NRS 455 Case Study: Mrs. R.
Grand Canyon University NRS 455 Case Study: Mrs. R.– Step-By-Step Guide
This guide will demonstrate how to complete the Grand Canyon University NRS 455 Case Study: Mrs. R. assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NRS 455 Case Study: Mrs. R.
Whether one passes or fails an academic assignment such as the Grand Canyon University NRS 455 Case Study: Mrs. R. depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NRS 455 Case Study: Mrs. R.
The introduction for the Grand Canyon University NRS 455 Case Study: Mrs. R. is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for NRS 455 Case Study: Mrs. R.
After the introduction, move into the main part of the NRS 455 Case Study: Mrs. R. assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NRS 455 Case Study: Mrs. R.
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NRS 455 Case Study: Mrs. R.
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NRS 455 Case Study: Mrs. R.
Critical Thinking Table
| Clinical Manifestations Describe the clinical manifestations present in Mrs. R., focusing on the normal and abnormal findings and how this relates to his current condition. | |
| Subjective | Mrs. R’s abnormal subjective manifestations include anxiety, complaints of not getting enough air, feeling as if her heart is running away, and being exhausted and not being able to drink by herself. These manifestations are attributed to inadequate body tissue perfusion. She is experiencing anxiety because of brain tissue hypoxia, which makes her feel an impending doom. She is not getting enough air because of the hyper-inflated alveoli and fluid collection in the lungs due to heart failure. She cannot drink by herself because of inadequate tissue perfusion, which leads to a low nutrient supply to most body parts. |
| Objective | The abnormal objective manifestations in Mrs. R’s case study include irregular heartbeat, low blood pressure, decreased peripheral pulses, presence of S3 heart sound, PMI at sixth ICS, and distant and bilateral jugular vein distention. It also includes atrial fibrillation and a ventricular fibrillation rate of 132. These manifestations develop from altered cardiac functioning secondary to uncontrolled hypertension and chronic heart failure. Mrs. R has respiratory crackles, decreased breath sounds in the right lower lobe, and coughing bloodstained sputum. These symptoms develop because of fluid collection in the lungs and bronchitis, which is a complication of COPD. |
| Cardiovascular Conditions Leading to Heart Failure Describe cardiovascular conditions in which Mrs. R. is at risk. | |
| Describe four cardiovascular conditions in which Mrs. R. is at risk and that may lead to heart failure. | Mrs. R. is at risk of several cardiovascular conditions. They include heart valve disease, coronary artery disease, myocarditis, and uncontrolled hypertension. Uncontrolled hypertension causes cardiomegaly, which predisposes to heart failure from uncontrolled heart filling and emptying. Mrs. R is at risk of coronary artery disease because of her history of smoking. She is also overweight, which increases the risk of fat deposits, coronary artery disease, and heart failure. Mrs. R is also at risk of heart valve disease because of the strained heart valves from hypertension and heart disease. She is also at risk of myocarditis, which would develop from cardiac muscle tissue hypertrophy (Triposkiadis et al., 2022). The hypertrophy develops from prolonged straining of the heart muscles. |
| Discuss any comorbidities Mrs. R. displays. | Mrs. R displays comorbidities that include bronchitis, obesity, smoking, and hepatomegaly. Bronchitis is a common comorbidity that is seen among patients with COPD. COPD exacerbation causes bronchial tube inflammation and mucus accumulation to impede the normal gaseous exchange in the lungs. Patients experience symptoms such as a cough, fever, dyspnea, and fatigue. Mrs. R. has these symptoms, hence, bronchitis is among the comorbidities that she has. Mrs. R is obese. Her BMI is 31.2. Obesity predisposes her to worsened cardiovascular status and health problems such as diabetes and coronary artery disease. Mrs. R also has hepatomegaly. The case study shows that she has hepatomegaly 4 cm below the costal margin. Hepatomegaly develops because of blood pooling up in the liver in patients with hepatomegaly. Mrs. R has a 40-year history of smoking. Smoking predisposes patients to respiratory conditions such as COPD and cardiovascular problems such as coronary artery disease. Mrs. R also has uncontrolled hypertension, which is a risk factor for heart disease (Triposkiadis et al., 2022). Uncontrolled hypertension causes heart muscle thickening, which impairs normal cardiac function. |
| How do these conditions increase her chance of heart failure? | The above comorbidities predispose Mrs. R to heart failure. Obesity is associated with increased levels of fatty deposits in the lumen of the blood vessels. The deposition causes the narrowing of the arteries, resulting in complications such as hypertension, coronary artery disease, and heart failure. Smoking also increases the risk of heart disease. Smoke particles stimulate inflammatory response mechanisms in the thickened blood vessels, hence, cardiovascular complications, including heart failure. Cigarette also has chemicals that stimulate blood clot formation and thickening of blood in the blood vessels (Kubicki et al., 2020). Uncontrolled hypertension damages heart valves and causes cardiac muscle hypertrophy, which plays a role in the development of heart failure. |
