Mrs. J. is a 63-year-old married woman with a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she has been smoking two packs of cigarettes daily for 40 years. The problem is that three days ago she had a sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. The woman has been unable to perform Activities of Daily Living (ADLs) and has required assistance in walking short distances and has been admitted to the hospital’s intensive care unit (ICU) with acute decompensated heart failure and acute exacerbation of COPD. With this clinical manifestation taken into consideration, this case needs to be studied to provide nurses with an enhanced understanding of the pathophysiological processes of disease.
Nursing Interventions and Medication
First, the nursing interventions at the time of the patient’s admissions can be evaluated as predominantly appropriate. IV furosemide (Lasix) is efficient for heart conditions such as chronic heart failure if it is not mixed with sucralfate, cholestyramine, and colestipol, and the dose is relevant for the weight of a patient with Mrs. J. being 95.5kg (Palazzuoli et al., 2017). Enalapril (Vasotec) was efficient because it is used to treat symptoms of hypertension the patient constantly suffers from. Metoprolol (Lopressor) is suitable for elderly patients to improve cardiac function, meanwhile, the medicine is especially efficient within the first phase of treatment.
IV morphine sulfate (Morphine) was not relevant because the patient feels exhausted and anxious while Morphine provokes such conditions. Inhaled short-acting bronchodilator (ProAir HFA) was useful to stop respiratory problems of the patient and avert shortness of breath caused by smoking. Inhaled corticosteroid (Flovent HFA) is not this efficient and helps to prevent such health conditions as asthma, but oxygen delivered at 2L/ NC was the most effective way to maintain the vital functions of Mrs. J.
The next step of the study requires the research of cardiovascular conditions that may lead to heart failure. First, coronary artery disease is dangerous with arteries clogged with cholesterol. The treatment includes cholesterol-modifying medications, beta-blockers, aspirin, nitroglycerin, exercising, proper diet, and quitting smoking. Coronary artery disease leads to other cardiovascular conditions such as heart attacks, which happen when blood cannot reach the heart because of the blocked arteries (Stewart et al., 2017). Without immediate treatment, the parts of the heart die and result in heart failure. The treatment includes artificial heart valve surgery, cardiomyoplasty, and atherectomy which should be conducted immediately.
Coronary artery disease and heart failure can cause arrhythmias with the heart beating excessively slowly, excessively quickly, or at changing speeds. The treatment should consist of medications prescribed individually, cardioversion, or implantation of a cardioverter-defibrillator. Hypertension is another widespread cardiovascular condition that leads to heart failure. The treatment may include medication such as Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin II receptor blockers (ARBs), Diuretics, Beta-blockers, and their combinations, then, a healthy lifestyle is needed.
Multiple Drug Interactions
As an old woman, Mrs. J. can suffer from taking at least six prescription medications. To prevent potential problems, first, the compatibility of medicines should be constantly checked, and they can be divided into several groups according to the level of their reconcilability. Second, the patient should be provided with brief information about each of the pharmaceuticals. Third, all medicines should have their exact daily time of consumption.
Health Restoration Plan
The health conditions of the patient require multidisciplinary resources for the rehabilitation plan. Apart from medication, psychological methods can be useful to assist the patient’s transition to independence. She should be recommended to spend more time outdoors, for example, with patients who have the same diagnosis, to control her and their conditions and evaluate risks on her own. Then, her lifestyle should be modified with exercising conducted daily basics and strategies of quitting smoking applied.
Taking into consideration the patient’s age, condition, and reluctance to quit smoking, a special educational method is required to teach Mrs. J. how to use medications. First, a rationale should be discussed with her, with doses explained. Then, the time of consumption should be regulated with a timeline written. The nurses are recommended to set alarms on the smartphone of Mrs. J. for she to remember about the pharmaceuticals. Additionally, Mrs. J. Should be provided with proper recommendations relevant to a healthy lifestyle.
Main COPD triggers that can increase exacerbation frequency include cigarette smoke, extreme weather, air pollution, respiratory infections, sand dust, and fumes. Smoking is the main cause of COPD with nearly 80% of all cases provoked by inhaling tobacco. Moreover, smoking damages the lungs by narrowing the air passages and destroying the air sacs (Mu et al., 2017). Consequently, smokers with COPD face higher risks of lung infections.
Mrs. J. is a long-term tobacco user whose health issues are predominantly caused by smoking. Respectively, quitting the hobby is the most efficient step for her convalescence. With educational talks having no effect, psychotherapy can be regarded as the best solution to the problem. Additionally, visiting an encounter group would keep the patient more active and motivated, because she would see how this affects people from different age groups.
Mrs. J. requires the prescribed medical treatment with the exclusion of Morphine and the multiple drug interactions controlled by nurses. Next, the recommendation for her further well-being should be given with a focus on medication that she should be properly educated to consume. Additionally, she should be explained that smoking is the cause of her health issues, and, if she does not work on quitting it, the consequences are to be fatal.
Mu, Z., Chen, P. L., Geng, F. H., Ren, L., Gu, W., Ma, J., Peng, L., & Li, Q. (2017). Synergistic effects of temperature and humidity on the symptoms of COPD patients. International Journal of Biometeorology, 61(1), 1919–1925. Web.
Palazzuoli, A., Ruocco, G., Vescovo, G., Valle, R., Di Somma, S., & Nuti, R. (2017). Rationale and study design of intravenous loop diuretic administration in acute heart failure: DIUR-AHF. ESC Heart Failure, 4(4), 479–486. Web.
Stewart, J., Manmathan, G., & Wilkinson, P. (2017). Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovascular Disease, 6(1). Web.