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Discussion 1
Identify a cardiac or respiratory dysfunction and its cause. Outline the key steps necessary to
prevent the dysfunction and improve health status.
Reply to three classmates
Discussion 2
Discuss what resources are available for chronic cardiorespiratory issues to support patient
independence and prevent readmission. Explain how readmission affects reimbursement. What
implications does readmission have on the hospital, and on the patient?
Reply to three classmates
Case study
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the
pathophysiological processes 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.
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
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Is very anxious and asks whether she is going to die.
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Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is “running away.”
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data
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Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
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.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy
blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
The following medications administered through drug therapy control her symptoms:
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IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:
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Describe the subjective and objective clinical manifestations present in Mrs. J.
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?
By following the nursing process, were the interventions at the time of admissions beneficial for
Mrs. J? Would you change any of the interventions to ensure patient independence and prevent
readmission?
Explain each of the seven medications listed in the scenario above. Include the classification, the
action, and the rationale for each of these. Discuss four nursing interventions that can help prevent
problems caused by multiple drug interactions in older patients. Provide a rationale for each of the
interventions you recommend.
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. Explain how the rehabilitation resources and modifications will assist the patients’
transition to independence and prevent readmission.
Considering Mrs. J.’s 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.
You are required to cite a minimum of three sources to complete this assignment. Sources must
be published within the last 5 years and appropriate for the assignment criteria and relevant to
nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the
Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to
become familiar with the expectations for successful completion.
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