[Solved] Mrs. J., a 63-year-old Pulmonary Disease Case Study

Case Study: Mrs. J

Some clinical manifestations present in Mrs. J. include shortness of breath, fatigue, anxiety, elevated heart rate, and flu-like symptoms. The patient reports that she is experiencing breathing difficulties and cannot get enough air. She also complains of excessive fatigue and exhaustion, making it hard for her to eat or drink without assistance. She is very anxious and fears that her condition might progress and result in death. Her heart rate has elevated, and she experiences a sensation that her heart is pounding or racing. The initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation, which indicates irregularities in the patient’s circulatory system. She also reports a sudden onset of flu-like symptoms such as nausea, fever, productive coughing with frothy blood-tinged sputum, and malaise, which insinuate a complication in her respiratory system.

The nursing interventions provided upon the patient’s admission were appropriate. Upon confirmation of breathing difficulties, the patient was administered 2 liters per minute of oxygen to stimulate circulation in the bloodstream. Inhaled corticosteroid was also administered to suppress inflammation in the patient’s chest that could be causing breathing difficulties. According to Williams (2018), Inhaled corticosteroids suppress inflammation mainly by switching off multiple activated inflammatory genes and offer quick relief to the patient. It was, therefore, important to provide such interventions to reduce the risks associated with an inadequate supply of oxygen in the body before conducting further diagnosis and treatment. Since the patient complained of pain and had high anxiety levels, it was necessary to administer IV morphine sulphate (Morphine) to reduce the severity of chronic pain, anxiety, and shortness of breath. Metoprolol was also administered to alleviate the patient’s rapid heart rate by reducing the level of blood pressure. The intervention is praised for offering immediate relief to high blood pressure and reducing the risk of strong among patients with cardiac complications (Cheng et al. 2020, p. 3485). Therefore, the patient was provided with rightful interventions after admission.

Some cardiovascular conditions that may lead to heart failure include high blood pressure, coronary artery disease, heart muscle disease, and deep vein thrombosis. High blood pressure is a health condition in which the long-term force of the blood against a person’s artery walls is too high that it eventually causes serious health conditions such as heart failure. The condition is often caused by high fat, salt, and cholesterol intake in diets. It is also attributed to obesity, whereby the heart is forced to work harder to pump blood through arteries that have excessive fat deposits (Harada & Obokata, 2020, p. 357). To prevent the development of heart failure due to hypertension, clinicians may administer anti-hypertensive drugs to allow the heart to pump blood at a normal rate. Coronary artery disease refers to the buildup of plaque in the arteries that supply oxygen-rich blood to the heart, which results in insufficiency of oxygen in the heart to cause heart failure. Clinicians may administer cholesterol-modifying medications to individuals with coronary artery disease to prevent its progression to heart failure.

Heart muscle disease is a health condition that weakens the myocardium and makes it hard for the heart to pump blood to other body parts. The condition causes ventricular and endothelial dysfunction in the coronary arteries, which leads to acute coronary events and eventually causes heart failure (Zuchi et al., 2020, p. 21). In the medical setting, clinicians may conduct a bypass surgery on a patient with severe heart muscle disease to restore blood flow and prevent heart failure. Deep vein thrombosis is a health condition that occurs when blood clots form in blood veins. When such blood clots form in blood capillaries within the endocardium, myocardium, or epicardium, they interfere with the heart’s normal functioning, leading to heart failure. Clinicians may administer anticoagulant medicines to patients to reduce their risk of developing heart failure.

Nursing interventions that can help prevent problems caused by multiple drug interactions in older patients include conducting medication reconciliations, assessing for drug-drug interactions, reviewing dosages, and eliminating duplicate medications. Caregivers ought to conduct medication reconciliations to ensure that the patient’s medication prescription is up to date to avoid making them take drugs for conditions that have already been alleviated. They should also confirm drug-drug interactions for the medications prescribed to avoid cases in which combining more than one drug causes serious side effects. Clinicians should also review dosages for prescribed medicine to avoid exposing the patient to multiple side effects of the drugs. Eliminating duplicate and substitute medication also helps ensure that the patient takes the required quantities of drugs for the existing condition.

The health promotion and restoration teaching plan for Mrs. J would focus on helping the patient restrain negative health behaviors. The patient has been smoking two packs of cigarettes for the last 40 years despite being diagnosed with serious chronic conditions such as hypertension, chronic heart failure, and chronic obstructive pulmonary disease. She is, therefore, in need of a teaching and restoration plan that would reduce her addiction to cigarette smoking. A multidisciplinary approach to rehabilitation could be adopted to ensure that the restoration plan addresses all social, health, and psychological provocations to engage in smoking. Therefore, the teaching and restoration plan could involve the patient’s family, a psychiatrist, rehabilitation nurses, and a recreational therapist. The patient’s family members and a recreational therapist would collaborate to ensure that the patient develops a healthier recreational behavior to replace smoking, while the psychiatrist and rehabilitation nurses could initiate interventions to reduce the patient’s emotional and psychological provocations to smoke.

A face-to-face teaching approach would be adopted to educate Mrs. J regarding medications needed to restore her health and prevent future hospital admission. Since it is important to establish trust with the patient, engaging in verbal communication with her and developing a personalized relationship is important. The strategy would also allow a therapist to recognize and adopt the patient’s preferable learning style. It would also help identify the need for various forms of modification that concur with the patient’s abilities to optimize her understanding. As such, the therapist needs to schedule regular clinical visits for Mrs. J to create a platform through which her health literacy may be improved and to allow regular assessment of her condition.

Some chronic obstructive pulmonary disease triggers that can increase exacerbation frequency and necessitate return visits include cigarette smoke, cold or humid air, and respiratory infections. Extreme weather conditions involving cold or humid air often increase the severity of existing symptoms of chronic obstructive pulmonary disease. Respiratory infections may also accelerate disease progression, causing the patient to experience more severe chronic obstructive pulmonary disease symptoms. Also, cigarette smoke constitutes a common factor for disease progression among individuals diagnosed with chronic obstructive pulmonary disease. Since Mrs. J smokes two packets of cigarettes daily, she ought to make a plan to quit smoking. She could also consider seeking support from qualified personnel to control the craving for smoking effectively. Eventually, Mrs. J could overcome her smoking sensation to avoid the progression of chronic obstructive pulmonary disease.

References

Williams, D. M. (2018). Clinical pharmacology of corticosteroids. Respiratory care, 63(6), 655-670. http://rc.rcjournal.com/content/63/6/655.short

Cheng, X., Zhu, M., Liu, Q., Feng, Z., & Meng, Y. (2020). Effectiveness of Metoprolol in Improving Cardiac and Motor Functions in Patients with Chronic Heart Failure: A Prospective Study. Drug Design, Development, and Therapy, 14, 3485. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7457782/

Harada, T., & Obokata, M. (2020). Obesity-related heart failure with preserved ejection fraction: pathophysiology, diagnosis, and potential therapies. Heart Failure Clinics, 16(3), 357-368. https://www.heartfailure.theclinics.com/article/S1551-7136(20)30017-9/abstract

Zuchi, C., Tritto, I., Carluccio, E., Mattei, C., Cattadori, G., & Ambrosio, G. (2020). Role of endothelial dysfunction in heart failure. Heart failure reviews, 25(1), 21-30. https://link.springer.com/article/10.1007/s10741-019-09881-3