| What can be done by way of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions. | One of the things that can be done to prevent the development of heart failure is encouraging Mrs. R to stop smoking. Smoking cessation will prevent and reduce the risk of heart failure due to effect of cigarette chemicals. Mrs. R should also be educated on the importance of treatment adherence to prevent the development of heart failure. Poor treatment adherence leads to uncontrolled hypertension and increases the risk of cardiac dysrhythmias, which causes heart failure. Health education on lifestyle and behavioral modifications should also be offered. This includes educating Mrs. R on the importance of a healthy diet, engaging in active physical activity, avoiding too much salt in food, and self-monitoring of blood pressure (Li et al., 2020). Self-monitoring of blood pressure will ensure early detection and management of unresponsive hypertension to the current treatment. |
| Evaluation of Nursing Interventions at Admissions Discuss the initial assessments and interventions provided to Mrs. R. | |
| According to the nursing process, were the initial assessments and interventions at the time of admission beneficial for Mrs. R? | The initial nursing assessments were beneficial to Mrs. R. Obtaining information about Mrs. R’s chief complaint and history of the health problem provided insights into the severity of her health problem. The subjective data increased understanding of Mrs. R’s experiences with her health problems. Her medical history helped the nurse understand the pathophysiology of Mrs. R’s health problem and the interaction between different factors in the development of the disease. The objective data was appropriate in validating the subjective information. The subjective and objective data-informed interventions such as the administration of oxygen and prescription of diuretics to help reduce fluid volume level. |
| Discuss changes to any of the initial assessments or interventions you would make to ensure patient independence and prevent readmission. | One of the interventions I would make to ensure patient independence and prevent readmission is offering comprehensive, patient-centered health education to Mrs. R. I will stress the importance of treatment adherence, lifestyle, and behavioral modifications, and self-monitoring of blood pressure to prevent readmission. I will also incorporate telehealth into Mrs. R’s care to ensure care continuity and reduce the risk of adverse events and readmissions (Allida et al., 2020). |
| Medications and Prevention of Problems Caused by Multiple Drug Interactions Explain each of the seven medications listed in the case study and increase the incidence of polypharmacy. | |
| Explain each of the seven medications listed in the case study. Include the classification, action, and rationale for each of these medications as they stem from pathophysiology for this patient’s condition (e.g., consider morphine use outside of pain management). | IV furosemide is a loop diuretic that inhibits sodium-potassium co-transporter. The inhibition results in sodium and fluid loss via the renal system, thereby, draining the excess body fluid volume in Mrs. R’s case. Enalapril is an angiotensin-converting enzyme inhibitor that blocks the conversation between angiotensin I to angiotensin II. The inhibition causes blood vessels the relaxation of blood vessels and increases oxygen and blood supply to the heart. Enalapril is prescribed in the case study to treat hypertension and prevent heart failure. Metoprolol is a beta-adrenergic blocker that inhibits beta-receptors to decrease cardiac output and workload in Mrs. R’s case. Morphine sulfate is an opioid, which binds with mu-opioid receptors in the peripheral and central nervous system to alleviate pain. Morphine has been prescribed for Mrs. R because it also decreases venous tone and the pooling of blood in the peripheries, which lowers cardiac workload. ProAIr HFA is a short-acting bronchodilator that binds to beta-2-adrenergic receptors to cause smooth muscle relaxation and inhibit mast cell release of hypersensitivity mediators. Mrs. R has been prescribed the drug to cause bronchial dilatation and prevent mucus production, hence, optimal air exchange in the lungs (Skidmore-Roth, 2022). Flovent HFA is a long-acting corticosteroid that inhibits the release of inflammatory cells, hence, preventing exacerbations in Mrs. R’s case. |
| 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. | One of the interventions that can prevent problems caused by multiple drug interactions is ensuring interprofessional collaboration in the prescription and Mrs. R’s use of the prescribed drugs. Healthcare providers such as pharmacists should be involved to prevent the client’s prescription of drugs with high-profile interactions. The second strategy is deprescribing. Deprescribing entails the systematic discontinuation of drugs that have more harm than benefits to Mrs. R. The third strategy is regular assessment of the prescribed medications based on risk and benefit, lack of benefit, indications, adverse drug events, and patient or provider’s goals. The last strategy is patient education. Patients and families should receive clear instructions on the indications, side, and adverse effects of the prescribed medications and follow-ups (Ali et al., 2021; O’Mahony et al., 2020). Patient education will increase adherence, reduce adverse events, and promote empowerment. |
| Health Promotion and Restoration Teaching Plan Develop a multidisciplinary health promotion and restoration teaching plan for Mrs. R. | |
| Discuss the steps needed to move the patient from acute care to subacute care, before discharging home and beginning a rehabilitation process. | Moving Mrs. R from acute to subacute care should be done following established protocols that would ensure care safety and quality outcomes. The nurse and other healthcare providers will use non-standardized to standardized assessments to assess Mrs. R’s readiness for transfer. Patient factors that would influence discharge decisions include functional mobility, pain and medication management skills, and cognitive functioning. The environmental considerations include environmental safety and social support Mrs. R will receive from her family members (Heydari et al., 2022). The patient’s family should be involved in all the discharge processes to ensure informed decision-making and optimize outcomes with the provision of patient-centered care. |
