NRS 410 Case Study: Mrs. J.

NRS 410 Case Study: Mrs. J.

Case Study: Mrs. J

            The case scenario discussed is of 63-year-old Mrs. J who has been in care for chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) and is now admitted due to their exacerbations. She reports a history of cigarette smoking, hypertension, poor compliance to medication, and a recent upper airway tract infection. This discussion aims to describe how she was managed, the reasons for exacerbation, and patient management plans.

Mrs. J. is a 63-year-old married woman who has 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 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, productive cough, nausea, and malaise. Over the past 3 days, 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.

Question 1

COPD that Mrs. J is characterized by an inflamed airway that impairs expiration of gases thus presenting with dyspnea. The limited expiration results in the accumulation of carbon (IV) oxide in the body which triggers anxiety (Choi & Rhee, 2020). On the other hand, CHF reduces the heart’s ability to pump blood thus irregular heartbeat occurs described as the heart running away (Schwinger, 2021). It also presents with fatigue due to impaired blood supply to the body tissues (Hajar, 2019).

Question 2

            Medications that have been administered to manage Mrs. J can be justified due to their effects. Furosemide and enalapril work through a different mechanisms of action to reduce the decompensation of the heart in CHF (Hajar, 2019). Although furosemide encourages diuresis by inhibiting the reabsorption of sodium in kidney tubules whereas enalapril inhibits the renin-angiotensin-aldosterone system (RAAS), they both lead to a decrease in preload and afterload (Lee et al., 2019). This reduces pressure against the heart and also corrects the reported edema especially due to furosemide use.

Metoprolol that was prescribed regulates the sympathetic system activation in heart failure thereby reducing the cardiac contractility and heart rate (Hajar, 2019). As such, it corrects the reported palpitations. Further, the inhaled bronchodilators and corticosteroids correct the bronchoconstriction due to COPD thus promoting expiration whereas morphine helped in reducing anxiety symptoms (Lief & McSparron, 2020). Due to Mrs. J’s low oxygen saturation, oxygen supplementation was also necessary to reverse the hypercapnia and promote oxygen delivery to tissues (Choi & Rhee, 2020). The prescribed drugs were therefore justified and appropriate for managing the exacerbations.

Question 3

            CHF results from most heart conditions whether they affect the valves, heart muscles, or the electrical conduction pathways. Some of these conditions include cardiomyopathy, valvular defects, coronary artery disease (CAD), and arrhythmias. Cardiomyopathy is where there is damage to the myocardium due to a myriad of factors including alcohol use and it consequently impairs the heart’s ability to pump blood (Hajar, 2019). Valvular defects whether resulting from infection of the valves, stenosis, or regurgitation are also implicated (Lee et al., 2019). CAD where there are narrowed coronary artery vessels with consequential cardiac ischemia as well as arrhythmias where the is uncoordinated heart beating such as atrial fibrillation are other risk factors for CHF (Schwinger, 2021). Most of these conditions can be prevented from resulting in CHF.

Different nursing interventions can help in preventing CHF from these cardiac conditions. Such measures include the adoption of physical exercise and dietary modification for CAD, reduced alcohol consumption for cardiomyopathy, and aggressive antibiotic therapy to prevent the advancement of valvular infection into CHF (Lee et al., 2019). Non-pharmacological vagal maneuvers may be applied to correct arrhythmias.

Question 4

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