From a subjective perspective, Mrs. J's clinical manifestations include extreme anxiety and fears she might be dying. Mrs. J also has difficulty in breathing, a fluttering feeling in her heart, and inability to take care of herself even in basic activities. From an objective perspective, Mrs. J has an elevated level of hypotension, together with a high and irregular heartbeat. The patient also has jugular vein distention and a very faint but detectable heartbeat. Mrs. J has slow and labored breathing with an oxygen saturation of 82%. Finally, the patient manifest Blumberg's sign as she indicated feeling pain when pressure was removed from her stomach; she also has a slightly enlarged liver.
The first intervention was IV furosemide, which was necessary for the management of excessive fluid accumulation in the patient's body. The intervention was proper as the patient exhibited signs of congestive heart failure. The second intervention was enalapril, an angiotensin-converting enzyme inhibitor used for treating hypertension (Dittrich et al., 2019). This intervention is both wrong and dangerous as the patient was already hypotensive. The next intervention was Metoprolol, used to mitigate anxiety, and lower blood pressure. In this instance, the intervention may have been necessary to mitigate the patient's anxiety, although the patient being hypotensive makes the choice of medication inappropriate. The most likely reason for combining enalapril and Metoprolol was to slow down the process of heart failure (Dittrich et al., 2019). The fourth intervention was IV morphine sulphate, a powerful pain management drug. This intervention is also suspect since the patient did not indicate the existence of any pain. Next, the nurse administered an inhaled short-acting bronchodilator, a nebulizer that was necessary to ease the patient's breathing. Finally, the nurse also administered inhaled corticosteroid, which was vital to counter the respiratory effects of chronic obstructive pulmonary disease (COPD), the most likely cause of the patient's ailment (Shukla et al., 2020). Over and above the medication above, the nurse also administered pure oxygen to the patient, an apt choice considering that the patient had a low oxygen saturation, at 82%.
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Cardiovascular Conditions Leading to Heart Failure and Interventions
Coronary artery disease is the most common cause of heart failure and results from the accumulation of cholesterol and fats plaques on the inner walls of the arteries (Francis & Tang, 2019). Intervention for the same includes guiding patients to eat a healthy diet and regularly undertake physical exercises. Another major cause of heart disease is uncontrolled hypertension. Nurses can assist patients in controlling hypertension by ensuring that they regularly take prescribed medication and adopt a healthy lifestyle. Myocardial infarction (MI) or heart attacks are another major cause of heart disease (Francis & Tang, 2019). Measures for prevention of heart attacks include adopting a healthy lifestyle, including limiting alcohol intake and not smoking. Finally, congenital heart defects are also a major cause of heart failure. Nurses can help mitigate the impact of congenital heart defects by advising early diagnosis and proper treatment and management.
Nursing Interventions for Older Patients to Prevent Multiple Drug-Interactions Problems
To prevent multiple drug interaction problems, nurses should train patients to ensure strict adherence to strict adherence to prescribed instructions (Potter at al., 2016). Failure to follow prescription instructions increases the chances of drugs interacting adversely with each other. Secondly, nurses to ensure that patients understand the proper nutrition for different drugs. The wrong foods can cause complications that exacerbate multiple drug interactions. Third, the nurse should seek to ensure that a third party monitors drug usage for older patients with memory problems or who are unable to take care of themselves (Potter at al., 2016). Finally, nurses should teach older patients and their caregivers on the avoidance of unnecessary medication and supplements when taking multiple prescription drugs. Unnecessary secondary drugs can cause an increase in propensity for the adverse interaction of multiple drugs.
Health Promotion and Restoration Teaching Plan
An effective health promotion plan for Mrs. J should have four main components. The first is medical in nature and involves strict adherence to medical prescriptions (Potter at al., 2016). Mrs. J has not taken her hypertension medication for the three days leading to her medical emergency. Hence, there should be measures to prevent a recurrence of the same. The second component is behavioral change and mainly involves the issue of smoking. The fact that the patient smokes two packets of cigarettes per day places her life in peril and need to change. The third component is patient education (Potter at al., 2016). For the rest of her life, Mrs. J will have to live with complicated health problems and needs apt training on how to handle them. Finally, there is the societal change component, involving loved ones around Mrs. J, who is married. The people around the patient needs to give her proper support and assistance, and current evidence shows that they have been failing.
Method for Providing Education to Prevent Hospital Readmissions
Mrs. J's age demands a simple, interesting, and continuous training and education method. She may not be able to read extensive notes or follow online training manuals. An effective way to train her would be to reduce the lessons into interesting and interactive short videos (Potter at al., 2016). The patient can be watching the short videos regularly and repeatedly to ensure that she understands and internalizes the lessons included therein. Having a designated loved one join the patient as she watches the videos can also assist. A professional such as a nursing assistant can also be visiting Mrs. J at home to provide supplementary lessons.
COPD Triggers and Options for Smoking Cessation
The three main triggers of COPD are cigarette smoke, air pollution, and infection (Shukla et al., 2020). Mrs. J is a chain smoker who is highly addicted, having smoked two packets a day for over four decades. She needs to stop smoking immediately as even limited smoking or secondary smoke can trigger COPD. The most effective solution would be an abrupt cessation of smoking, combined with nicotine replacement therapy (NRT) (Hartmann‐Boyce et al., 2018). For the prevention of air pollution, Mrs. J should avoid areas with high levels of pollutions, such as highways and industrial parks. Finally, to reduce the propensity for infection, Mrs. J should adopt high levels of hygiene in her home and in the food she eats (Potter at al., 2016). She should also be vigilant to any signs of infection and seek medical attention immediately.
References
Dittrich, S., Graf, E., Trollmann, R., Neudorf, U., Schara, U., Heilmann, A., ... & Müller-Felber, W. (2019). Effect and safety of treatment with ACE-inhibitor Enalapril and β-blocker metoprolol on the onset of left ventricular dysfunction in Duchenne muscular dystrophy-a randomized, double-blind, placebo-controlled trial. Orphanet journal of rare diseases , 14 (1), 105.
Francis, G. S., & Tang, W. W. (2019). Pathophysiology of congestive heart failure. Reviews in cardiovascular medicine , 4 (S2), 14-20.
Hartmann‐Boyce, J., Chepkin, S. C., Ye, W., Bullen, C., & Lancaster, T. (2018). Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews , (5).
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing-E-Book . Elsevier health sciences.
Shukla, S. D., Walters, E. H., Simpson, J. L., Keely, S., Wark, P. A., O'Toole, R. F., & Hansbro, P. M. (2020). Hypoxia‐inducible factor and bacterial infections in chronic obstructive pulmonary disease. Respirology , 25 (1), 53-63.
