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History of hypertension, chronic heart failure

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

Is very anxious and asks whether she is going to die.
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

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:

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:

Describe the clinical manifestations present in Mrs. J.
Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
Taking into consideration the fact that most mature adults take at least six prescription medications, 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. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

Sample Solution

Amartya Sen, a nobel memorial prize winner in economic sciences, http://en.wikipedia.org/wiki/Amartya_Sen, defined economic development in terms of personal freedom, freedom to choose from a variety of options. Economic growth may lead to an increase in the purchasing power of people but if the economy is repressed then there is lack ot choice and thus personal freedom is restricted. This clearly implies that growth has taken place without any development. Taking another example into consideration, increase in defence output of a nation accounts for an increased GDP but does not contribute to economic development. When we measure economic growth we are limited to increases in national income or per capita but when we measure economic development factors such as GDP, per capita income, poverty, life expectancy, infant mortality, etc is all taken into consideration. While economic growth may lead to improvements in the standard of living of a relatively small proprotion of population whilst the majority of the population remains poor. It is how the economic growth is spread among the population that determines the level of development. Economic development involves a more complex process than economic growth. According to economist, Gerald Meier, economic growth remains an important signal of the achievement of development, in agreement with certain other stipulated outcomes. The concept of economic development differs from economic growth and has eventually more dimensions. Thus after reaching to a conclusion, economic growth and economic development are interrelated. Economic development may be considered our short term goal towards the achievement of an ideal life in the long run, and economic growth is one of the important factors necessary for bringing about economic development. It is a much broader term concerned with a lot more than just the monetary aspect of development. Hence it is true and it can be said that ‘Economic growth is a necessary but not sufficient condition of economic development.’
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