A 63-year old patient admitted to the ICU demonstrates the symptoms of COPD exacerbation and acute decompensated heart failure. The clinical manifestations present in Mrs. J. include an increased body temperature of 37.6 C that indicates a pathological process, an increased and irregular heart rate of 118, and low blood pressure of 90/58. Moreover, the patient has difficulty breathing, pulmonary crackles are identified, Mrs. J. coughs blood-tinged sputum, and the level of oxygen is lower than the norm and constitutes 82%. Hepatomegaly indicates the enlargement of the liver and is a sign of heart failure. Since the patient reported not having taken any prescribed medications for her hypertension for three days and taking into account her vital signs, immediate hospitalization with the necessary nursing interventions applied is needed.
The nursing interventions initiated at the time of Mrs. J.’s admission addressed the major clinical manifestations of cardiovascular and respiratory issues. The immediate administration of oxygen to control the level of O2 was adequately and timely administered, as well as the necessary medications provided. The prescription of IV furosemide Lasix is validated by the properties of this medication to act like a diuretic and eliminate tension in heart functioning (Cobretti et al., 2017). The administration of enalapril Vasotec is also appropriate in the case of Mrs. J. since this medication treats hypertension by stabilizing heart rate and blood pressure (Cobretti et al., 2017). Metoprolol Lopressor lowers heart rate and has a positive effect on the functioning of the heart due to the properties of blocking beta receptors (Cobretti et al., 2017). The administering of morphine in combination with oxygen delivery and inhaled short-acting bronchodilator and corticosteroid is an appropriate decision due to the pain management and oxygen circulation improvement for the patient.
Heart failure as a severe health condition that is characterized by a high mortality rate might be caused by several cardiovascular conditions. Four of them include hypertension, high level of heart rate, coronary artery disease, and previous heart attack (Komanduri et al., 2017). In order to prevent the development of heart failure on the stage of the emergence of these health conditions, such nursing interventions as preventative education for healthy lifestyle adjustment, cessation of bad habits, and regular intake of medications might be introduced. In addition, regular check-ups should be administered to control and monitor the condition of the patients.
Since patients like Mrs. J., who have several conditions that necessitate regular intake of prescribed medications, it is vital to apply nursing interventions that would reduce the risks and enhance the capacity of drug interactions. Firstly, medication reconciliation should be initiated for a patient to incorporate all the prescriptions and eliminate unnecessary drugs from the list (Accetta, 2016). Secondly, the inter-drug interaction should be assessed to eliminate the contradictory or risky combinations that might endanger the patient’s health. Thirdly, patient education on the guidelines for taking each medication might be a useful nursing intervention due to the knowledge disseminated to the patient about the drugs prescribed. Finally, a doctor-assisted medication intake plan will significantly help older patients keep track of their treatment and eliminate potential problems with drug interaction.
After the extensive treatment during the time of hospitalization and the experienced severe health conditions, Mrs. J. will need assistance in completing her rehabilitation process. To provide her with a complete health promotion and restoration teaching plan, a nurse should introduce behavioral and lifestyle modifications that will allow the patient to adjust to unassisted life at home. Since the transition from the hospital setting to home is a critical period in the patient’s rehabilitation, the education plan should include the following elements. Firstly, the dissemination of the basic information about the prevalence and manifestations of heart failure should be initiated. Secondly, elimination of risk factors, such as smoking or stress, will contribute to the patient’s awareness. Thirdly, the education of the patient about the engagement strategies will facilitate the individual’s persistence in medication intake and regimen following. Finally, regular appointments and instances of immediate referral to specialists must be discussed.
An effective method for providing education for Mrs. J. concerning the importance of taking medications to eliminate repeated hospitalization might be an e-Health method. Using an application that tracks medication intake using a system of reminders, provides information, motivation, and exercising tips will allow for enhancing Mrs. J.’s consistency in home-based treatment and prevention of heart failure in the future.
Since the patient has a history of suffering from COPD, it is vital to address the factors contributing to this condition and the ways of eliminating them. The most common triggers of COPD include smoking cigarettes, air pollution, dust, and respiratory infections. Therefore, for Mrs. J. to address these triggers, she should cease smoking, adhere to an active lifestyle by spending more time in the fresh air, avoid dusty areas and places with air pollution, as well as take care of her health not to get infected with a respiratory illness. The options for cigarette smoking cessation include nicotine patches, nicotine gum, self-help materials learning, and counseling.
Accetta, R. C. (2016). Polypharmacy: Strategies for reducing the consequences of multiple medications. Today’s Geriatric Medicine, 9(3), 24.
Cobretti, M. R., Page, R. L., II, S. A. L., Deininger, K. M., Ambardekar, A. V., Lindenfeld, J., & Aquilante, C. L. (2017). Medication regimen complexity in ambulatory older adults with heart failure. Clinical Interventions in Aging, 12, 679 – 686.
Komanduri, S., Jadhao, Y., Guduru, S. S., Cheriyath, P., & Wert, Y. (2017). Prevalence and risk factors of heart failure in the USA: NHANES 2013–2014 epidemiological follow-up study. Journal of Community Hospital Internal Medicine Perspectives, 7(1), 15 – 20.