Nursing Case Study

Nursing Case Study

Mrs. J has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). COPD is a respiratory disease that can be caused by a virus or increased air pollution in the environment. Smoking two packets of a cigarette each day for a period of more than 40 years might have affected Mrs. J’s lungs leading to COPD. The effects of the chronic obstructive pulmonary disease worsen with time. Cough and breathlessness are the common symptoms of COPD. Due to the breathing difficulties caused by chronic obstructive pulmonary disease, Mrs. J survives by 2L of oxygen daily. Three days ago, Mrs. J showed flu-like symptoms. Malaise, nausea, productive cough, and fever are the common flu-like symptoms shown by Mrs. J. In the last three days, Mrs. J has not taken her medication to control hypertension and heart failure. After health deterioration, Mrs. J has presented herself to the hospital with acute decompensated heart failure and acute exacerbation of COPD, which requires appropriate nursing interventions.

Several medications were administered to Mrs. J through drug therapy to control her condition. IV furosemide was the first medication administered to the patient. Furosemide medicine can be administered orally or injected into the patient’s vein (Fabiano, et.al, 2016). The furosemide medicine reduces water and salt from the body and allows the kidney to make more urine. Since Mrs. J experienced some difficulties, while breathing, furosemide medication was appropriate because, after the removal of excess fluid from the body, the patient’s heart pumps better. Secondly, Mrs. J was instructed to take enalapril medicine. Enalapril is distributed by the brand name Vasotec. Enalapril, which is normally used with furosemide diuretic, treats high blood pressure and heart failure. Since Mrs. J had a decompensated heart failure, Enalapril medication was the right intervention for her condition.

Besides, Mrs. J was instructed to take metoprolol medicine. Metoprolol medicine is useful for treating patients with hypertension (Edsberg & Jacobsen, 2019). Since Mrs. J had a history of hypertension, metoprolol medicine was appropriate. Morphine sulphate medicine is used to relieve pain among patients experiencing severe pain. Mrs. J did not complain of severe body pain. Administering Mrs. J with morphine medicine was inappropriate because the medicine has severe side effects among the elderly. COPD had caused Mrs. J to develop some breathing problems. Inhaled short-acting bronchodilator was a suitable intervention because it allows more air to move in and out of the lungs of the patient. Flovent HFA is used mostly among patients who show symptoms of asthma. Since Mrs. J was non-asthmatic, administering Flovent HFA was not a suitable intervention. Oxygen delivered at 2L/NC was necessary to aid Mrs. J’s breathing system.

Heart failure is a serious chronic condition that is caused by various cardiovascular conditions. Coronary artery disease limits the amount of blood flowing to the heart because of the fat deposits on the walls of the main arteries (Arques, 2018). Coronary artery disease can be avoided by managing weight and taking nutritious food. Abnormal heart valves result in heart failure. If the heart valves do not open or close normally during a heartbeat, the heart is forced to overwork, which can result in heart failure with time. The problem of abnormal heart valves cannot be controlled since it is present at birth. Cardiomyopathy is a condition that damages heart muscles, resulting in heart failure. Surgery is an appropriate treatment for cardiomyopathy. Hypertension causes high blood pressure at the veins, which can result in heart failure. Hypertension can be controlled by changing lifestyle and proper medication for lowering blood pressure.

Most adults take at least six prescription medications. Polypharmacy may have adverse health effects on older patients, hence the need for nursing intervention (Rieckert, et.al, 2018). The nurses can prevent the effects of polypharmacy by providing essential drug information to the patients. Providing Mrs. J with a list that includes the medicine names and dosing frequency for each drug will prevent her from overdosages. Nurses can assist older patients by educating them on important medical instructions. For instance, Mrs. J should be educated on the need for taking medication as directed. The education will ensure that Mrs. J does not skip some doses. Nurses have a duty of cautioning old patients against sharing drugs with others. Mrs. J should be taught the proper ways to dispose of expired medicines. Also, Mrs. J should be educated on the side effects of her drugs. Educating mature adults on the adverse effects of their prescribed drugs prepares them psychologically, which allows them to properly manage their medication.

The chronic obstructive pulmonary disease causes exacerbations to its victims. At high frequencies, exacerbations can be life-threatening. Smoking tobacco triggers exacerbations for patients suffering from COPD (Viniol & Vogelmeier, 2018). Inhaling irritating substances from polluted air increases the risk of exacerbations among COPD patients. Excessive physical activity and weather changes can also trigger exacerbations. Mrs. J has a long history of smoking tobacco. Since Mrs. J is suffering from chronic obstructive pulmonary disease, smoking tobacco can result in exacerbations. Because Mrs. J is addicted to smoking tobacco, a suitable cessation is essential to help her quit tobacco smoking. Nicotine replacement therapy will be an appropriate cessation option for Mrs. J. Through the nicotine replacement therapy, Mrs. J will replace tobacco with an unharmful inhaler, which will allow her to cope with life without smoking tobacco.

References

Arques, S. (2018). Human serum albumin in cardiovascular diseases. European journal of internal medicine, 52, 8-12.

Edsberg, B., & Jacobsen, T. A. (2019). U.S. Patent Application No. 16/068,255.

Fabiano, V., Carnovale, C., Gentili, M., Radice, S., Zuccotti, G. V., Clementi, E., … & Mameli,    C. (2016). Enalapril associated with furosemide induced acute kidney injury in an infant        with heart failure. A case report, a revision of the literature and a pharmacovigilance     database analysis. Pharmacology, 97(1-2), 38-42.

Rieckert, A., Trampisch, U. S., Klaaßen-Mielke, R., Drewelow, E., Esmail, A., Johansson, T., …   & Piccoliori, G. (2018). Polypharmacy in older patients with chronic diseases: a cross-         sectional analysis of factors associated with excessive polypharmacy. BMC family    practice, 19(1), 113.

Viniol, C., & Vogelmeier, C. F. (2018). Exacerbations of COPD. European Respiratory    Review, 27(147), 170103.