Clinical Manifestation Presented by Mrs. J
Mrs. J showed the following clinical manifestations in the past days: she experienced symptoms of flue, which include malaise, fever, nausea, and productive cough. Mrs. J also stated that of late, she has been unable to carry out Activities of Daily Living (ADLs) and admits that she cannot walk short distances without being assisted.
Effectiveness of The Interventions During Admission and Rationale
Based on the patient’s objective and subjective, it is crucial for the RN to start a healthcare plan for left-sided heart failure. Mrs. J experienced declined sound breaths in the right lower lobe in addition to COPD exacerbation, which pointed to extreme markers of cardiac failure. In addition, Mrs. J had frothy sputum that had bloodstains, which pointed to an acute respiratory complication, which interfered with the patient’s normal breathing, which made it appropriate to administer oxygen therapy. Also, the pulmonary crackles experienced by Mrs. J indicated fluid congestion and overload plus jugular vein distention (JVD), which is often managed using IV administered diuretics. Hence, the interventions used by the RNs were justifiable and essential with the objective of averting Mrs. J’s looming CHF and improving the respiratory system of the patient.
Delegate your assignment to our experts and they will do the rest.
Enalapril (Vasotec)
Enalapril sold under the brand name Vasotec is an ACE inhibitor and usually used to treat hypertension. The drug is also effective in treating CHF when used together with diuretics (Vallerand, 2018).
IV furosemide (Lasix)
Lasix is a water pill (diuretic) used in the treatment of edema that results from heart failure. It helps in mobilization of excess fluids due to CHF, which makes the heart to pump better (Vallerand, 2018).
Metoprolol (Lopressor)
Metoprolol is a β-Blocker that has effects on the heart and on the circulation. Mr. J has irregular heart rhythm, and Lopressor can is effective in treating her Atrial fibrillation (A-fib) (Vallerand, 2018).
IV morphine sulphate
IV Morphine is a narcotic that for a long time has been used in adverse cardiac events, for example, heart failure. IV morphine assists in opening up blood vessels and improves cardiac overload, and reduce pain and anxiety (Vallerand, 2018). Morphine in CHF is effective in ameliorating symptoms. However, it is associated with poor patient outcomes. The most prevalent side effect of using morphine is respiratory depression, which is life-threatening and also can lead to death from cardiogenic shock. Hence, based on Mrs. J’s objective data, IV morphine is not a rational medication to be used.
Inhaled corticosteroid (Flovent HFA)
Is typically used in the treatment of asthma to alleviate shortness of breath (Vallerand, 2018). Mrs. J experienced shortness of breath; hence it was an appropriate quick-fix medication.
Inhaled short-acting bronchodilator (ProAir HFA): is a quick-acting “rescue” or “reliever” therapy used in asthma attacks to open the airways.
Oxygen delivered at 2L/NC :
Mrs. J had an acute respiratory complication which interfered with her normal breathing
Four CVDS That May Result in CHF
Tobacco smoking
This is a primary risk element for the development of IHD which is a primary factor for heart failure (Haarmann et al. 2019). A nursing intervention to address smoking is to educate on the need for cessation and increase awareness of the risk factors of smoking. Patients may be given respiratory therapy, such as nicotine patches to stop smoking.
Obesity :
Obesity can result in an increased workload for the heart, making to work harder than usual and can lead to sleep apnea (Haarmann et al. 2019). A nursing intervention to address obesity is to encourage patients to eat healthier foods and encourage exercise activities to help with weight loss.
Hypertension :
Unregulated BP is a risk factor for the development of CHF because it makes the heart to pump harder, making the heart weaker with time (Haarmann et al. 2019). Nursing intervention includes ensuring all home medication is listed on the MAR and to ensure routine BP measurements are done. Also, the RN is to ensure BP medications are adjusted according to MD and educate the patient on taking BP medications.
Sleep apnea :
Is a sleeping disorder in which breathing repeatedly starts and stops and can lead to fatigue of the heart, high BP, stroke, diabetes, and heart failure (Haarmann et al. 2019). Nursing intervention includes ensuring a patient completes a study sleep and ensure all the prescribed medications are available at night.
RN Interventions in Preventing Challenges Associated with Multiple Drug Interactions
The first intervention is to educate the patient on the need to maintain a precise log of all medications, including herbal, that the patient is taking (Whitehead, 2018). The purpose of this is to minimize the chances of an MD ordering medication that may lead to drug interactions. The second intervention is to educate a patient on the essence of having one primary care provider to minimize polypharmacy (Whitehead, 2018). The third intervention is to assist and inform a patient on the importance of adhering to the dosage and dosage frequency through a medication organizer. The fourth intervention is to inform a patient on the probable interactions associated with herbal medicine to notify the care provider of all herbal regimens.
Health Promotion and Restoration Teaching Plan for Mrs. J.’
Based on Mrs. J’s subjective data, her condition has made her have a fear of dying. Such thoughts are even more dangerous to her life, and she would need counseling sensations. Hence, a health restoration approach would entail counseling sessions to assist Mrs. J to manage her condition (Whitehead, 2018). In addition, the next intervention is to encourage Mrs. J to join support groups with people undergoing similar health challenges, and she can achieve substantial advantages from such groups and accountability in adhering to the treatment regime. The other intervention plan is to stop the smoking habit, and this can be achieved by replacing smoking with nicotine-based therapies such as nicotine patches.
Method for Providing Education for Mrs. J
The best method for educating Mrs. J on medications to be maintained is through preparing a MAR. According to Whitehead (2018), the MAR contains uniform plans for the charting of treatments and medication using the pharmacy generated approved flowsheet and records. The format of MAR differs from hospital to hospital; at a minimum, it contains the name of the patient, the name of the medication, the frequency of dosage and route. Since the MAR has a plan of care, it will be essential for Mrs. J to adhere to treatments even if she decides to change a care provider.
COPD Triggers
COPD exacerbations can be triggered by smoking, irritating substances from acute allergies, excessive stress, poor sleep pattern, and changes in weather conditions. In this case scenario, the first line of medication for Mrs. J is Varenicline, which lowers the urge for nicotine and reduces withdrawal symptoms (Lee et al. 2019). Alternatively, Mrs. J may be given nicotine patches to help with withdrawal symptoms. The second option is for Mrs. J to join smoking cessation groups, whereby the group therapies can help her to reduce smoking and eventually stop smoking.
References
Haarmann, H., Koch, J., Bonsch, N., Mende, M., Werhahn, S. M., Lüers, C., ... & Pieske, B. (2019). Morbidity and mortality in patients with cardiovascular risk factors and obstructive sleep apnoea: results from the DIAST-CHF cohort. Respiratory medicine , 154 , 127-132.
Kim, J., & Parish, A. L. (2017). Polypharmacy and medication management in older adults. Nursing Clinics , 52 (3), 457-468.
Lee, J. H., Hailey, K. L., Vitorino, S. A., Jennings, P. A., Bigby, T. D., & Breen, E. C. (2019). Cigarette smoke triggers IL-33–associated inflammation in a model of late-stage chronic obstructive pulmonary disease. American journal of respiratory cell and molecular biology , 61 (5), 567-574.
Vallerand, A. H. (2018). Davis’s drug guide for nurses . FA Davis.
Whitehead, D. (2018). Exploring health promotion and health education in nursing. Nursing Standard , 33 (8).
