Clinical manifestation includes any physical observations made by a physician or subjective data collected from the patient which is used to conduct an effective diagnosis and developing effective treatment intervention. These may include physical symptoms related to a certain illnesses as well as changes in normal functioning of body organs (Grand Canyon University, 2018). Based on the case study the clinical manifestations present in Mrs. J include fever, nausea, malaise, and productive cough. The patient also reports requiring assistance in walking short distances, decompensated heart failure, and acute exacerbation of COPD. Subjective data from the patient indicate that the patient has a difficulty in getting enough air and is exhausted that she cannot eat or drink by herself.
Nursing Interventions at the Time of Her AdmissionsAt the time of her admission, the patient reports a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). The nursing interventions implemented to address these conditions include 2L of oxygen/nasal cannula at home during activity, antihypertensive medications to control her heart failure (Peacock, 2017). The doctor administered IV furosemide, Enalapril, Metoprolol, IV morphine sulphate, Inhaled short-acting bronchodilator, Inhaled corticosteroid, and Oxygen delivered at 2L/ NC to address the present symptoms affecting Mrs. J. These medications will help in stabilizing the health of Mrs. J. to normal functioning (Peacock, 2017). This nursing intervention is appropriate as it aims at addressing Mrs. J respiratory problems. The adddministration of IV Furosemide medication is meant to address pulmonary edema affecting Mrs. J. that is caused by heart failure. This medication is also meant to treat congestive heart failure by addressing fluid retention. The other medication that is administered to Mrs. J. is Enapril which is meant to treat hypertension (Trevor & Chipps, 2018).
This medication will help the patient since she has not taken her antihypertensive medications for three days that are important for controlling heart failure. Enapril is mostly used in emergencies due to its quick effect if administered through an injection into the vein (Trevor & Chipps, 2018). The patient is also administered Metoprolol which is a drug meant to address congestive heart failure and hypertension. Since the patient has an abnormal heart rate, this may worsen the heart failure condition which can be prevented by using this medication (Trevor & Chipps, 2018).
The physician also administers Morphine to the patient which is aimed at minimizing pain associated with congestive heart failure. This medication is also beneficial in addressing stress that may trigger hypertension symptoms (Trevor & Chipps, 2018). Inhaled short-acting bronchodilator is a quick acting reliever to address asthma attacks by opening the airways. This is helpful as the patient reports continuing to smoke on daily occasions and feels like she cannot get enough air (Trevor & Chipps, 2018). The patient is also issued with inhaled corticosteroid which is aimed at preventing asthma attacks and improving the functioning of the lungs. The last nursing intervention involves administration of oxygen which is delivered at 2L/ NC. This is meant to improve the flow of oxygen to the lungs for patients with acute exacerbation of COPD (Trevor & Chipps, 2018).
Four Cardiovascular Conditions That May Lead To Heart Failure and Nursing Interventions to Prevent the Development of Heart Failure in Each ConditionCoronary Artery DiseaseCoronary artery disease is characterized by narrowing or blocking of the coronary arteries that may be caused by obesity since cholesterol may build up on the inner walls of the arteries affecting the flow of blood to the heart and to other body parts (Hruby et al., 2016). In coronary artery disease, the fat deposits in the inner walls of the arteries may form a plaque that may rupture leading to a blood clot in the artery. This clot may cause blockage preventing the flow of blood to the heart which may deprive the heart and other body parts from adequate supply of oxygen (Hruby et al., 2016). Medical interventions to prevent coronary artery disease include addressing the risk factors associated with this disease such as obesity.
High Blood PressureHigh blood pressure is a condition where the force of the blood against the artery walls is too high. If this is not controlled, it may lead to heart problems in the long-term. High blood pressure is diagnosed by measuring the systolic and diastolic blood pressure in the blood vessels (Hruby et al., 2016). If blood pressure is above 140/90, the patient is considered to have high blood pressure. This disease may have no symptoms and may cause other health problems such as stroke or heart failure. Medical interventions to prevent high blood pressure involve taking medications to lower high blood pressure above the normal rate (Hruby et al., 2016). High-risk individuals should also exercise regularly and reduce salt intake as this triggers high blood pressure. StrokeStroke is a condition caused by a limited supply of blood to the brain that affects the supply of oxygen in the brain causing brain damage. Oxygen is important in supplying necessary nutrients in the brain to enable efficient functioning of the brain (Rahko, 2014). If there is a lack of these nutrients, brain cells will begin to die and the brain may fail to function optimally affecting other body functions as the brain is responsible for controlling diverse body functions. Medical interventions to prevent stroke is addressing and controlling risk factors that may lead to stroke (Rahko, 2014). These include high blood pressure and obesity that can be managed by adopting a healthy life style.
