Respiratory Distress: Causes, Symptoms, and Treatment

Clinical Manifestations 

Mrs. J presents with respiratory distress manifested by difficulty breathing and fatigue. She also experiences palpitations, chest pains, and chest tightness. The difficulty breathing is exacerbated on exertion and physical activities, in which she experiences shortness of breath. She also presents with productive cough with greenish-yellow sputum. GI disturbances of nausea and changes in appetite are also present. Generally, the patient feels week and is unable to perform ADL due to malaise. 

Nursing Interventions 

Administering IV furosemide was required to increase urine output and thus remove extra fluid from body compartments and circulation. This makes the heart pump better by easing congestion (Ziaeian & Fonarow, 2016). 

Enalapril (Vasotec) is an angiotensin-converting enzyme (ACE) administered for high blood pressure. The medication was administered because the patient is hypertensive (Ziaeian & Fonarow, 2016). 

Metoprolol (Lopressor) is effective in lowering blood pressure and treating angina. The medication was administered because the patient is hypertensive (Ziaeian & Fonarow, 2016). 

Morphine is used to treat chronic pain. IV administration of morphine is required appropriate because the patient was experiencing chest pains caused by decompensated heart failure. 

Inhaled short-acting bronchodilator (ProAir HFA) provides quick relief by relaxing the airway muscles, making it easier for the patient to breathe (Wedzicha et al., 2018). This is especially important as the patient is experiencing shortness of breath and thus requires fast-acting interventions. 

Flovent HFA is a long-acting corticosteroid that eases the symptoms of COPD. The medication is appropriate, as the patient requires a drug that will help her in the long-term management of her condition (Wedzicha et al., 2018). 

Oxygen delivered at 2L/ NC: The patient is experiencing difficulty breathing and shortness, exacerbated by heart failure. She thus may be predisposed to asphyxia and thus requires oxygen therapy (Wedzicha et al., 2018). 

Conditions that cause Heart Failure 

High blood pressure: Constriction of the blood vessels o low oxygen saturation may cause the heart to pump harder to meet the oxygen demand. Over time, the heart muscle chambers may weaken (Ziaeian & Fonarow, 2016). Nursing interventions include advocating for lifestyle and diet changes, and regular exercise. 

Myocardial Infarction: Blockage of an artery that supplies blood to the heart causes an attack and deprives the heart of oxygen and essential nutrients. Nursing interventions include the administration of ACE inhibitors and ARBs, aspirins, and sublingual nitroglycerin (Ziaeian & Fonarow, 2016). 

COPD and respiratory distress: Shortness of breath and limited oxygen concentration makes the heart pump faster to compensate for the oxygen deficiency, eventually resulting in wearing out of the heart muscles. Nursing interventions include the administration of oxygen and corticosteroids to ameliorate the COPD symptoms (Ziaeian & Fonarow, 2016). 

Diabetes: Diabetes results in elevated lipid levels, predisposing the individual to atheresceleoris and hypertension. Nursing interventions include advocating for diet and lifestyle changes, regular exercise, and insulin administration (Ziaeian & Fonarow, 2016). 

Nursing Interventions to Prevent Drug-Interactions 

Determining the most effective drugs – Given the large variety available for different drug classes, the nurse has to select the most effective drug or a class that involves a combination to minimize the need to administer multiple drugs (Marengoni, & Onder, 2015). 

Adequate knowledge of the drugs’ pharmacokinetics – understanding how the drugs work will make it easy for the NP to determine and select the appropriate drugs to administer. 

Knowledge of drug pharmacodynamics – The action of the drug on the body is important in ascertaining the extent of drug interactions. Drugs that take longer to be eliminated, for example, can be administered with drugs that are eliminated faster (Marengoni, & Onder, 2015). 

Health Promotion and Restoration Teaching Plan 

Active smoking and a sedentary lifestyle are important triggers and exacerbating factors for the condition. Smoking cessation program and nicotine replacement therapy (NRT) are effective in limiting the habit to a minimum. It is, therefore important to reduce smoking and maintain an active lifestyle. The inhalator should always be readily available for use in case of an attack. Counseling and rehabilitative programs and group therapies are also available to improve the quality of life (Wedzicha et al., 2018). 

Providing Education 

Individualized counseling and education programs are available for the patient. This involves face-to-face interaction between the NP and the patient, during which the NP explains to the patient the need to comply with the prescribed medication (Wedzicha et al., 2018). Face-to-face interaction is effective given that the patient is a senior citizen and might have difficulty accessing digital or print media. 

COPD Triggers 

Continued smoking, sedentary lifestyle, and poor diet may exacerbate the COPD and result in return visits. 

Smoking Cessation 

Nicotine replacement therapy, cognitive-behavioral therapy (CBT), individual and group counseling sessions are effective in smoking cessation for the patient. Given that the patient is a chronic long-term smoker, it is important to introduce the nicotine replacement and placebos gradually to prevent withdrawal symptoms (Wedzicha et al., 2018). Withdrawal can be monitored and managed by invoking CBT and counseling. 

References 

Marengoni, A., & Onder, G. (2015). Guidelines, polypharmacy, and drug-drug interactions in patients with multimorbidity. 

Miravitlles, M., Roche, N., Cardoso, J., Halpin, D., Aisanov, Z., Kankaanranta, H., ... & Blasi, F. (2018). Chronic obstructive pulmonary disease guidelines in Europe: a look into the future.  Respiratory research ,  19 (1), 11. 

Ziaeian, B., & Fonarow, G. C. (2016). Epidemiology and aetiology of heart failure.  Nature Reviews Cardiology ,  13 (6), 368.