NRS 410 WEEK 1 Assignment Paper
NRS 410 WEEK 1 Assignment Paper
NRS 410 WEEK 1 Assignment Paper
Case Study: Mrs. J
Subjective and Objective Clinical Manifestations
The subjective manifestations include the patient’s anxiety and concerns about whether she will die. Patients with multiple comorbidities usually fear the unknown, and they continuously worry if they will die any time soon. She also denies pain but says that she cannot get enough air. Similarly, she feels her heart is “running away”; she is experiencing palpitations brought about by the increased workload of the heart. She is also exhausted and cannot drink or feed herself.
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The objective manifestations show that the patient is obese for her height; she weighs 95.5kg despite being 175cm tall. She also has a heart rate of 118 bpm and a respiratory rate of 34 breaths per minute. Her increased respiratory rate is because the respiratory system is trying to get more oxygen to different organs in the body; it is a compensatory mechanism. Her bp is 90/58 mmHg. There is the presence of S1, S2, and S3; they are distant. There is PMI at the sixth ICS and faint. All peripheral pulses are 1+, bilateral distension of the jugular veins is noted, and the cardiac monitor results indicate atrial fibrillation and a ventricular rate of 132. Pulmonary crackles are auscultated with decreased breath sounds in the right lower lobe. The presence of crackles suggests the presence of fluids in the lungs. The patient coughs blood-tinged sputum and has an SPO2 of 82%. Hepatomegaly is detected, 4cm below the costal margin.
Four Cardiovascular Conditions the Client is at Risk
The client may also be at risk for hypertrophic cardiomyopathy (HCM), a heart muscle condition characterized by left ventricular hypertrophy (LVH) with no apparent cause (Contributors & Firth, 2019). LVH hypertrophy is a compensatory strategy to boost cardiac output because the patient’s heart is overworked. Heart failure from HCM can be mitigated with the help of beta-blockers like metoprolol and calcium channel blockers like verapamil.
Valvular heart disease is any condition that affects the heart valves. While age is the most common cause, congenital disabilities, disease, and physiologic processes can also play a role. Smoking cessation, alcohol moderation, antibiotics, antithrombotic drugs, aspirin, blood thinners, and water pills are frequent ways to prevent valvular heart disease (Peters et al., 2022).
Coronary artery disease, in which atherosclerotic plaque narrows coronary arteries and reduces blood supply to the heart muscle, is likely to affect the patient. Ischemia and heart failure can develop because of the compromised oxygen supply to the heart (Malakar et al., 2019). The patient should be advised to eat a low-sodium and cholesterol diet, keep her weight in check, quit smoking, and maintain regular physical exercise.
Another possible high-risk disease that can occur is acute myocarditis. Inflammation of the heart muscle is the underlying cause of this form of acquired cardiomyopathy (Lampejo et al., 2021). A viral infection primarily causes inflammation associated with the condition. Mrs. J is likely to have low immunity, predisposing her to infections. The underlying causes of the infections should be treated as soon as possible, and the client should adhere to the entire course of treatment.
The Nursing Interventions at Admission
Mrs. J. benefited from the interventions provided to her upon admission, which helped alleviate her symptoms and bring her condition under control. She is a high-risk client, and admitting her to the ICU is critical in ensuring that essential support for her declining organs is available so she can recuperate. Her heart and respiratory systems cannot meet the body’s needs, and thus they require machinery support. Her condition benefited from using various medications, including Lasix for fluid volume control, Enalapril and Metoprolol for hypertension and heart failure management, intravenous morphine sulphate for pain relief, and a short-acting bronchodilator for inhalation to lower airway resistance. All these interventions would help to control the clinical manifestations she presented with.
Medications and their Mode of Actions
IV Furosemide (Lasix): This loop diuretic decreases sodium and chloride reabsorption at Henle’s loop, increasing water excretion and lowering blood volume (Whalen, 2022). The rationale for use is that it helps to reduce the overworking of the heart, preventing fatigue of heart muscles that may cause heart failure.
Enalapril (Vasotec): This is an angiotensin-converting enzyme inhibitor that lessens cardiac and vascular remodeling after persistent hypertension (Whalen, 2022). The medication reduces the potential for heart failure to occur.
