Understanding Older Patients
Question 1
Several clinical manifestations present in the patient. There is the presence of acute decompensated heart failure. This is due to a history of heart failure and sudden onset of disease (Kurmani & Squire, 2017). This is characterized by signs of right and left-sided heart failure. Shortness of breath and systolic failure that is evidenced by the presence of an audible s3 heartbeat shows possible left-sided failure while right-sided heart failure is evidenced by the presence of an enlarged liver – hepatomegaly. This is a sign of fluid buildup in the organ as a result of reduced pressure on the right-hand side. There is also the presence of a regular irregular heart rate of 34 which is a sign of tachycardia suggestive of heart failure.
Question 2
Furosemide is a diuretic used to deal with excess production of urine in emergencies and is not recommended for the elderly. Enalapril is used for the management of hypertension and the management of congestive heart failure which is appropriate for the patient. Metoprolol is used for control of heart failure and reduce the risk of death at the onset of heart failure. However, this medication is a risk with the patient due to a history of severe heart failure. Morphine is used for the treatment of pain but the patient does not complain of any pain and as such, might have been redundant. Inhaled short-acting bronchodilators are used to relieve sudden symptoms of lung congestion especially asthma which was necessary to reduce the shortness of breath in the patient. Inhaled corticosteroid has the long-term effect of reducing asthma and is necessary for the patient to reduce the inflammatory process of lungs. Oxygen delivery at 2 L/NC is appropriate for the slow delivery of oxygen which is appropriate for the patient’s shortness of breath.
Question 3
Hypertension, coronary heart disease, arrhythmia, and cardiomyopathy are four heart conditions that are linked to heart failure. Hypertension is a long-term condition characterized by elevated pressure in arteries. Nursing intervention that can be used is antihypertensive drug therapy and regular patient review. Coronary heart disease develops from the narrowing of the heart’s arteries due to the build-up of cholesterol in walls. Nursing interventions include the increase in oxygen delivery through pharmacological therapy. Cardiomyopathy is the weakening of the heart muscles leading to difficulty in pumping blood. Nursing intervention is reducing oxygen demand through bed rest and administration of diuretics. Arrhythmia is the abnormal heartbeat which creates more work for the heart. Nursing interventions include medication therapy and education on lifestyle changes.
Question 4
To reduce multiple drug interaction problems, there is a need to encourage lifestyle changes (Accetta, 2020). Engaging in physical activity can reduce symptoms and the need for using multiple medications for conditions such as hypertension. There is a need to for de-prescribing where medications are systematically reviewed and reduced with an emphasis of weighing risk and benefits. There is also a need to identify and reduce multiple drug prescriptions, especially where there is duplication to reduce overload. Finally, there is a need to have adequate drug prescription indications on the labels as a way of encouraging safe prescribing especially for older patients.
Question 5
There is a need to integrate the family into the process as a necessary support structure in the rehabilitation process. This step is necessary for reintegration into society. Finally, inter-professional collaboration with psychologists may be necessary to enable Mrs. J to gather her mental strength after a near-death experience. Some rehabilitation resources that can be used are physiotherapy which can help build the cardiovascular strength necessary for the development of an active lifestyle. This can be coupled with a heart patients’ support group for purposes of sharing and supporting each other in reintegration.
Question 6
To facilitate health, there is a need to provide information. As such, the first step is teaching Mrs. J on the existing conditions that she has. This can be done through the teach-back technique where she repeats the teaching in her understanding to promote understanding. This is supported by additional teaching materials which include brochures and demonstration. The teach-back method is patient-centered and allows the nurse to confirm the understanding of the patient by asking her to explain the concepts afterward. This can be good at enhancing self-management and increasing their accountability to their health. As such, some of the elements included in the education process includes the signs and symptoms, dieting, and other lifestyle changes that are necessary.
Question 7
Several COPD triggers exist that can lead to Mrs. J returning to the hospital. To begin with, there is cigarette smoking which she is highly susceptible to due to her high smoking rate. Other factors include indoor pollution, dust, and exposure to chemical fumes. To reduce her smoking rate, there are alternatives available. There is the presence of nicotine patches and gums which deliver the desired amount of nicotine for the same sensation as smoking. There is also the introduction of e-cigarettes that have been found to reduce the level of smoking and promote cessation.
References
Accetta, R. C. (2020). nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Today’s Geriatric Medicine. 9(2): 24
Kurmani, S., Squire, I. (2017). Acute Heart Failure: Definition, Classification, and Epidemiology. Current Heart Failure Reports.