Understanding of the pathophysiological process of disease,

Understanding of the pathophysiological process of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span. Evaluate the health history and medical information for Mrs,J; presented below. Complete the critical Thinking report. Mrs. J is a 63-year old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive disease(COPD) requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD. Subjective clinical manifestations present (1) Is very anxious and asks whether she is going to die. (2) Denies pain but says she feels like she cannot get enough air, (3) says her heart feels it is “running away”.(4) Reports that she is exhausted and cannot eat or drink by herself. Objective Data (1) Height 175 cm, weight 95.5 kg, (2) Vital signs T 37.6 c, HR 118 and irregular, RR 34, B/P 90/50. (3) Cardiovascular; Distant S1, S2,S3 present PMI at sixth ICS and faint: all peripheral pulses are 1+ : bilateral jugular vein distension: Initial cardiac monitoring indicates a ventricular rate of 132 and arterial fibrillation. (4) Respiratory: Pulmonary crackles decreased breath sounds right lower lobe, coughing frothy blood tinged sputum,spo2 82% (5) Gastrointestinal; B S present: Hepatomegaly 4 cm below costal margin. The following medications administered through drug therapy control her symptoms (1) IV furosemide (lasix) (2) Enalapril (vasotec) (3) Metoprolol(Lopressor) (4) IV Morphine sulfate(morphine) (5) Inhaled short- acting bronchodialator (proAir HFA) (6) Inhaled corticorsteriod (Flovent HFA) (7) Oxygen delivered at 2L/NC. Critically evaluate Mrs, J. S situation, to address (1) Describing the subjective and objective clinical manifestations present in Mrs, J (2) Describing four cardiovascular conditions in which Mrs J is at risk and that may lead to heart failure. (3) what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions? (4) By following the nursing process, were the interventions at the time of admission beneficial for Mrs J? (5) Would you change any of the interventions to ensure patient independence and prevent readmission? (4) (A) Explain each of the seven medications listed in the scenario above. (B) Include the classification, the action, and the rationale for each of these. (C) Discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. (D) Provide a rationale for each interventions recommended (E) Provide a health promotion and restoration teaching plan for Mrs J, including multidisciplinary resources for rehabilitation and any modifications that may be needed, including maintenance of medications. (F) Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence and prevent readmission. (G) Considering Mrs, Js’ current and long term tobacco use, discuss what options for smoking cessation should be offered. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits.

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