Critical Thinking in Nursing
Nurses need to demonstrate a good knowledge about the pathophysiological process of illness, clinical manifestations, and treatment protocols include their effects on the patient over their lifetime. This essay evaluates the health and medical information related to Mrs. J based on the presented case information.
Relevant Nursing Intervention at Admission
Mrs. J appears to suffer from acute respiratory distress, as per the given data. Subjective data revealed that Mrs. J has anxiety, impending doom, exhaustion, and insufficient breathing air. These conditions are due to the accumulation of fluid in her lungs and pulmonary edema, which is causing hypoxia, compounded by a history of COPD, extensive smoking history, high blood pressure, and chronic heart failure. Objective data further confirm pulmonary distress as evidenced by pulmonary crackles, elevated respiratory rate, frothy sputum, faint PMI, and 82 percent pulse oximetry.
An immediate intervention at admission is to secure and maintain her airway, continuous pulse oximetry, and oxygen supplement using a non-breather mask. It is also vital to assess her ventilation need and warranted support. Immediate medications include intravenous IV fluids, but must be administered with extreme caution. The patient’s cardiac or telemetry to be monitored closely with pacer pads for possible cardioversion. A urinary catheter can be considered to monitor monitoring concise output on initiating diuretic therapy. The next therapy will include medications for correcting the retention of intravascular fluid and hemodynamic. There is also a need to assess the renal function and electrolyte status of the patient.
The rationale for administered medications
- Lasix is a diuretic medication administered to inhibit the reabsorption of chloride and sodium from the renal tubules. Medically, diuretic mobilizes excess fluid and diuresis to reduce blood pressure and improve oxygenation.
- Vasotec/enalapril is an antihypertensive drug used in combination with diuretic medicines to treat heart failure symptoms.
- Lopressor is also a hypertensive medication used alongside other drugs to treat heart failure. The medication relaxes blood vessels to improve the flow of blood, thereby slowing down blood pressure and heart rate.
- Morphine is an opioid analgesic used to manage pain, reduce anxiety, and shortness of breath, as indicated by Mrs. J. It works by altering the processes of the brain and nervous system.
Cardiovascular conditions leading to heart failure and relevant interventions
Most cardiac disorders progressively lead to heart failure. Coronary artery disease (CAD) and hypertension are the most disorders known to results in heart failure. The conditions are managed through lifestyle modification, including smoking cessation, physical exercise, and a healthy diet. These interventions are relevant in reducing CAD precursors like hyperlipidemia, diabetes, and obesity. Managing hypertension requires close monitoring and the use of antihypertensive drugs to control blood pressure.
Valvular and congenital heart defects can also cause heart failure. These defects are managed by medications that control possible arrhythmias and prevent infections like endocarditis using prophylactic antibiotics. Myocardial infarction can weaken and damage tissues of the heart leading to heart failure. It occurs when damaged tissues are unable to pump blood are required. The intervention for MI includes lifestyle change, such as diet, exercise, and smoking cessation. Patients are also required to maintain a healthy body to deter the development of heart failure precursors such as diabetes, hyperlipidemia, and obesity. Patients are advised to take prescribed drugs, including statins, anti-hypertension, and platelet medications.
A nursing intervention to prevent problems associated with multiple drug interactions
Today, most adults are taking multiple drugs, which puts them at risk of possible drug interactions. The use of multiple medications above five is known as polypharmacy. Polypharmacy can have a severe health implication on the patient, particularly to patent with reduced access to healthcare services and an infrequent visit to the care providers. Educating patients about the correct use of prescribed medication is the first and essential nursing intervention in mitigating possible drug interaction. A patient can be sensitized to avoid unnecessary use of OTC drugs. OTC medication can potentiate side effects and adverse outcomes after interacting with prescribed medications due to overdose or drug reactions.
The second nursing intervention can involve teaching the patient about storage techniques and daily dose or pill organizers to deter the chances of over and underdosing prescribed medications. The third intervention consists in using memory aids to ensure the timely taking of drugs by the patient to prevent possible drug interactions. Since the majority of older patients are struggling with memory loss, teaching them how to use memory aids such as cloak alarm will lead to the timely taking of prescribed drugs. The final intervention for avoiding possible interactions involves asking the patient to compile a list of all medications, including instruction for taking drugs. Advising an older patient to use one pharmacy in filling prescribed medication will add another safeguard against drug interactions.
Conclusion
The essay has evaluated the health and medical information related to Mrs. J based on the presented case information. The case analysis of Mrs. Has demonstrated my understanding and knowledge about the pathophysiological process of illness, clinical manifestations, and treatment protocols include their effects on the patient over their lifetime. In particular, it reveals my ability to administer immediate treatment to the patient at admission and subsequent medication based on a patient’s health history and medical information.
References
American Heart Association. (2018). Heart failure. Retrieved from http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp
Copstead, L. & Banasik, J. (2013). Pathophysiology. (5 thed.). St. Louis, MO: Elsevier
Medline Plus. (2018). Drugs, herbs, and supplements. Retrieved from https://medlineplus.gov/druginformation.html
UpToDate. (2018). Treatment of acute decompensated heart failure. Retrieved from https://www.uptodate.com/contents/treatment-of-acute-decompensated-heart-failure-components-of-therapy
Woodruff, K. (2010). Preventing polypharmacy in older adults. American Nurse Today 5(10). Retrieved from https://www.americannursetoday.com/preventing-polypharmacy-in-older-adults/