NRS-410V Module 3 – Mrs. J Case Study

Pathophysiology and Nursing Management
of Clients Health Alterations of Hematology and Cardiovascular Systems

Use
the following Case Scenario, Subjective Data, and Objective Data to answer the
Critical Thinking Questions.

Case Scenario

Mrs. J. is a 63-year-old woman who
has a history of hypertension, chronic heart failure, and sleep apnea. She has
been smoking two packs of cigarettes a day for 40 years and has refused to
quit. Three days ago, she had an onset of flu with fever, pharyngitis, and
malaise. She has not taken her antihypertensive medications or her medications
to control her heart failure for 4 days. Today, she has been admitted to the
hospital ICU with acute decompensated heart failure.

Subjective Data

1.
Is very anxious and asks whether she
is going to die.

2.
Denies pain but says she feels like
she cannot get enough air.

3.
Says her heart feels like it is
“running away.”

4.
Reports that she is so exhausted she
cannot eat or drink by herself.

Objective Data

1.
Height 175 cm; Weight 95.5 kg

2.
Vital signs: T 37.6 C, HR 118 and
irregular, RR 34, BP 90/58

3.
Cardiovascular: Distant S1, S2, S3,
S4 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

4.
Respiratory: Pulmonary crackles;
decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum;
SpO2 82%

5.
Gastrointestinal: BS present:
hepatomegaly 4 cm below costal margin

Critical Thinking Questions

What nursing interventions are
appropriate for Mrs. J. at the time of her admission? Drug therapy is started
for Mrs. J. to control her symptoms. What is the rationale for the administration
of each of the following medications?

1.
IV furosemide (Lasix)

2.
Enalapril (Vasotec)

3.
Metoprolol (Lopressor)

4.
IV morphine sulphate (Morphine)

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 rationale for each of the
interventions you recommend.

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