Metoprolol (Lopressor): Metoprolol works by inhibiting 1 adrenergic receptor in cardiac muscle cells, which slows down K+ release and increases the slope of phase 4 of the nodal action potential by decreasing Na+ absorption (Whalen, 2022). It helps the heart muscles contract and relax smoothly, preventing any anomalies in blood pumping.
IV Morphine Sulphate (Morphine): It is an opioid analgesic that reduces pain by causing analgesia, respiratory depression, and drowsiness; it reduces cough by interacting centrally in the medulla; and it modulates ascending pain pathways, so modifying the response to pain (Whalen, 2022). Its application aims to lessen suffering and raise the quality of life by decreasing pain.
Inhaled Short-Acting Bronchodilator (ProAir HFA): Short-acting bronchodilators help to relieve sudden symptoms by causing swift dilation of the airways to allow the exchange of gases (Whalen, 2022). They are preferred when the patient’s status deteriorates quickly and immediate effects are needed to preserve life.
Inhaled Corticosteroid (Flovent HFA): This steroidal drug suppresses inflammation that occurs on exposure to airway irritants that prevent the production of copious secretions that lead to blocking the airways (Whalen, 2022). It is preferred to maintain airway patency to promote adequate gas exchange.
Oxygen Delivered at 2L/NC: Supplemental oxygen helps to increase the oxygen supply to the muscles to prevent ischemia.
The necessity of not skipping doses, taking drugs with food, and avoiding alcohol should all be stressed to the patient. Monitoring for toxicity by regularly evaluating vital signs, mental status, and drug levels is also crucial. The client must bring all their medications along for each doctor’s visit for evaluation if they have been adhering to the doses. The nurse should also do regular medication reconciliation to maintain an accurate and up-to-date medication list. These initiatives aim to check for side effects and drug interactions and ensure the individual is taking the proper drugs at the right doses.
Health Promotion and Restoration Teaching Plan
Mrs. J.’s health may only be restored by implementing the restoration teaching plan. The first step in getting her healthy again will be teaching her the importance of proper nutrition and regularly exercising. To improve her health and decrease the risk of heart failure, she should start eating foods low in sodium and cholesterol (Billingsley et al., 2020). Appropriate testing will also be incorporated to reduce anxiety. She must maintain a healthy cognitive performance to guarantee a high quality of life. To ensure she understands the need to take her medications as prescribed, the healthcare should teach her about them. This will ensure she understands why she takes them, what they are for, and how to administer them safely. She can get a lot of aid from the Chronic Obstructive Pulmonary Disease (COPD) Foundation on her road to recovery, as it will enable her to join support groups with people with the same condition. Smokefree.gov and the American Lung Association are two more options when searching for help making changes. She will be better able to control her smoking habits as a result.
Options for Smoking Cessation that should be Offered
Counseling, medication, and nicotine replacement treatment should all be available to help people stop smoking. Sessions can be held over the phone or in person with a counselor or with a group of people. Bupropion and varenicline are two treatments used to help her quit smoking. Nicotine replacement therapies include nicotine lozenges, patches, inhalers, and nicotine gum and patches (Kotz et al., 2020). Environmental triggers like smoke, pollution, fumes, viral diseases, lung infections, and weather changes might increase the frequency of COPD exacerbations and subsequent hospital visits. Exacerbations can become more frequent when exposed to allergens, stress, or medication shifts.
