Assignment Instructions:
Case Study: Mrs. J
As an RN-BSN-prepared nurse, it is crucial to demonstrate a comprehensive understanding of the pathophysiological processes of disease, clinical manifestations, treatment protocols, and how they affect clients across the lifespan. In this case study assignment, you will evaluate the health history and medical information of Mrs. J, a 63-year-old woman with a complex medical history. Based on your Assessment, you will complete a Critical Thinking Essay assignment.
Health History and Medical Information:
Health History:
Mrs. J. is a 63-year-old married woman with a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite needing 2L of oxygen via nasal cannula during activity at home, she continues to smoke two packs of cigarettes a day for the past 40 years. Three days ago, she developed sudden flu-like symptoms, including fever, productive cough, nausea, and malaise. Over the last three days, she has been unable to perform activities of daily living (ADLs) and required Helpance for short-distance walking. She has not taken her antihypertensive medications or heart failure medications for three days. Mrs. J. has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Subjective Data:
Mrs. J. is very anxious and expresses concerns about her prognosis.
She denies pain but feels like she cannot breathe adequately.
She describes her heart as feeling like it is “running away.”
Mrs. J. reports exhaustion and inability to eat or drink without Helpance.
Objective Data:
Height: 175 cm; Weight: 95.5 kg.
Vital signs: Temperature 37.6°C, Heart rate 118 (irregular), Respiratory rate 34, Blood pressure 90/58.
Cardiovascular: Distant S1, S2, S3 present; Point of Maximal Impulse (PMI) at sixth intercostal space and faint; 1+ peripheral pulses; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
Respiratory: Pulmonary crackles; decreased breath sounds in the right lower lobe; coughing up frothy blood-tinged sputum; Oxygen saturation (SpO2) at 82%.
Gastrointestinal: Bowel sounds present; hepatomegaly, liver palpable 4 cm below costal margin.
Intervention:
Mrs. J. is receiving the following medications as part of her treatment plan:
IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulfate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/NC
Critical Thinking Essay (750-1,000 words):
In your essay, critically evaluate Mrs. J.’s situation by addressing the following points:
Clinical Manifestations: Describe the subjective and objective clinical manifestations present in Mrs. J. Provide a comprehensive overview of her symptoms and findings.
Nursing Interventions at Admission: Discuss the appropriateness of the nursing interventions implemented at the time of Mrs. J.’s admission to the hospital. Explain the rationale for each of the medications listed in her treatment plan.
Cardiovascular Conditions Leading to Heart Failure and Interventions: Describe four cardiovascular conditions that may lead to heart failure. Discuss medical and nursing interventions that can prevent the development of heart failure in each of these conditions.
Preventing Problems Caused by Multiple Drug Interactions in Older Patients: Discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each recommended intervention.
Health Promotion and Restoration Teaching Plan: Develop a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any necessary modifications. Explain how these resources and modifications will Help Mrs. J. in transitioning to independence.
Educating Mrs. J. on Medication Maintenance: Describe a method for educating Mrs. J. about the importance of maintaining prescribed medications to prevent future hospital admissions. Provide a rationale for your chosen approach.
COPD Triggers and Smoking Cessation: Outline COPD triggers that can increase exacerbation frequency and lead to return hospital visits. Considering Mrs. J.’s tobacco use history, discuss appropriate options for smoking cessation that should be offered to her.
Ensure you cite a minimum of two sources published within the last five years that are relevant to nursing practice. Follow the guidelines found in the APA Style Guide for formatting. An abstract is not required.
Please review the rubric before beginning the assignment to understand the expectations for successful completion.