| Discuss alternative discharge options and qualifications to facilitate a smooth transition to the next level of care. | The alternative discharge options that might be considered include hospital at home, rapid response nursing, virtual ward, and Mrs. R’s admission to a care home (Sharma et al., 2023). The qualifications to facilitate a smooth transition to the next level of care include patient and family involvement, prioritizing risk reduction decisions, and ensuring the availability of a skilled workforce to meet Mrs. R’s needs. |
| Explain how the rehabilitation resources, including medication management, and modifications will assist the patient’s transition to promote independence and prevent readmission. | Medication management will ensure that Mrs. R gets the required medications at appropriate doses to ensure optimum recovery and prevention of other comorbidities. The provision of telehealth services will ensure care continuity and patient-centeredness, hence, early detection and management of health problems to prevent readmissions and enhance independence (Sharma et al., 2023). |
| Pathophysiological Changes Discuss the pathophysiological changes that come with Mrs. R.’s long-term tobacco use. | |
| Cigarette smoking cause significant changes in the respiratory and cardiovascular system. The chemicals in cigarette smoke cause vasomotor dysfunction, which activates atherosclerotic changes. Smoking also reduces the levels of nitric oxide, which is involved in vasodilator functions in the blood vessels. There is also the increased release of inflammatory cells with smoking. Cigarette chemicals modify the lipid profile, which promotes atherosclerosis. Prolonged smoking also impairs respiratory functions such as ciliary functions, which increases predisposition to respiratory disorders such as COPD (Benowitz & Liakoni, 2022). | |
| COPD Triggers and Options for Smoking Cessation Discuss options for smoking cessation education. | |
| What options for smoking cessation should be offered to Mrs. R? | The options for smoking cessation that should be offered to Mrs. R include nicotine replacement therapy, bupropion, nicotine patch, behavioral therapy, nicotine lozenge, lozenges, gum, and varenicline (Rigotti et al., 2022). |
| Explain the COPD triggers that can increase exacerbation frequency, resulting in readmission. | The COPD triggers that can increase exacerbation frequency include tobacco smoking, exposure to dust and pollen, intensive physical activity, and indoor air pollution (Raby et al., 2023). |
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References
Ali, S., Salahudeen, M. S., Bereznicki, L. R. E., & Curtain, C. M. (2021). Pharmacist-led interventions to reduce adverse drug events in older people living in residential aged care facilities: A systematic review. British Journal of Clinical Pharmacology, 87(10), 3672–3689. https://doi.org/10.1111/bcp.14824
Allida, S., Du, H., Xu, X., Prichard, R., Chang, S., Hickman, L. D., Davidson, P. M., & Inglis, S. C. (2020). MHealth education interventions in heart failure. Cochrane Database of Systematic Reviews, 7. https://doi.org/10.1002/14651858.CD011845.pub2
Benowitz, N. L., & Liakoni, E. (2022). Tobacco use disorder and cardiovascular health. Addiction, 117(4), 1128–1138. https://doi.org/10.1111/add.15703
Heydari, M., Lai, K. K., Fan, Y., & Li, X. (2022). A Review of Emergency and Disaster Management in the Process of Healthcare Operation Management for Improving Hospital Surgical Intake Capacity. Mathematics, 10(15), Article 15. https://doi.org/10.3390/math10152784
Kubicki, D. M., Xu, M., Akwo, E. A., Dixon, D., Mu, ñoz D., Blot, W. J., Wang, T. J., Lipworth, L., & Gupta, D. K. (2020). Race and Sex Differences in Modifiable Risk Factors and Incident Heart Failure. JACC: Heart Failure, 8(2), 122–130. https://doi.org/10.1016/j.jchf.2019.11.001
Li, H., Hastings, M. H., Rhee, J., Trager, L. E., Roh, J. D., & Rosenzweig, A. (2020). Targeting Age-Related Pathways in Heart Failure. Circulation Research, 126(4), 533–551. https://doi.org/10.1161/CIRCRESAHA.119.315889
O’Mahony, D., Gudmundsson, A., Soiza, R. L., Petrovic, M., Cruz-Jentoft, A. J., Cherubini, A., Fordham, R., Byrne, S., Dahly, D., Gallagher, P., Lavan, A., Curtin, D., Dalton, K., Cullinan, S., Flanagan, E., Shiely, F., Samuelsson, O., Sverrisdottir, A., Subbarayan, S., … Eustace, J. (2020). Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: The SENATOR* randomized controlled clinical trial. Age and Ageing, 49(4), 605–614. https://doi.org/10.1093/ageing/afaa072
Raby, K. L., Michaeloudes, C., Tonkin, J., Chung, K. F., & Bhavsar, P. K. (2023). Mechanisms of airway epithelial injury and abnormal repair in asthma and COPD. Frontiers in Immunology, 14, 1201658. https://doi.org/10.3389/fimmu.2023.1201658
Rigotti, N. A., Kruse, G. R., Livingstone-Banks, J., & Hartmann-Boyce, J. (2022). Treatment of Tobacco Smoking: A Review. JAMA, 327(6), 566–577. https://doi.org/10.1001/jama.2022.0395
Sharma, S., Salibi, D. G., & Tzenios, N. (2023). Modern approaches of rehabilitation in COPD patients. Special Journal of the Medical Academy and Other Life Sciences., 1(6), Article 6. https://doi.org/10.58676/sjmas.v1i6.39
Skidmore-Roth, L. (2022). Mosby’s 2023 Nursing Drug Reference – E-Book: Mosby’s 2023 Nursing Drug Reference – E-Book. Elsevier Health Sciences.
Triposkiadis, F., Xanthopoulos, A., Parissis, J., Butler, J., & Farmakis, D. (2022). Pathogenesis of chronic heart failure: Cardiovascular aging, risk factors, comorbidities, and disease modifiers. Heart Failure Reviews, 27(1), 337–344. https://doi.org/10.1007/s10741-020-09987-z
Sample Answer 2 for NRS 455 Case Study: Mrs. R.
Case Study: Mrs. R.