Congenital Heart Disease
Congenital heart disease is a condition characterized by a problem with the structure of the heart. A person may be born with a heart defect that can affect the walls of the heart, heart valves, arteries, or veins near the heart affecting normal flow of blood (Rahko, 2014). This defect may block the flow of blood or cause blood to flow to the wrong place failing to reach the heart. This condition can be prevented by using medications that improve the functioning of the heart and the flow of blood to the heart (Rahko, 2014). Pace makers can also be used to regulate an abnormal heart as well as prevent some of the problems associated with a defective heart. Four Nursing Interventions That Can Help Prevent Problems Caused By Multiple Drug Interactions in Older PatientsOne of the ways to prevent help prevent problems caused by multiple drug interactions in older patients is educating the patients and close family members to enable them understand the effects of this process and effective ways of managing the effects (Golchin, Frank, Vince, Isham, Meropol, 2015). This will help the patient and family members to monitor the health of the patient and implement effective measures accordingly. The second nursing intervention involves undertaking medical reviews where patients have regular appointments with doctors to determine the state of their health and determine effective interventions to implement based on the health status of the patient (Golchin et al., 2015).
This can also enable the doctor to determine some of the unnecessary medications that can be stopped. Another nursing intervention to prevent problems caused by multiple drug interactions in older patients is addressing any negative side effects affecting patients due to the use of multiple drugs (Golchin et al., 2015). Patients should seek medical help after detecting any changes in their health to prevent adverse effects of using multiple drugs. The last nursing intervention involves the use of other alternatives to medications. These may include behavior changes or changes in diet (Golchin et al., 2015).
Health Promotion and Restoration Teaching Plan for Mrs. J.
One effective way for Mrs. J. to ensure stable health is to adopt a healthy lifestyle due to the conditions affecting her health. This requires a good diet, exercise, and controlling the underlying conditions using appropriate medications. Despite the patient requiring 2L of oxygen/nasal cannula at home during activity, the patient continues to smoke two packs of cigarettes a day. This has negatively affected her health and the patient should implement effective strategies to reduce the habit that will drastically improve her health. The patient can seek rehabilitation services to help her with the addiction problem. The patient is also reluctant to take her antihypertensive medications to control her heart failure which needs to be addressed. Patient education will help the patient to understand the risk factors that have contributed to her current status and what effective strategies can be implemented at home to help her improve her health in diverse forms.
Providing Education for Mrs. J.Patient education is important in helping the patient to adopt a healthy lifestyle as well as control the health conditions currently affecting her. This will also help her to become responsible for her own health, as she will be able to take an active role in managing her own care (Grand Canyon University, 2018). One way of providing patient education to Mrs. J. is taking advantage of technology as this makes education materials more accessible to patients. Patients can access education materials at the touch of a button anytime using their smart phones (Grand Canyon University, 2018). This is important in addressing individual patient needs as Mrs. J. can access adequate information regarding the risk factors associated with inadequate management of the underlying conditions well as effective measures to apply in improving her health. Mrs. J. can also use reminders to remind her on the time to take her drugs and prevent some of the negative effects of not taking her medications effectively (Grand Canyon University, 2018).
COPD Triggers That Can Increase Exacerbation Frequency, Resulting In Return VisitsOne COPD trigger that can increase exacerbation frequency is tobacco smoke which is the leading cause of COPD and increases the progression of the disease. Tobacco smoke can lead to difficulty in breathing, coughing, and wheezing as experienced by the patient who continues to smoke two packs of cigarettes a day regardless of her health condition (Baker & Fatoye, 2019). Second hand is also harmful to non-smokers as this can also trigger COPD exacerbations. Another trigger is air pollution such as vehicle exhaust, fumes at the gas pump station, and pollution from factories as these may irritate the lungs triggering a COPD flare up (Baker & Fatoye, 2019). High-risk individuals should avoid exposure to these chemicals while performing outside activities such as walking, shopping, or exercising. Considering Mrs. J. s current and long-term tobacco use, the doctor may administer Varenicline which a prescription medication that aims at reducing cravings for tobacco as well as controlling nicotine withdrawal symptoms by blocking nicotine receptors in the brain (Baker & Fatoye, 2019).
References
Baker, E., & Fatoye, F. (2019). Patient perceived impact of nurse-led self-management interventions for COPD: A systematic review of qualitative research. International Journal of Nursing Studies, 91, 22-34. doi: 10.1016/j.ijnurstu.2018.12.004. Epub 2018 Dec 31.Golchin, N., Frank, S. H., Vince, A., Isham, L., Meropol, S. B. (2015).
Polypharmacy in the elderly. Journal of Research in Pharmacy Practice, 4(2), 85-88.Grand Canyon University. (2018).
Pathophysiology: Clinical Applications for Client Health. Grand Canyon University.Hruby, A., Manson, J. E., Qi, L., Malik, V. S., Rimm, E. B., Sun, Q., Willett, W. C., & Hu, F. B. (2016).
Determinants and Consequences of Obesity. American Journal of Public Health, 106(9), 1656-1662.Peacock, W. F. (2017). Short Stay Management of Acute Heart Failure. Cham: Springer International Publishing.Rahko, P. S. (2014).
Heart failure: A case-based approach. New York: Demos Medical.Trevor, J. L., & Chipps, B. E. (2018).
Severe Asthma in Primary Care: Identification and Management. The American Journal of Medicine, 131(5), 484-491. doi: 10.1016/j.amjmed.2017.12.034. Epub 2018 Mar 30