References
Billingsley, E., Hummel, L., & Carbone, S. (2020). The role of diet and nutrition in heart failure: A state-of-the-art narrative review. Progress in Cardiovascular Diseases, 63(5), 538–551. https://doi.org/10.1016/j.pcad.2020.08.004
Contributors, M., & Firth, J. (2019). Cardiology: Hypertrophic cardiomyopathy. Clinical Medicine, 19(1), 61–63. https://doi.org/10.7861/clinmedicine.19-1-61
Kotz, D., Batra, A., & Kastaun, S. (2020). Smoking cessation attempts and common strategies employed. Deutsches Aerzteblatt Online. https://doi.org/10.3238/arztebl.2020.0007
Lampejo, T., Durkin, M., Bhatt, N., & Guttmann, O. (2021). Acute myocarditis: Aetiology, diagnosis and management. Clinical Medicine, 21(5), e505–e510. https://doi.org/10.7861/clinmed.2021-0121
Malakar, K., Choudhury, D., Uddin, A., & Chakraborty, S. (2019). A review on coronary artery disease, its risk factors, and therapeutics. Journal of Cellular Physiology, 234(10), 16812–16823. https://doi.org/10.1002/jcp.28350
Peters, S., Duggan, P., Trachiotis, D., & Antevil, L. (2022). Epidemiology of valvular heart disease. Surgical Clinics of North America, 102(3), 517–528. https://doi.org/10.1016/j.suc.2022.01.008
Whalen, K. (2022). Lippincott Illustrated Reviews: Pharmacology. Lippincott Williams & Wilkins.
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WEEK 1 CLASS NRS 410
Case Study: Mrs. J.
WEEK 1 CLASS NRS 410
RESOURCE
Pathophysiology: Clinical Applications for Client Health
Read Chapter 1 in Pathophysiology: Clinical Applications for Client Health.
View Resource
Acute Myocardial Infarction
Read “Acute Myocardial Infarction,” by Reed, Rossi and Cannon, from The Lancet (2017).
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0140673616306778
Congestive Heart Failure and Congenital Defects
Read “Congestive Heart Failure and Congenital Defects,” located on the American Heart Association website.
https://www.heart.org/en/health-topics/congenital-heart-defects/the-impact-of-congenital-heart-defects/congestive-heart-failure-and-congenital-defects
Evaluating the Effectiveness of an Online Cardiac Rehabilitation Resource (www.svhhearthealth.com.au) in Improving Knowledge and Confidence for Patients With Newly Diagnosed Cardiac Conditions: A Pre-Experimental Pilot Study
Read “Evaluating the Effectiveness of an Online Cardiac Rehabilitation Resource (www.svhhearthealth.com.au) in Improving Knowledge an
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https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S144395061830129X
GOLD Initiative for Chronic Obstructive Lung Disease
Explore the Global Initiative for Chronic Obstructive Lung Disease (GOLD) website.
Identifying Self-Care Practices in Heart Failure Patients
Read “Identifying Self-Care Practices in Heart Failure Patients”, by Koster, J, from The Nursing Voice, 9(1) (
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https://lopes.idm.oclc.org/login?url=https://www.proquest.com/trade-journals/identifying-self-care-practices-heart-failure/docview/2556886757/se-2?accountid=7374
Patient Perceived Impact of Nurse-Led Self-Management Interventions for COPD: A Systematic Review of Qualitative Research
Read “Patient Perceived Impact of Nurse-Led Self-Management Interventions for COPD: A Systematic Review of Qualitative Research,”
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https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S002074891830258X
Nurseslabs-For All Your Nursing Needs
Refer to the nurseslabs.com website for pharmacology support in completing the assignment for the topic 1 case study.
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https://nurseslabs.com/
Optional- A Nursing Care of Patients After Cardiac Arrest in the Course of Myocardial Infarction
For additional information, the following is recommended:
“A Nursing Care of Patients After Cardiac Arrest in the Course of Myo
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https://doaj.org/article/39ac6a139c46478997596aa30cf17811?
Optional- Atrial Fibrillation Symptom Perception
For additional information, the following is recommended:
“Atrial Fibrillation Symptom Perception,” by Streur, from
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https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1555415518306974
Optional- Exploring New Pathways and Emerging Data for Better Control and Management in the Personalized Treatment of Severe Asthma
For additional information, the following is recommended:
“Exploring New Pathways and Emerging Data for Better Control and Man
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https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=143062031&site=ehost-live&scope=site&custid=s8333196&groupid=main&profile=ehost
Optional- Ludwig’s Angina: a Multidisciplinary Concern
For additional information, the following is recommended:
“Ludwig’s Angina: A Multidisciplinary Concern,” by Parker and Mo
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https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=136368623&site=eds-live&scope=site
