Evaluate the Health History and Medical Information for Mrs. J., presented below.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.
Health History and Medical Information
Health History
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.
Subjective Data
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 like it is “running away.”
4. Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:
1. Describe the subjective and objective clinical manifestations present in Mrs. J.
2. Describe four cardiovascular conditions in which Mrs. J is at risk, and that may lead to heart failure. What can be done in the form of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions?
Sample Solution
Mrs. J is a 55-year old female who presents for her annual physical exam with no reported complaints. She has no known allergies and reports that she does not take any prescription medications (only vitamins and supplements). Her social history includes smoking cigarettes daily for the past 20 years, occasional alcohol consumption, and mild exercise 2-3 times per week. She indicates that she is in good overall health but has some concerns about family history of heart disease and diabetes. Mrs. J’s mother passed away due to complications from heart disease at age 65 while her father died of diabetes at age 72; both parents suffered from high blood pressure as well. Mrs. J also reports a family history of breast cancer on her mother’s side of the family, but states that there have been no other cases in recent generations among close relatives or friends.
Sample Solution
Mrs. J is a 55-year old female who presents for her annual physical exam with no reported complaints. She has no known allergies and reports that she does not take any prescription medications (only vitamins and supplements). Her social history includes smoking cigarettes daily for the past 20 years, occasional alcohol consumption, and mild exercise 2-3 times per week. She indicates that she is in good overall health but has some concerns about family history of heart disease and diabetes. Mrs. J’s mother passed away due to complications from heart disease at age 65 while her father died of diabetes at age 72; both parents suffered from high blood pressure as well. Mrs. J also reports a family history of breast cancer on her mother’s side of the family, but states that there have been no other cases in recent generations among close relatives or friends.