Critical Thinking Table
| Clinical Manifestations Describe the clinical manifestations present in Mrs. R., focusing on the normal and abnormal findings and how this relates to his current condition. | |
| Subjective | Subjective manifestations refer to the patient’s expression of his/her experiences with a disease. The abnormal subjective manifestations in Mr. R’s case study include anxiety, feeling that she cannot get enough air, feeling that her heart is running away, and feeling exhausted and unable to drink by herself. The above manifestations relate to Mr. R’s current condition. For example, he cannot get enough air because of pulmonary congestion. He also feels exhausted because of inadequate gaseous exchange in the lungs (Irgashev, 2023). He is feeling that his heart is running away because of abnormal heart functions, which cause palpitations. |
| Objective | The abnormal objective manifestations in the case study include an irregular heart rate of 118 beats/minute, respiratory rate of 34, blood pressure of 90/58, presence of S3 heart sounds and distant S1 and S2 heart sounds, and decreased peripheral pulses. They also include bilateral jugular vein distention, ventricular heart rate of 132, atrial fibrillation, pulmonary crackles, decreased breath sounds in the right lower lobe, coughing blood-stained sputum, SPO2 82%, and hepatomegaly. These symptoms relate to Mr. R’s current condition. For example, decreased cardiovascular functioning results in blood buildup in the lungs, hence, crackles and bloodstained sputum (Schwinger, 2021). The decreased cardiovascular function also impairs cardiac filling, hence, jugular venous distention. |
| Cardiovascular Conditions Leading to Heart Failure Describe cardiovascular conditions in which Mrs. R. is at risk. | |
| Describe four cardiovascular conditions in which Mrs. R. is at risk and that may lead to heart failure. | Mrs. R is at risk of cardiovascular conditions, including cardiomyopathy, coronary artery disease, myocarditis, and poorly controlled hypertension. A failure in the heart muscle to pump blood will result in cardiomyopathy and worsening heart failure. Mrs. R is also at risk of coronary artery disease. Her history of smoking two packs of cigarettes daily places her at an increased risk of developing coronary artery disease. Myocarditis can also develop in Mrs. R. Myocarditis refers to the inflammation of the heart muscle. Mrs. R has a history of hypertension, which can cause myocardial functional and structural changes. These changes can result in myocarditis and heart failure (Townsend et al., 2022). Mrs. R is at risk of poorly controlled hypertension and heart failure. She has not taken her antihypertensive medications for three days, which could worsen her hypertension. |
| Discuss any comorbidities Mrs. R. displays. | Mrs. R has COPD and congestive hepatomegaly as her comorbidities. Patients with a long history of heavy cigarette smoking have an increased risk of developing COPD. Statistics show that smoking contributes to 70% of all COPD cases in developed countries. Cigarettes contain chemicals that irritate the lung tissues and weaken their defense against infection. The chemicals also stimulate inflammatory processes, airway narrowing, and air sac destruction, which lead to COPD. Mrs. R has developed congestive hepatomegaly as a complication of heart failure. Heart failure causes a buildup of blood in the liver. This occurs from the pooling up of blood in the inferior vena cava, which affects other blood vessels, including the hepatic veins (Goel, 2021). Too much pressure on hepatic veins from blood buildup in the inferior vena cava causes congestive hepatomegaly. |
| How do these conditions increase her chance of heart failure? | Cardiomyopathy, coronary artery disease, myocarditis, and poorly controlled hypertension increase Mrs. R’s chances of heart failure. Cardiomyopathy affects the functioning of the heart muscles. This includes contraction and relaxation of the heart muscles. Impaired functioning of the heart muscles will affect cardiovascular filling and emptying, hence, increasing the risk of heart failure. Coronary artery disease will cause narrowing of the arteries, which will increase vascular pressure and resistance. These changes will cause increased cardiac workload, worsening Mrs. R’s risk of heart failure. Poorly controlled hypertension causes functional and structural changes in the heart muscles and tissue (Kario & Williams, 2021). For example, patients are at risk of myocarditis, which impairs normal cardiac filling and contraction, hence, heart failure. |
| What can be done by way of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions? | The patient should be administered IV furosemide, enalapril, and metoprolol for cardiomyopathy. These drugs will reduce fluid volume overload, and cardiac volume, and maintain normal blood pressure. Mrs. R should be administered furosemide, angiotensin-converting enzyme inhibitors, and beta-blockers for myocarditis. Mrs. R should be administered furosemide and beta-blockers for poorly controlled hypertension. She should also be administered aspirin, diuretics such as furosemide, blood thinning medications such as enoxaparin, statins, and antihypertensive drugs such as beta-blockers, calcium channel blockers, or angiotensin-converting enzyme inhibitors (Sindone et al., 2022). Some of the nursing interventions include daily weighing Mrs. R to detect fluid volume overload, health education on lifestyle and behavioral modifications, respiratory support, and educating on self-management of her comorbidities. |
| Evaluation of Nursing Interventions at Admissions Discuss the initial assessments and interventions provided to Mrs. R. | |
| According to the nursing process, were the initial assessments and interventions at the time of admission beneficial for Mrs. R? | The initial assessments and interventions were beneficial for Mrs. R. Subjective data provided insights into Mrs. R’s experience with her health problems and their severity. The data also provided baseline information to determine her health needs. The objective assessment confirmed the subjective data. It also informed the body systems involved in Mrs. R’s problems. Interventions such as the administration of IV furosemide were appropriate to increase excessive fluid loss through the kidneys. Enalapril and metoprolol were appropriate to decrease cardiac workload through increased vasodilation and decreased cardiac contractility. Morphine was appropriate for pain reliever, anxiolytic, and inhibition of the sympathetic nervous system to lower afterload and preload. Inhaled corticosteroids and short-acting bronchodilators were appropriate to open the airways and improve respiratory function. Oxygen delivered 2L/NC was appropriate to increase body tissue oxygenation since the patient has a saturation of 82% and respiratory difficulties due to the disease process. |
| Discuss changes to any of the initial assessments or interventions you would make to ensure patient independence and prevent readmission. | Mrs. R has congestive hepatomegaly. She is at risk of developing hepatic encephalopathy. Therefore, I would prescribe oral lactulose 15-30 ml thrice daily to prevent ammonia buildup (Goel, 2021). |
| Medications and Prevention of Problems Caused by Multiple Drug Interactions Explain each of the seven medications listed in the case study and increase the incidence of polypharmacy. | |
