Case Study: Mrs. J.
When a person smokes, chronic obstructive pulmonary disease (COPD) may be diagnosed. Smoking cessation is required, but smokers are not always ready to quit this habit, and serious health complications are observed. In this paper, evaluating the patient’s history and medical information will help discuss available nursing interventions, cardiovascular conditions, and medications to promote health and education, understand COPD triggers, and prevent readmissions.
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Mrs. J’s vital signs are temperature 37.6 C, blood pressure 90/58, irregular heart rate 118, respiration rate 34, and BMI 31 (obese). Her main complaints include productive cough, fever, nausea, malaise, and shortness of breath. Atrial fibrillation is also reported due to an irregular heart rate, which leads to tachycardia (approved by a high ventricular rate of 132). Her heart failure and bilateral jugular vein distention tell about right-sided heart failure that provokes problems with pumping blood, and left-sided heart failure causes vein bulge. Respiratory changes are introduced by pulmonary crackles, low oxygen saturation, and decreased breath sounds that prove the presence of excessive fluid in the airways and hemoptysis (frothy blood-tinged sputum), a sign of a lung infection. The patient is anxious because of a possible lethal outcome and has eating, drinking, and breathing difficulties. She denies any kind of pain except the impossibility to breathe freely.
Evaluation of Nursing Interventions at Admissions
Mrs. J is diagnosed with acute decompensated heart failure, and a number of interventions and medications are offered. In addition to vital signs monitoring and the necessity to modify the patient’s lifestyle, nurses are responsible for medication administration and oxygen therapy. Therefore, high-flow 2L of oxygen/nasal cannula is an effective therapy to improve oxygen saturation and predict heart failure complications (Kang et al., 2019). The purpose of this therapy is to increase the level of oxygen up to at least 90% (at this moment, her rate is 82%). The patient is anxious, and the creation of a calm environment is an integral step in a nursing care plan. Attention should be paid to these medications:
- Furosemide is a diuretic to be administrated intravenously to treat fluid retention because of heart failure. The patient’s body does not absorb enough salt that is passed to urine, and this medication blocks ion transportation and inhibits sodium and chloride reabsorption in the proximal and distal tubules (Ellison & Felker, 2017). The possibility to control excess fluids results in decreased blood pressure and improved oxygenation.
- Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that aims at treating high blood pressure. Mrs. J has a history of hypertension, and this medication prevents vasoconstriction because of diuretics (furosemide) (Shah et al., 2017). It is expected to decrease the severity of such symptoms as shortness of breath and anxiety.
- Metoprolol is a beta-blocker to treat chest pain and hypertension in combination with other medications. It blocks β1-adrenergic receptors in the heart and compensates for the outcomes of heart failure ejection fraction (Shah et al., 2017). This drug promotes survival after heart failure, which is crucial for the patient.
- IV morphine sulphate is a common medication to relieve symptoms and discomfort in patients. According to Miró et al. (2017), heart failure causes respiratory distress, anxiety, and fear of death, and morphine is an effective means to minimize the impact of these feelings. Although Mrs. J does not experience pain, this medication is necessary to stabilize her condition.
- Inhaled corticosteroid is a steroid hormone that deals with inflammation and allergies. Inpatients are prescribed with this drug, along with bronchodilators and antibiotics (Čelutkienė et al., 2017). This medication promotes good results in rehabilitation and stabilization of breathing activities.
- Inhaled short-acting bronchodilator is used to facilitate breathing and relax muscles. It widens the airways and treats dyspnoea and COPD effectively (Čelutkienė et al., 2017). Still, if side effects are observed, it has to be replaced with another steroid.
Cardiovascular Conditions Leading to Heart Failure and Interventions
Cardiovascular diseases may affect the condition of the heart, and it is necessary to identify them and predict their complications:
- Arrhythmia is characterized by abnormal heart rhythms that result in an abnormal pumping function (Inamdar & Inamdar, 2016). To prevent its development, antidysrhythmics, vital signs’ monitoring, and the creation of a favorable healthy environment are recommended.
- Heart failure history means that the heart has already poorly functioned to provoke salt and water being held in the body (Inamdar & Inamdar, 2016). Regular physical activities and dietary modifications maintain a healthy weight and decrease the load on the heart.
- High blood pressure provokes serious conditions like strokes and heart attacks that challenge the heart (Inamdar & Inamdar, 2016). Heart tones’ auscultation, a calm environment, and diuretics are necessary to prevent its negative impact.
- Valve disease causes problematic blood flows, and the heart becomes overloaded. No smoking, healthy eating, and vital signs’ control are the main preventive tips.
Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions
Patient-nurse cooperation plays an important role in predicting problems because of multiple drug interactions and a lack of knowledge and experience. The following interventions should help Mr. J to stabilize her condition and the nurse to succeed in following a care plan:
- To improve the patient’s knowledge about the effects of each medication. Each drug has its effect, and if the woman stops taking one of them, replaces with another analog, or forgets the dosage, the interaction between other drugs may be challenged.
- To create a list of medications and make sure to follow it precisely. Some older patients could forget about the necessity to take medications, and a nurse should support the client and demonstrate effective clinical documentation.
