Case Study: Mrs. R.
Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit this completed template to the assignment dropbox.
Case Study: Mrs. R.
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. R., presented below.
Health History and Medical Information
Mrs. R. is a 68-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 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. |
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| Subjective | |
| Objective | |
| Cardiovascular Conditions Leading to Heart Failure
Describe cardiovascular conditions in which Mrs. R. is at risk. |
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| Describe four cardiovascular conditions in which Mrs. R. is at risk and that may lead to heart failure. | |
| Discuss any comorbidities Mrs. R. displays. | |
| How do these conditions increase her chance 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. | |
| Evaluation of Nursing Interventions at Admissions
Discuss the initial assessments and interventions provided to Mrs. R. |
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| According to the nursing process, were the initial assessments and interventions at the time of admission beneficial for Mrs. R? | |
| Discuss changes to any of the initial assessments or interventions you would make to ensure patient independence and prevent readmission. | |
| 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. |
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| 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). | |
| 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. | |
| Health Promotion and Restoration Teaching Plan
Develop a multidisciplinary health promotion and restoration teaching plan for Mrs. R. |
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| Discuss the steps needed to move the patient from acute care to subacute care, before discharging home and beginning a rehabilitation process. | |
| Discuss alternative discharge options and qualifications to facilitate a smooth transition to the next level of care. | |
| Explain how the rehabilitation resources, including medication management, and modifications will assist the patient’s transition to promote independence and prevent readmission. | |
| Pathophysiological Changes
Discuss the pathophysiological changes that come with Mrs. R.’s long-term tobacco use. |
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| COPD Triggers and Options for Smoking Cessation
Discuss options for smoking cessation education. |
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| What options for smoking cessation should be offered to Mrs. R? | |
| Explain the COPD triggers that can increase exacerbation frequency, resulting in readmission. | |
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