| Explain each of the seven medications listed in the case study. Include the classification, action, and rationale for each of these medications as they stem from the pathophysiology of this patient’s condition (e.g., consider morphine use outside of pain management). | Furosemide is a diuretic that works by inhibiting sodium and chloride reabsorption in the ascending loop of Henle, hence, increasing fluid loss with sodium and chloride. Furosemide was prescribed to treat fluid volume excess from heart failure. Enalapril is an angiotensin-converting enzyme inhibitor that blocks the conversion of angiotensin 1 to angiotensin II. The inhibition prevents vasoconstriction. It was prescribed to cause vasodilation, creased cardiac preload, and increased blood and oxygen supply to the heart. Metoprolol is a beta-1-receptor blocker that inhibits beta-1-receptors to cause decreased cardiac output from its negative chronotropic and inotropic effects. Metoprolol was prescribed to lower cardiac workload by inhibiting increased excitation of the cardiac muscles. IV morphine sulfate was prescribed as an anxiolytic and a depressant of the sympathetic nervous system. The suppression of the sympathetic nervous system would lower cardiac preload and afterload. ProAir HFA is a short-acting bronchodilator that acts on beta-2-adrenergic receptors to cause bronchial smooth muscle relaxation. ProAir HFA was prescribed to treat airway inflammation and to increase airflow to the lungs. Floven HFA is a corticosteroid that was prescribed to inhibit anti-inflammatory and vasoconstriction activity in the respiratory system (Remien & Bowman, 2024). It works by inhibiting inflammatory cells such as mast cells, monocytes, and eosinophils in the respiratory system. |
| 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. | One of the nursing interventions that can help prevent problems caused by multiple drug interactions is patient education. Mrs. R should be educated on the appropriate use of the prescribed medications and avoiding over-the-counter medications to prevent multiple drug interactions. The other nursing intervention is implementing the use of screening tools to identify and address polypharmacy in older patients. Tools such as NO TEARS can be used in healthcare settings to help identify and eliminate any drug with an increased risk of adverse outcomes if prescribed for older patients. The other strategy is encouraging interprofessional collaboration in drug prescribing, dispensing, and use by elderly patients. Interprofessional strategies such as involving pharmacists in patient education on drug safety reduce the risk of polypharmacy among older patients (Drenth-van Maanen et al., 2020; Hailu et al., 2020). The last strategy is adopting deprescribing. Deprescribing entails identifying and discontinuing any medication whose harm is more than its benefits and those having unclear patient benefits. |
| Health Promotion and Restoration Teaching Plan Develop a multidisciplinary health promotion and restoration teaching plan for Mrs. R. | |
| Discuss the steps needed to move the patient from acute care to subacute care, before discharging home and beginning a rehabilitation process. | Qualified providers should assess and make decisions related to Mrs. R’s movement from acute care to subacute care before their discharge home and the start of the rehabilitation process. The assessment determines Mrs. R’s health status, needs, and functioning ability. The second step would be discussing and involving Mrs. R in the decision-making process. The third step is planning for the patient transfer and determining any need for support such as caregiver training. The fourth step entails planning for follow-up appointments. Providers should also determine whom the patient should contact should they require any assistance. |
| Discuss alternative discharge options and qualifications to facilitate a smooth transition to the next level of care. | The alternative discharge options for Mrs. R include respite care, rehabilitation facilities, and home healthcare facilities. Mrs. R can be discharged for home healthcare if she has a caregiver who can meet her health needs at home. This includes a skilled provider who will administer intravenous medications at home should she be discharged with such medications. Mrs. R can be discharged to rehabilitation facilities to help her overcome her substance use problem. She can be discharged from the hospital to respite care should she have difficulties in meeting their daily needs due to her illness. The qualifications for a smooth transition to the next level of care include care coordination, multidisciplinary collaboration, active patient involvement, and ready access to patient data for different providers involved in Mrs. R’s care. |
| Explain how the rehabilitation resources, including medication management, and modifications will assist the patient’s transition to promote independence and prevent readmission. | Rehabilitation resources such as medication management promote optimum disease management and improved treatment adherence. Treatment adherence would reduce the risk of adverse outcomes in Mrs. R’s management, hence, reducing the hospitalization rate and emergency department visits. Resources such as telehealth would ensure Mrs. R’s timely access to specialized care and support, which would lower the risk of adverse events (Kitzman et al., 2021). Telehealth facilitates virtual patient-provider interaction, assessment, treatment, monitoring, and evaluation. |
| Pathophysiological Changes Discuss the pathophysiological changes that come with Mrs. R.’s long-term tobacco use. | |
| Long-term tobacco use is associated with significant adverse health effects. Studies have shown that long-term tobacco use causes endothelial dysfunction. It also predisposes individuals to thrombotic and atherogenic problems that are associated with ischemic conditions such as stroke and coronary syndrome. Long-term tobacco use also affects the blood-brain barrier. Evidence shows that tobacco smoke causes leaky brain micro-vessels and altered blood-brain barrier integrity. This leads to an increased risk of silent cerebral infarction and stroke. The additional effects of long-term tobacco use include insulin resistance, hemodynamic alterations, alterations in the lipid profile, and hypercoagulable state in the affected patients (El-Mahdy et al., 2021). | |
| COPD Triggers and Options for Smoking Cessation Discuss options for smoking cessation education. | |
| What options for smoking cessation should be offered to Mrs. R? | Several options for smoking cessation exist for Mrs. R. They include nicotine replacement therapy, bupropion, varenicline, or behavioral therapies. |
| Explain the COPD triggers that can increase exacerbation frequency, resulting in readmission. | Some of the COPD triggers that can increase exacerbation frequency and result in readmission include cigarette smoking, illnesses such as pneumonia, exposure to dust or fumes, allergens, and extreme temperature changes (Ji et al., 2022). These triggers are stressors that cause inflammatory processes that are associated with COPD development and symptoms. |
References
Drenth-van Maanen, A. C., Wilting, I., & Jansen, P. A. F. (2020). Prescribing medicines to older people—How to consider the impact of ageing on human organ and body functions. British Journal of Clinical Pharmacology, 86(10), 1921–1930. https://doi.org/10.1111/bcp.14094
El-Mahdy, M. A., Mahgoup, E. M., Ewees, M. G., Eid, M. S., Abdelghany, T. M., & Zweier, J. L. (2021). Long-term electronic cigarette exposure induces cardiovascular dysfunction similar to tobacco cigarettes: Role of nicotine and exposure duration. American Journal of Physiology-Heart and Circulatory Physiology, 320(5), H2112–H2129. https://doi.org/10.1152/ajpheart.00997.2020
Goel, S. K. (2021). Hepatic parameters in congestive heart failure patients: A prospective study. Journal of Advanced Medical and Dental Sciences Research, 9(4). http://jamdsr.com/uploadfiles/37vol9issue4pp162-166.20211215042656.pdf
Hailu, B. Y., Berhe, D. F., Gudina, E. K., Gidey, K., & Getachew, M. (2020). Drug related problems in admitted geriatric patients: The impact of clinical pharmacist interventions. BMC Geriatrics, 20(1), 13. https://doi.org/10.1186/s12877-020-1413-7
Irgashev, I. E. (2023). “Pathological Physiology of Heart Failure.” American Journal of Pediatric Medicine and Health Sciences (2993-2149), 1(8), Article 8.
