Pathophysiological Processes: The Case Study of 63 Year-Old Mrs J. with Chronic Obstructive Pulmonary Disease (COPD), Hypertension, and Chronic Heart Failure (CHF)
In this case study, the 63 year-old female has three significant chronic comorbidities that determine the symptoms she is presenting with. She is a chronic smoker of 2 packs of cigarettes per day despite having hypertension and heart disease. Chronic heart failure is the persistent inability of the heart to effectively pump blood to the rest of the body. One of the causes of this is chronic hypertension (AHA, 2017). With a lifestyle habit of smoking over the years, there is chronic irritation of the airway lining resulting in hypertrophy of the mucus glands and chronic inflammation. This is followed by coughing, wheezing, inability to breathe properly (dyspnea), and reduced air volumes as determined by spirometry (Hammer & McPhee, 2018; Huether & McCance, 2017). The purpose of this paper is to analyze this patient’s presentation and her management. Pathophysiological Processes Essay Example
A Description of the Clinical Manifestations by Mrs J
The picture of this patient’s presentation indicates that she is having an exacerbation of her COPD. This usually occurs when an irritant precipitates the symptoms of an already present COPD. This could be an infection that is viral or bacterial. The patient has a mild fever of 37.6°C and this could be confirmatory of an infection. In her case, she is presenting with flu-like symptoms and this could be the trigger for the exacerbation. This patient is also smoking 2 packs in a day and this increases irritation from the smoke. The COPD exacerbation is seen in her productive cough and the malaise that she portrays. In COPD, there is a loss of elasticity of the alveoli and mucus production is increased because of the hypertrophy of the mucus glands (Hammer & McPhee, 2018). The large amounts of mucus produced cannot therefore be removed fast enough since the mechanism of mucociliary clearance is compromised (Singh et al., 2018).
A combination of the heart failure and the COPD makes the brain’s centers be starved of oxygen. Because of this, the chemoreceptor trigger zone or CTZ may be irritated to result in the nausea that she has. An SpO2 of 82% and a respiratory rate of 34 indicates hypoxemia and this explains why she cannot perform her activities of daily living or ADLS.
Appropriateness of the Nursing Interventions at the Time of Admission
The nursing interventions undertaken at admission were appropriate. The patient’s vital signs were taken and he was correctly put on supplemental oxygen by face mask at 2 liters per minute. The other appropriate nursing intervention done was administering the prescribed medications to the patient. As for the rationale behind the medications administered, furosemide or Lasix helps reduce fluid and hence helps the heart and also the hypertension. It is a loop diuretic acting on the glomerulus (Katzung, 2018). Enalapril (Vasotec) reduces hypertension and heart failure by interfering with the renal-angiotensin-aldosterone pathway (Katzung, 2018). The beta-blocker metoprolol (Lopressor) is also there to manage the hypertension and heart failure by blocking the actions of catecholamines on the heart and blood vessels. Morphine in this case is used to reduce the intensity of the dyspnea while the inhaled bronchodilator is a SABA (short-acting beta-agonist) that opens up the airways to relieve dyspnea. Lastly, the corticosteroids treat the chronic inflammation of the airways (Katzung, 2018). Pathophysiological Processes Essay Example
Four Cardiovascular Conditions that May Lead to Heart Failure
There are a number of cardiovascular conditions that may result in the development of heart failure. Four of these are hypertension, coronary artery disease (CAD), valvular heart disease, and previous non-fatal myocardial infarction (Hammer & McPhee, 2018; AHA, 2017).
Atherosclerotic changes in CAD mean that there is occlusion of coronary arteries resulting in the starvation of the myocardium of oxygen. The heart is then not able to function efficiently. This is the same mechanism by which MI causes heart failure. The atherosclerotic occlusion results in the necrosis of a section of the myocardium which then reduces the efficiency of the heart. Hypertension increases the resistance to blood flow from the aorta and hence causes back pressure to the left ventricle. It then has to work harder to overcome this pressure and in the process hypertrophies and becomes overwhelmed. Lastly but not least, valvular incompetence because of structural abnormalities and other causes will also result in heart failure due to regurgitation (Hammer & McPhee, 2018; AHA, 2017; Huether & McCance, 2017). Interventions to prevent heart failure in each condition include secondary prevention with medications like statins (MI), primary prevention regarding lifestyle change (CAD and hypertension), and screening at birth for cardiovascular congenital abnormalities (Hammer & McPhee, 2018; Huether & McCance, 2017).
