and social needs. Mrs J may also be referred to smoking cessation programs tailored to her needs.
Smoking cessation options and COPD exacerbations
Interventions available for Mrs J to stop her chronic smoking habit include; continuous encouragement from the healthcare teams for her to stop smoking and educating her on the risksof smoking on her condition. Specialist cessation services should also be sought.Mrs J may also use nicotine replacement therapy (Piper et al., 2020). COPD triggers that can increase exacerbations include respiratory infections. For instance, sinus infection, flu and common cold are some of the most common causes that trigger COPD (Ritchie&Wedzicha, 2020). Mrs J presents with similar flu-like symptoms of productive cough, malaise and fever. Smoking, air pollution, and allergens can also trigger COPD.
Mrs J has acute decompensated heart failure and COPD and has been managed with diuretics, analgesics and drugs to relieve symptoms of COPD. Adjustments to the patient’s lifestyle such salt intakerestrication has been adressed. The paper hassaddressed the mechanism of action of certain drugs used to manage heart failure. A multidisciplinary approach has also been indicated for the patient to address her physical, emotional and social needs.

Abraham, B., Megaly, M., Sous, M., Fransawyalkomos, M., Saad, M., Fraser, R., Topf, J., Goldsmith, S., Simegn, M., Bart, B., Azzo, Z., Mesiha, N., & Sharma, R. (2020). Meta-Analysis Comparing Torsemide Versus Furosemide in Patients with Heart Failure. The American Journal of Cardiology, 125(1), 92–99.
Alabed, S., Sabouni, A., Al Dakhoul, S., & Bdaiwi, Y. (2020). Beta-blockers for congestive heart failure in children. The Cochrane Database of systematic reviews, 7(7), CD007037.
Amelard, R., Flannigan, N., Patterson, C. A., Heigold, H., Hughson, R. L., & Robertson, A. D. (2022). Assessing jugular venous compliance with optical hemodynamic imaging by modulating intrathoracic pressure. Journal of biomedical optics, 27(11), 116005.
Arrigo, M., Jessup, M., Mullens, W., Reza, N., Shah, A. M., Sliwa, K., & Mebazaa, A. (2020). Acute heart failure. Nature reviews. Disease primers, 6(1), 16.
Brennan E. J. (2018). Chronic heart failure nursing: integrated multidisciplinary care. British Journal of Nursing (Mark Allen Publishing), 27(12), 681–688.
Carlisle, M. A., Fudim, M., DeVore, A. D., & Piccini, J. P. (2019). Heart Failure and Atrial Fibrillation, Like Fire and Fury. JACC. Heart failure, 7(6), 447–456.
Güder, G., & Störk, S. (2019). COPD and heart failure: differential diagnosis and comorbidity. COPD und Herzinsuffizienz: Differenzialdiagnose und Komorbidität. Herz, 44(6), 502–508.
Hoel, R. W., Connolly, R. M. G., & Takahashi, P. Y. (2021). Polypharmacy management in older patients. In Mayo Clinic Proceedings (Vol. 96, No. 1, pp. 242-256). Elsevier.
Piper, M. E., Bullen, C., Krishnan-Sarin, S., Rigotti, N. A., Steinberg, M. L., Streck, J. M., & Joseph, A. M. (2020). Defining and measuring abstinence in clinical trials of smoking cessation interventions: an updated review. Nicotine and Tobacco Research, 22(7), 1098-1106.
Ritchie, A. I., &Wedzicha, J. A. (2020). Definition, causes, pathogenesis, and consequences of chronic obstructive pulmonary disease exacerbations. Clinics in chest medicine, 41(3), 421-438.


NRS 410V Assignment:

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.


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 subjective and objective clinical manifestations present in Mrs. J.

Describe four cardiovascular conditions in which Mrs. J is at risk, and that may lead to heart failure. What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions?

By following the nursing process, were the interventions at the time of admissions beneficial for Mrs. J? Would you change any of the interventions to ensure patient independence and prevent readmission?

Explain each of the seven medications listed in the scenario above. Include the classification, the action, and the rationale for each of these. 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, including maintenance of medications. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence and prevent readmission.

Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits.

You are required to cite a minimum of three 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.

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