Ji, S., Dai, M.-Y., Huang, Y., Ren, X.-C., Jiang, M.-L., Qiao, J.-P., Zhang, W.-Y., Xu, Y.-H., Shen, J.-L., Zhang, R.-Q., & Fei, G.-H. (2022). Influenza a virus triggers acute exacerbation of chronic obstructive pulmonary disease by increasing proinflammatory cytokines secretion via NLRP3 inflammasome activation. Journal of Inflammation, 19(1), 8. https://doi.org/10.1186/s12950-022-00305-y
Kario, K., & Williams, B. (2021). Nocturnal Hypertension and Heart Failure: Mechanisms, Evidence, and New Treatments. Hypertension, 78(3), 564–577. https://doi.org/10.1161/HYPERTENSIONAHA.121.17440
Kitzman, D. W., Whellan, D. J., Duncan, P., Pastva, A. M., Mentz, R. J., Reeves, G. R., Nelson, M. B., Chen, H., Upadhya, B., Reed, S. D., Espeland, M. A., Hewston, L., & O’Connor, C. M. (2021). Physical Rehabilitation for Older Patients Hospitalized for Heart Failure. New England Journal of Medicine, 385(3), 203–216. https://doi.org/10.1056/NEJMoa2026141
Remien, K., & Bowman, A. (2024). Fluticasone. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK542161/
Schwinger, R. H. G. (2021). Pathophysiology of heart failure. Cardiovascular Diagnosis and Therapy, 11(1), 263–276. https://doi.org/10.21037/cdt-20-302
Sindone, A. P., De Pasquale, C., Amerena, J., Burdeniuk, C., Chan, A., Coats, A., Hare, D. L., Macdonald, P., Sverdlov, A., & Atherton, J. J. (2022). Consensus statement on the current pharmacological prevention and management of heart failure. Medical Journal of Australia, 217(4), 212–217. https://doi.org/10.5694/mja2.51656
Townsend, N., Kazakiewicz, D., Lucy Wright, F., Timmis, A., Huculeci, R., Torbica, A., Gale, C. P., Achenbach, S., Weidinger, F., & Vardas, P. (2022). Epidemiology of cardiovascular disease in Europe. Nature Reviews Cardiology, 19(2), 133–143. https://doi.org/10.1038/s41569-021-00607-3
NRS 455 Case Study Mrs. T. Sample Answer
Case Study: Mrs. T.
Critical Thinking Table
Clinical Manifestations Describe the clinical manifestations present in Mrs. T., focusing on what is normal and abnormal and how this relates to her current condition. | |
Subjective | Nurses working with patients should obtain subjective and objective data to guide them in decision-making. Subjective data refers to the information the patient or others give about the health problem. The abnormal subjective manifestations in the case study include Mrs. T not acting like herself and the information that the symptoms were sudden and lasted 5 minutes. The symptoms developed from changes in brain tissue perfusion, mimicking those seen in patients with a transient ischemia attack (Panuganti et al., 2024). |
Objective | Healthcare providers obtain objective information. Some of the abnormal objective manifestations include elevated blood pressure, pulse, blood glucose, NIHSS score, and cholesterol level. It also includes the inspection findings by the nurse such as mumbling something, her right arm appearing limp, slackening the right side of her face, not making sense when talking, and denying pain. These symptoms arise from the impaired blood supply to a brain region. For example, the slacking of the night side of her face implies that the left side of the brain is involved in the disease process. Symptoms such as elevated blood pressure and glucose are physiological responses to ensure adequate brain tissue oxygenation and supply of essential nutrients (Panuganti et al., 2024). The cholesterol levels are elevated because of hyperlipidemia. |
Primary and Secondary Diagnoses Discuss the primary and secondary medical diagnoses that should be considered for Mrs. T., and why you chose this diagnosis. | |
Primary medical diagnosis and why you chose this diagnosis. | Transient ischemic attack is the primary diagnosis for Mrs. T. Transient ischemic attack is a sudden episode of neurologic dysfunction because of focal brain, retinal, or spinal cord ischemia without tissue injury or acute infarction. The symptoms of transient ischemic attack last less than an hour and are minutes in most cases. The risk of stroke is high following a transient ischemia attack. Patients experience symptoms such as speech disturbance and focal neurological deficits (Mendelson & Prabhakaran, 2021). Mrs. T developed symptoms of neurological deficits such as facial paralysis, speech disturbances, and arm weakness with normal brain CT scan findings. The symptom duration was five minutes. This means that transient ischemic attack is the primary diagnosis for her. |
Secondary medical diagnosis and why you chose this diagnosis. | The secondary medical diagnosis I would consider for Mrs. T is a stroke. A stroke is a medical emergency that develops from the occlusion of blood supply to the brain or bleeding to the brain. There is impaired tissue oxygenation in the brain, which causes cell death and loss of function in the affected brain areas. Patients with stroke present to the hospital with symptoms such as paralysis, facial drooping, speech impairment, difficulty coordinating movements, and numbness and weakness among others. They also have abnormal CT and MRI scans of the brain (Amarenco, 2020). Despite Mrs. T having symptoms seen in stroke, stroke is the least likely diagnosis because of the normal brain imaging results. |
Formulate a nursing diagnosis from the medical diagnoses | One of the nursing diagnoses that can be developed from the medical diagnoses is ineffective brain tissue perfusion related to the interrupted blood supply to the brain as evidenced by speech difficulty. |