Four Nursing Interventions to Prevent Multiple Drug Interactions in the Elderly
Polypharmacy in elderly patients carries the risk of severe interactions due to the lowered physiological threshold of old age. Four nursing interventions that could prevent this and their rationales are:
i. Compartmentalization of medications as per their dose, frequency, and route. There are special containers designed for this. The medications are packaged in compartments in advance so that the patient just needs to take them out at the right time. The rationale is that older patients need cognitive reinforcement due to amnesia.
ii. Education on the recognition of early signs of drug reactions and interactions. The rationale is that when the patient recognizes these while at home, they can stop taking the medications and return to be seen immediately. Pathophysiological Processes Essay Example
iii. Encouraging strict compliance to bring about complete remission of symptoms. The rationale is that with remission, the patient will no longer require some of the drugs and this will reduce the number of different medications taken and also the likelihood of reactions.
iv. Lastly, use of telehealth or home visitations can help monitor the older patient for drug interactions and take action early. The rationale is that these two modalities keep the patent in the eyes of the nurse and therefore any reactions will be spotted immediately.
Health Promotion and Restoration Teaching Plan for Mrs J
This will involve measures that include:
• Taking her medications as prescribed without missing (compliance)
• Reducing the amount of cigarettes that she smokes to reduce the airway irritation
BUY A PLAGIARISM-FREE PAPER HERE
• Start moderate and measured isotonic aerobic exercise (walking) that has been shown to help with hypertension and overweight (MacDonald & Pescatello, 2018)
• Low salt diet
• More fresh fruits and vegetables in diet
These rehabilitation resources and modifications are tried and tested and will reduce the patient’s weight, control the comorbid conditions, remove risk factors, and promote overall well-being.
Method of education for Compliance, COPD Triggers, and Smoking Cessation
Because of her advanced age and the difficulty with mobility, telemonitoring would be the best way to give continuing education on compliance. This will require the involvement of family members and caregivers who will facilitate this. Telehealth will be used via video link between the patient at home and the clinician/ nurse. The rationale is convenience and prevention of hospital-acquired infections/ Covid-19.
The COPD triggers that can increase exacerbation frequency include infections, allergens, and irritants like smoke and industrial pollution. In this case the important trigger i cigarette smoke. The options for smoking cessation that could be offered to Mrs J are the use of nicotine patches or combining that with a program of reducing gradually the number of sticks smoked per day.
American Heart Association [AHA] (May 31, 2017). Causes of heart failure. https://www.heart.org/en/health-topics/heart-failure/causes-and-risks-for-heart-failure/causes-of-heart-failure
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.
Huether, S.E. & McCance, K.L. (2017). Understanding pathophysiology, 6th ed. Elsevier, Inc.
Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. McGraw-Hill Education.
MacDonald, H.V. & Pescatello, L.S. (2018). Exercise prescription for hypertension: New advances for optimizing blood pressure benefits. Lifestyle in Heart Health and Disease, 115-136. https://doi.org/10.1016/B978-0-12-811279-3.00009-4
Singh, D., Barnes, P.J., Stockley, R., Valera, M.V.L., Vogelmeier, C. & Agusti, A. (2018). Pharmacological treatment of COPD: The devil is always in the detail. European Respiratory Journal, 51(4), https://doi.org/10.1183/13993003.00263-2018
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.
Evaluate the Health History and Medical Information for Mrs. J., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD. Pathophysiological Processes Essay Example
- Is very anxious and asks whether she is going to die.
- Denies pain but says she feels like she cannot get enough air.
- Says her heart feels like it is “running away.”
- Reports that she is exhausted and cannot eat or drink by herself.
- Height 175 cm; Weight 95.5kg.
- Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
- Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
- Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
- Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
The following medications administered through drug therapy control her symptoms:
- IV furosemide (Lasix)
- Enalapril (Vasotec)
- Metoprolol (Lopressor)
- IV morphine sulphate (Morphine)
- Inhaled short-acting bronchodilator (ProAir HFA)
- Inhaled corticosteroid (Flovent HFA)
- Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:
- Describe the clinical manifestations present in Mrs. J.
- Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
- Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
- Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
- Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
- Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
- Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.
You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Pathophysiological Processes Essay Example