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Evaluate the health history and medical information for Mrs. J., a 63-year-old woman with a history of hypertension, chronic heart failure, and COPD. She was admitted with acute decompensated heart failure and COPD exacerbation, presenting symptoms such as shortness of breath, fatigue, jugular vein distention, and irregular heartbeat. She has not taken her medications recently, and her vital signs indicate hypotension, tachycardia, tachypnea, and hypoxia. Her clinical manifestations include pulmonary crackles, frothy sputum, peripheral edema, and altered cardiac rhythm. Appropriate nursing interventions at admission included oxygen therapy at 2L/min, administration of diuretics (furosemide), antihypertensives (enalapril), beta-blockers (metoprolol), and medications to reduce anxiety and relieve symptoms such as morphine and bronchodilators.

For each medication administered, the rationale is as follows: IV furosemide facilitates diuresis to reduce preload and pulmonary congestion; enalapril inhibits the renin-angiotensin-aldosterone system, decreasing afterload and blood pressure; metoprolol reduces myocardial oxygen consumption, controls heart rate, and prevents arrhythmias; morphine provides relief from dyspnea and anxiety while also reducing preload; bronchodilators open airways to improve airflow; corticosteroids decrease airway inflammation; oxygen therapy corrects hypoxia. These interventions are appropriate for managing her acute symptoms, stabilizing her cardiovascular status, and relieving respiratory distress.

Cardiovascular conditions that may lead to heart failure include hypertension, coronary artery disease (CAD), myocardial infarction, and valvular heart disease. Hypertension damages arterial walls and increases afterload, leading to hypertrophic changes and eventual failure. Medical strategies include blood pressure control through antihypertensive medications, lifestyle modifications, and regular monitoring. CAD causes ischemia and myocardial damage, which impair contractility; interventions involve managing lipid levels, promoting smoking cessation, and revascularization if needed. Myocardial infarction leads to loss of functional myocardium; prevention involves timely reperfusion, managing risk factors, and cardiac rehabilitation. Valvular diseases like aortic stenosis or regurgitation cause volume and pressure overload, which can be mitigated through surgical interventions and medical management to reduce workload.

In older adults, polypharmacy increases the risk of adverse drug interactions. Four nursing interventions to mitigate these issues include: (1) comprehensive medication review and reconciliation during each healthcare encounter to ensure appropriateness; (2) education focused on medication adherence and awareness of potential interactions; (3) regular monitoring for adverse effects or toxicity, including labs and physical assessments; (4) involvement of a multidisciplinary team including pharmacists to optimize medication regimens. These measures help prevent medication-related complications and ensure safe drug use.

A health promotion and restoration teaching plan for Mrs. J. should include education on disease process management, medication adherence, and lifestyle modifications. Collaboration with multidisciplinary teams such as dietitians, physical therapists, and social workers can support her rehabilitation and foster independence. For example, cardiac and pulmonary rehabilitation programs can improve functional capacity, enhance oxygen utilization, and boost confidence in performing daily activities. Modifications may include environmental adaptations at home and assistive devices to prevent falls and injury. Transitioning to independence involves structured education about symptom management, recognizing early signs of exacerbation, and ensuring access to community resources such as home health services and support groups.

Education regarding medication maintenance is essential. Mrs. J. should be taught to understand the purpose, dosing, and potential side effects of her medications to enhance adherence and prevent readmission. Utilizing teach-back techniques ensures comprehension. For example, she can be instructed on taking diuretics in relation to weight monitoring and signs of overdiuresis. Rationale for education includes promoting self-care, reducing hospitalizations, and improving quality of life. Regular follow-up appointments and medication reviews can sustain medication compliance and monitor for adverse effects.

Expressions of COPD triggers that increase exacerbation risk include respiratory infections, exposure to pollutants or irritants (smoke, dust, fumes), weather changes, and stress. Avoidance and management of these triggers are critical. Vaccinations such as influenza and pneumococcal vaccines should be recommended to prevent infections. Pulmonary rehabilitation and smoking cessation programs are essential components of long-term management. Pharmacological options for smoking cessation include nicotine replacement therapy, varenicline, and bupropion, which can significantly increase cessation success rates. Offering behavioral counseling and support groups complements pharmacotherapy, addressing the psychological aspects of quitting smoking. Given her long-term smoking history, ongoing support and personalized interventions are necessary to maximize the chances of successful cessation and improve her respiratory health.

References

  • American Heart Association. (2022). Heart failure: Overview and treatment. https://www.heart.org
  • Gerry, F. (2021). Pharmacology for nurses: A pathophysiological approach (6th ed.). Elsevier.
  • National Institute on Aging. (2023). Managing polypharmacy in older adults. https://www.nia.nih.gov
  • Qaseem, A., et al. (2019). Pharmacologic management of chronic obstructive pulmonary disease (COPD). Annals of Internal Medicine, 171(12), 878-887.
  • Yancy, C. W., et al. (2020). 2022 AHA/ACC/HFSA guideline for the management of heart failure. Journal of Cardiac Failure, 28(4), 290-354.
  • Levine, S., & Wills, K. (2019). Pathophysiology of heart failure. Journal of Cardiology Practice, 45(2), 113-120.
  • Salive, M. E. (2020). Polypharmacy and strategies to improve medication safety. Journal of Gerontology Nursing, 46(3), 8-13.
  • U.S. Department of Health and Human Services. (2021). Smoking cessation: A report of the Surgeon General. https://www.hhs.gov
  • World Health Organization. (2022). COPD management and prevention. https://www.who.int
  • National Heart, Lung, and Blood Institute. (2023). Heart failure. https://www.nhlbi.nih.gov

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