Pathophysiological Changes Explain the pathophysiological changes in Mrs. T. | |
What pathophysiological changes would you expect to be happening to Mrs. T.? | Mrs. T experienced a transient interruption of arterial blood supply to the brain. The interruption affected the functioning of the brain area supplied by the artery. The sources of interruption could be due to ischemia or mild bleeding in the artery to the brain. Besides, cardiac embolism could have caused an interrupted blood supply to the brain. The emboli in the cardiac chamber could impede the normal blood supply to the brain, leading to ischemia (Grotta et al., 2021). The cessation in blood supply affects the functioning of the brain supplied by the artery, hence, symptoms such as paralysis, speech difficulty, and inability to move. |
How will pathophysiological changes transition in the subacute phase after diagnosis and initial treatment? | Diagnosis and initial treatment will prevent the progression of transient ischemic attack to a stroke. Early treatment will reduce the risk of early stroke. Studies show that the risk of patients developing stroke within 3 months of a transient ischemic attack is 20% with at least 50% of them occurring within 2 days of a transient ischemic attack. Diagnosis and treatment of other comorbidities such as atrial fibrillation and hyperlipidemia significantly reduce the risk of disease progression to stroke (Ortiz-Garcia et al., 2022). Treatments such as the use of aspirin and clopidogrel provide the appropriate antiplatelet therapy that prevents blood clot formation and subsequently stroke development. |
Health Status Effect Describe the effects Mrs. T.’s current health status may have on her. | |
Describe the physical, psychological, and emotional effects Mrs. T.’s current health status may have on her. | Mrs. T’s current health status might be associated with considerable physical, psychological, and emotional health effects. One of the physical effects of transient ischemic attack is the increased risk of subsequent attacks and progression to a stroke. Such risks predispose her to premature disability, decreased functioning, poor quality of life, and premature death. Mrs. T is also likely to suffer from increased care demands. Patients with transient ischemic attacks incur high healthcare costs due to frequent hospitalizations and hospital visits. Some patients diagnosed with transient ischemic attacks have to make changes such as reducing the number of hours worked and avoiding driving for long distances, which affect their financial status and overall functioning. The transient ischemic attack also affects social relationships (Katzan et al., 2021). The diagnosis increases anxiety in others and lowers intimate relationships since the suitability for different contraceptive methods changes. A diagnosis of a transient ischemic attack also has considerable psychological and emotional health impacts. For example, the diagnosis brings significant uncertainty and anxiety for patients and their significant others. The increased risk of stroke makes patients anxious and at times depressed, which affects the overall treatment outcomes. The risk of stress among patients with transient ischemic attack is also high due to decreased functioning, poor quality of life, and fear of unknown outcomes (Prost et al., 2021). Therefore, strategies to minimize the impacts of the diagnosis on health should be adopted. |
Discuss the impact it can have on her role in the family. | The diagnosis of a transient ischemic attack affects Mrs. T’s role in the family. Firstly, it affects her contribution to her family’s financial status. A diagnosis of a transient ischemic attack might imply that Mrs. T has to work fewer hours than usual to prevent the risk of complications due to stress. This would reduce her financial status and contribution to the family. Mrs. T’s diagnosis is also likely to act as a source of financial strain for the family. Patients with transient ischemic attack can develop stroke and require frequent hospital visits and hospitalization. The changes can have a considerable financial toll on the family. The diagnosis also affects the social and emotional well-being of the family. Mrs. T’s family members are anxious and fearful of unknown outcomes associated with the diagnosis. The fact that a transient ischemic attack could progress to a stroke acts as a stressor for the family members (ANDERSSON et al., 2021; Tsalta-Mladenov & Andonova, 2021). The diagnosis also affects Mrs. T’s intimate relationships. In this case, she has to consider the suitability of different contraceptive options, which would affect her sexual life with her partner. |
Treatments and Support Discuss treatments and support that can be completed for Mrs. T. | |
Discuss the immediate treatments that can be completed for Mrs. T. | Immediate medical therapy should be implemented for Mrs. T. Firstly, antiplatelet therapy should be initiated for Mrs. T. Antiplatelets effectively prevent stroke in high-risk patients. The therapy has positive outcomes on vascular death, nonfatal stroke, and non-fatal myocardial infarction. Some of the antiplatelet medications that might be prescribed include aspirin, ticlopidine, and dipyridamole. Combined or dual antiplatelet therapy should also be considered for Mrs. T. This includes combining drugs such as clopidogrel and aspirin to improve outcomes. Underlying etiologies should also be treated. This includes hypertension, hyperlipidemia, and hyperglycemia. Revascularization might be considered if Mrs. T is diagnosed with symptomatic cervical internal carotid artery stenosis. Oral anticoagulation should be considered if Mrs. T is diagnosed with atrial fibrillation (Mendelson & Prabhakaran, 2021). |