- To communicate with the patient and educate about the risks of polypharmacy. Some drugs may cause adherence or addiction, and older people need to report their health changes, current conditions, and feelings.
- To support the patient and create a favorable environment. The presence of several medications in the list provokes anxiety and worries that many health problems occur at once, and the nurse has to explain everything to the woman and calm her down.
Health Promotion and Restoration Teaching Plan
The multidisciplinary model of a restoration teaching plan and health promotion includes several professionals and steps to be taken. The people (resources) who should help Mrs. J are (Sundh et al., 2017):
- a specially trained COPD nurse to control the use of medication and assist in completing daily routine tasks;
- an occupational therapist to support the patient in developing and improving her everyday activities and a healthy lifestyle;
- a nutritionist to define the best dietary habits and prevent the growth of obesity-related problems;
- a psychologist to communicate with the patient and prove the importance of smoking cessation and the necessity to deal with personal fears.
To pass a rehabilitation program successfully, the patient should know about the lungs and the disease that damages their functions. Physical exercises may be necessary, but those where less shortness of breath is observed. It is expected to improve the work of the muscles in the lungs. Group meetings and counseling services are available to citizens at local clinics. Sundh et al. (2017) focus on continuous patient education and self-management skills. Even if the symptoms disappear, a healthy lifestyle (no smoking, dietary habits, and physical activities) should not be stopped or neglected.
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Method for Providing Education to Prevent Hospital Readmissions
The patient is anxious about her current condition and breathing difficulties. The discussion of new health changes and possible outcomes is the method of education to prevent Mrs. J’s hospital readmission. Enhanced communication will help reduce anxiety symptoms, remind about the threats of smoking, and understand the diagnosis (Warchol et al., 2019). It is not enough to discuss the benefits of rehabilitation but to underline the problems that can be observed as soon as bad habits are preferred over the healthy recommendations. Therefore, this method is also effective in promoting medication use, self-care, and regular vital signs’ assessment.
COPD Triggers and Options for Smoking Cessation
People are exposed to many COPD triggers, and cigarette smoke is one of them. It is required to quit smoking and avoid second-hand smoke because tobacco affects the lungs (Centers for Disease Control and Prevention, 2020). Nicotine replacement therapy, transdermal patches, and nasal spray are the options for smoking cessation that can be offered to the patient. The necessity to stop smoking provokes new problems like anger and depression, which makes people return to their smoking habits. Therefore, group counseling should be combined with medications and inhalation therapies. Other COPD triggers include outside allergens (dust), air pollution (fumes), and chemicals (scented candles) that irritate the lungs and become the sources of new problems.
In general, Mrs. J. should take responsibility for COPD development in this case. She is aware that smoking is a serious trigger that has to be removed to control her shortness of breath and heart-related complications. As soon as flu-like symptoms are noticed, professional health assessment and care are required. The patient’s education and communication with medical workers are the two important steps that help to understand the nature of the disease, its treatment, and outcomes.
Čelutkienė, J., Balčiūnas, M., Kablučko, D., Vaitkevičiūtė, L., Blaščiuk, J., & Danila, E. (2017). Challenges of treating acute heart failure in patients with chronic obstructive pulmonary disease. Cardiac Failure Review, 3(1), 56-61.
Centers for Disease Control and Prevention. (2020). Smoking and COPD. CDC. Web.
Ellison, D. H., & Felker, G. M. (2017). Diuretic treatment in heart failure – From physiology to clinical trials. The New England Journal of Medicine, 377(20), 1964-1975.
Inamdar, A. A., & Inamdar, A. C. (2016). Heart failure: Diagnosis, management and utilization. Journal of Clinical Medicine, 5(7).
Kang, M. G., Kim, K., Ju, S., Park, H. W., Lee, S. J., Koh, J.S., Hwang, S. J., Hwang, J. Y., Bae, J. S., Ahn, J. H., Jang, J. Y., Park, Y., Jeong, Y. H., Kwak, C. H., & Part, J. R. (2019). Clinical efficacy of high-flow oxygen therapy through nasal cannula in patients with acute heart failure. Journal of Thoracic Disease, 11(2), 410-417.
Miró, O., Gil, V., Peacock, W. F. (2017). Morphine in acute heart failure: Good in relieving symptoms, bad in improving outcomes. Journal of Thoracic Disease, 9(9), 871-874.
Shah, A., Ganghi, D., Srivastava, S., Shah, K. J., & Mansukhani, R. (2017). Heart failure: A class review of pharmacotherapy. Pharmacy and Therapeutics, 42(7), 464-472.
Sundh, J., Lindgren, H., Hasselgren, M., Montgomery, S., Janson, C., Ställberg, B., & Lisspers, K. (2017). Pulmonary rehabilitation in COPD – Available resources and utilization in Swedish primary and secondary care. International Journal of Chronic Obstructive Pulmonary Disease, 12, 1695-1704.
Warchol, S. J., Monestime, J. P., Mayer, R. W., & Chien, W. W. (2019). Strategies to reduce hospital readmission rates in a non-Medicaid-expansion state. Perspectives in Health Information Management, 16. Web.