Case Summary
Mrs. J is very anxious and asks whether she will die. She also denies pain but admits to not getting enough air. The patient feels like her heart is “running away,” she cannot drink or eat alone, and she is exhausted. Her objective data indicate that the patient weighs 95 kg and stands 175 cm tall. Mrs. J’s body temperature is 37.6°C, her heart rate is 118 and irregular, while her respiratory rate is 34, with a blood pressure of 90/58 mmHg.
Cardiovascular readings show the presence of Distant S1, S2, and S3, faint PMI at the sixth ICS, all peripheral pulses indicate 1+, and there is bilateral jugular vein distention. Initial cardiac monitoring presents a ventricular rate of 132 and atrial fibrillation. The respiratory system presents with pulmonary crackles, coughing, frothy blood-tinged sputum, decreased breath sounds in the right lower lobe, and a SpO2 of 82%. The gastrointestinal report shows the presence of bowel syndrome and a 4 cm hepatomegaly below the coastal margin.
Cardiovascular Conditions Leading to Heart Failure and Interventions
Mrs. J is at risk of developing four cardiovascular conditions, including coronary heart disease, high blood pressure, heart inflammation, and irregular heartbeat. These conditions put the patient at risk of heart failure and thus must be intervened (Fuchs & Whelton, 2020). Interventions to prevent coronary heart disease include consuming a healthy, balanced diet, being physically active, and quitting smoking.
To prevent the recurrence of hypertension, Mrs. J should be physically active, lose weight, and reduce sodium intake. Interventions for heart inflammation include engaging in moderate physical activity, consuming a balanced diet, and maintaining a high intake of high-fiber fruits, whole grains, vegetables, and nuts (Fuchs & Whelton, 2020). Controlling an irregular heartbeat involves managing cholesterol levels, shedding excess weight, and maintaining a healthy diet.
Nursing Interventions
Admission
Following Mrs. J’s health conditions, the interventions during admission were beneficial. IV furosemide (Lasix) administration helps decrease ventricular filling pressures while improving the patient’s symptoms (Carrier, 2022). Oxygen delivery and inhalation help regulate the heart and respiratory rates, thereby settling irregular heartbeats. Accordingly, the rest of the medications worked to resolve heart failure and COPD exacerbation. I would not change any of the given interventions because the patient’s condition requires urgency to return to normal conditions.
Older Patients
IV furosemide (Lasix) is a diuretic class that increases sodium excretion from the patient’s kidneys to the urine. It is also essential in controlling blood pressure levels. Enalapril (Vasotec) is an angiotensin-converting enzyme inhibitor that decreases the chemicals that constrict blood vessels, thereby enabling smooth blood flow and heart function (Carrier, 2022). Metoprolol (Lopressor) is a beta-blocker that relaxes blood vessels and helps decrease blood pressure. IV morphine sulfate (Morphine) is an opioid agonist and a painkiller to relieve severe to moderate pain (Mesana, 2019).
Inhaled short-acting bronchodilator (ProAir HFA) belongs to a class of medications that relax the muscles around the airways, thereby making breathing easier. Inhaled corticosteroids (Flovent HFA) are corticosteroid drugs that reduce inflammation in the lung airways, making breathing easier (Vitacca & Paneroni, 2019). Oxygen delivered at 2L/ NC is administered using low-flow or high-flow equipment to help the patient breathe.
One intervention to prevent multiple drug interaction problems is keeping track of side effects. Monitoring the side effects of various drugs is essential because the caregiver can prevent complications by withdrawing or discontinuing the administration of drugs with severe side effects (Vitacca & Paneroni, 2019).
Another intervention is taking the right foods and drinks alongside various drugs and learning what drugs should not be taken with what drink or meal, which prevents complications (Mesana, 2019). Strictly following medication directions is a necessary intervention that helps prevent overdose or underdosage (Vitacca & Paneroni, 2019). The fourth intervention is being aware of the various drugs to avoid allergies. The patient should communicate any drug allergy to prevent possible drug interaction complications.
Health Promotion and Restoration Teaching Plan
Adopting a multidisciplinary disease-management program for Mrs. J will reduce the chances of readmission and improve the recovery process. The program involves rehabilitation by mobilizing resources, including medication, therapy, counseling, exercise, and lifestyle education (Vitacca & Paneroni, 2019). Mrs. J will also be educated on the importance of exercise and smoking cessation.
The rehabilitation resources, such as exercise and a healthy diet, will help the patient maintain a stable heart rate and blood pressure. According to Vitacca and Paneroni (2019), exercise training can improve diastolic function in patients with heart failure, thus enabling them to function independently. Patients are also encouraged to take their medications as prescribed to prevent readmission.
Considering Mrs. J’s condition and history of smoking, she should use a Nicotine transdermal patch (long-acting) and short-acting replacement therapy as options for smoking cessation. Nicotine replacement therapy, available in short-acting forms such as gum, inhalers, mouth spray, and sublingual tablets, could be offered. COPD triggers that could increase exacerbation include smoking, humid, cold, and hot weather, air pollution, respiratory infections, fumes, and dust (Mesana, 2019). Therefore, the patient must keep off these triggers and any resulting activity.
References
Carrier, J. (2022). Managing long-term conditions and chronic illness in primary care: A guide to good practice. Taylor & Francis.
Fuchs, F. D., & Whelton, P. K. (2020). High blood pressure and cardiovascular disease. Hypertension, 75(2), 285-292. Web.
Mesana, T. (2019). Heart teams for treatment of cardiovascular disease: A guide for advancing patient-centered cardiac care. Springer.
Vitacca, M., & Paneroni, M. (2019). Rehabilitation of patients with coexisting COPD and heart failure. COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(3), 231-237. Web.