Describe the long-term support she may need to return to the baseline activity level. | Mrs. T requires a range of long-term support services for her to return to her baseline activity level. One of them is rehabilitation services. Mrs. T might suffer impaired normal functioning such as difficulty with speech and movement after the treatment. As a result, she might require long-term rehabilitation services such as occupational, speech, and physical therapy to help her achieve the desired functioning level. The second aspect of long-term support that Mrs. T requires is psychological support. Decreased functioning and poor quality of life predispose Mrs. T to adverse psychological outcomes such as depression and anxiety disorders. The nurse must ensure that Mrs. T accesses psychological support services, including support groups and counseling to help her cope with changes brought by the disease. Mrs. T also required medical management as part of the long-term support for her to return to baseline functioning (Ali et al., 2021). She should be actively followed and supported to ensure treatment adherence and compliance for optimum outcomes and prevention of stroke and other complications. |
Explain how the interdisciplinary team is utilized to help her family support and cope with her diagnosis. | The interdisciplinary team is utilized to help Mrs. And her family support and cope with her diagnosis. Interdisciplinary team members such as counselors will equip Mrs. T and her family knowledge and skills needed to overcome the psychological impacts of the diagnosis. The counselor will also link them to social support services, which would improve their coping with the increasing demands of the diagnosis. Interdisciplinary team members such as nurses will support the coping with the diagnosis by providing close follow-up, continuous health education, and ensuring adherence to treatment adherence, lifestyle, and behavioral modifications. They will also implement nurse-led interventions for self-management of transient ischemic attacks to prevent complications and worsening health status. Interdisciplinary team members such as physicians will evaluate the effectiveness of the adopted treatments and recommend changes or improvements in the treatment plans (Nardai et al., 2021). They will also recommend rehabilitation services such as speech and occupational therapy, which will help the patient and family cope with the diagnosis and its demands. |
References
Ali, A., Tabassum, D., Baig, S. S., Moyle, B., Redgrave, J., Nichols, S., McGregor, G., Evans, K., Totton, N., Cooper, C., & Majid, A. (2021). Effect of Exercise Interventions on Health-Related Quality of Life After Stroke and Transient Ischemic Attack. Stroke, 52(7), 2445–2455. https://doi.org/10.1161/STROKEAHA.120.032979
Amarenco, P. (2020). Transient Ischemic Attack. New England Journal of Medicine, 382(20), 1933–1941. https://doi.org/10.1056/NEJMcp1908837
ANDERSSON, J., STÅLNACKE, B.-M., SÖRLIN, A., MAGAARD, G., & HU, X. (2021). LONG-TERM PERCEIVED DISABILITIES UP TO 10 YEARS AFTER TRANSIENT ISCHAEMIC ATTACK. Journal of Rehabilitation Medicine, 53(3), 2767. https://doi.org/10.2340/16501977-2808
Grotta, J. C., Albers, G. W., Broderick, J. P., Kasner, S. E., Lo, E. H., Sacco, R. L., Wong, L. K., & Day, A. L. (2021). Stroke E-Book: Pathophysiology, Diagnosis, and Management. Elsevier Health Sciences.
Katzan, I. L., Schuster, A., Daboul, L., Doherty, C., Speaker, S., Uchino, K., & Lapin, B. (2021). Changes in Health-Related Quality of Life After Transient Ischemic Attack. JAMA Network Open, 4(7), e2117403. https://doi.org/10.1001/jamanetworkopen.2021.17403
Mendelson, S. J., & Prabhakaran, S. (2021). Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke: A Review. JAMA, 325(11), 1088–1098. https://doi.org/10.1001/jama.2020.26867
Nardai, S., Lanzer, P., Abelson, M., Baumbach, A., Doehner, W., Hopkins, L. N., Kovac, J., Meuwissen, M., Roffi, M., Sievert, H., Skrypnik, D., Sulzenko, J., van Zwam, W., Gruber, A., Ribo, M., Cognard, C., Szikora, I., Flodmark, O., & Widimsky, P. (2021). Interdisciplinary management of acute ischaemic stroke: Current evidence training requirements for endovascular stroke treatment: Position Paper from the ESC Council on Stroke and the European Association for Percutaneous Cardiovascular Interventions with the support of the European Board of Neurointervention. European Heart Journal, 42(4), 298–307. https://doi.org/10.1093/eurheartj/ehaa833
Ortiz-Garcia, J., Gomez, C. R., Schneck, M. J., & Biller, J. (2022). Recent advances in the management of transient ischemic attacks. Faculty Reviews, 11, 19. https://doi.org/10.12703/r/11-19
Panuganti, K. K., Tadi, P., & Lui, F. (2024). Transient Ischemic Attack. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK459143/
Prost, A., Kubitz, K., Pelz, J., Hobohm, C., Hinz, A., & Michalski, D. (2021). Acute and long-term impairments regarding emotional symptoms and quality of life in patients suffering from transient ischemic attack and stroke. Neurological Research, 43(5), 396–405. https://doi.org/10.1080/01616412.2020.1866370
Tsalta-Mladenov, M., & Andonova, S. (2021). Health-related quality of life after ischemic stroke: Impact of sociodemographic and clinical factors. Neurological Research, 43(7), 553–561. https://doi.org/10.1080/01616412.2021.1893563