Smoking harms the heart and blood circulation, heightens the risk of coronary artery disease, stroke, peripheral vascular disease, and cerebrovascular disease (damaged arteries that supply blood to the brain) (Fowler & Landry, 2019). In Mrs. J’s case, the disease history shows that her condition is related to the unhealthy lifestyle that she led, including ongoing smoking. Her account of chronic heart failure, chronic obstructive pulmonary disease (COPD), and hypertension may as well be related to the fact that Mrs. J smokes and has been doing so for the last 40 years. Moreover, her condition is worsening even further, since Mrs. J has not taken the medications prescribed for her to control heart failure and antihypertensive medications for three days.
The clinical manifestations present in Mrs. J include elevated body temperature, fever, cough, nausea, and malaise. Besides, she has been very anxious about the situation and has complained about certain discomfort in the heart area. Considering all the above, the following medications were administered to control her symptoms. Lasix is applied to prevent heart failure, since it reduces pressure in the pulmonary artery, while Enalapril is used to treat Mrs. J’s arterial hypertension (Cooper & Gosnell, 2018). Consequently, Metoprolol is combined with other antihypertensive agents (Enalapril) to treat the patient’s arterial hypertension (Cooper & Gosnell, 2018). In Mrs. J’s case, Morphine is administrated to reduce the severe pain associated with coughing and shortness of breath. In order to alleviate Mrs. J’s cough and breathing troubles, inhaled short-acting bronchodilator and corticosteroid are also provided. Furthermore, Mrs. J was given oxygen to increase the blood oxygenation levels as a part of her respiratory therapy (Cooper & Gosnell, 2018). All of the nursing interventions and the drugs administrated served as an adequate measure in preventing further complications in Mrs. J’s case.
Cardiovascular diseases refer to a group of heart and blood vessel conditions that include, for example, coronary heart disease, arterial hypertension, chronic heart failure, and pulmonary hypertension, all of which can lead to a fatal outcome (Fowler & Landry, 2019). The primary manifestation of coronary heart disease is chest pain, the severity of which may vary from mild discomfort and burning in the chest area to severe pain. For secondary heart failure prevention, modern drug treatment of coronary heart disease, in addition to taking antianginal and anti-ischemic drugs, should include the use of antithrombotic, lipid-lowering drugs, ACE inhibitors and metabolic agents (Fowler & Landry, 2019). Arterial hypertension predisposes the development of cardiovascular diseases, the complications of which often lead to heart failure (Fowler & Landry, 2019). Consequently, pulmonary hypertension is a potentially lethal disease, so providing anticipatory care to prevent the further development of the disease is of priority: prompt care upon extension of pulmonary hypertension and monitoring responses to medical intervention is the primary responsibility for a nurse in such cases.
Polypharmacy may increase the potential risk of adverse effects, such as errors in administering medication and drug interactions, and it is even a more acute issue with senior patients. The role of nurses in preventing the harmful effects of polypharmacy is crucial, and the nursing interventions, in this case, should be: instructing the elderly patients, implementing informative programs, providing consultations, and organizing assistance (Cooper & Gosnell, 2018). A nurse is supposed to teach the patients about each medication (for instance, its name, effects, and appearance) and efficiently convey the dangers of polypharmacy. Additionally, nursing personnel organizes secure medication storage for a patient, for instance, to avoid sharing. Suggesting the patients to keep a list of medications and instructions is another nursing intervention that helps avoid polypharmacy.
Foremost, Mrs. J’s health promotion and restoration teaching plan would include recommendations concerning quitting smoking and the ways to achieve it, as it is one of the main damaging factors in her case. The patient’s post-stationary period rehabilitation would consist of a diet, maintaining a proper lifestyle, physical activity, taking supportive medications, and regular monitoring by specialists (Cooper & Gosnell, 2018). After inpatient treatment, physical activity should gradually increase, helping the patient to achieve more independence: walking and therapeutic exercises are considered especially useful. Mrs. J would be recommended to start with 15 minutes of physical activity per day, increasing the time by five minutes weekly, until the duration of the physical activity reaches an hour. However, a doctor should determine the number and type of exercises: excessive diligence can lead to negative results.
The question of inadequate usage of medication by patients remains a complex and urgent problem, and the issue of the patient informing quality, and the sufficiency of advisory support remains open at the moment. In Mrs. J’s case, the following aspects regarding her medication should be explained: its purpose, effects and side effects, names, warnings, and specific instructions such as food and alcohol interactions (Talbot, 2019). Nevertheless, multi-paged complicated documentation may seem overwhelming to some patients; thus, specific educational sheets may be developed, incorporating color-coding to help patients in navigating the instructions.
In order to prevent an increase in exacerbation frequency, COPD triggers should be minimized. Such substances as dust, strong odors, perfumes, aerosols, and pet fur should be avoided. In Mrs. J’s case, tobacco is another powerful trigger, which leads to the importance of her stopping smoking. Smoking cessation may be extremely difficult for Mrs. J considering the number of years that she has been doing so. Nevertheless, there are two main strategies to achieve it: nicotine replacement therapy (patches and nasal sprays) and prescribing specific medication that reduces the craving for smoking. Provided that Mrs. J improves her lifestyle and adheres to the recommendations, further hospital admission may be prevented, and her habitual life may be renewed.
References
Cooper K., & Gosnell K. (2018). Foundations of nursing (8th ed.). Elsevier.
Fowler L. H., & Landry J. (Eds.). (2019). Interventions for cardiovascular disease, an issue of critical care nursing clinics of North America (vols. 1–31). Elsevier.
Talbot, B. (2019). Improving patient medication education. Nursing, 48(5), 58-60.