Describe the clinical manifestations present in Mrs. R., focusing on the normal and abnormal findings and how this relates to his current condition.

Question

Dan Palmer · Accepted Answer

Clinical Manifestations Subjective; Dyspnea or breathlessness is one of the manifestations seen with Mrs. R, with worsening COPD being a potential cause of this symptom. A sensation of increased heartbeat which signifies impaired functioning of the heart. Tiredness and weakness: She needs assistance with activities of daily living.     Objective Failure of the right side of the heart due to the enlargement of the live. 82% oxygen saturation: Signifies the deterioration of COPD, resulting to low saturation of oxygen. Normal saturation goes beyond 95%. Pulmonary congestion: Indicated by the presence of sputum that is blood-tinged. The other sign is the pulmonary crackles which could be linked to impaired respiration. Fluid overload: This is evidenced by S3 heart sound.   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. Atrial fibrillation: A condition in which the heart beats rapidly affecting the flow of blood. It manifests as tiredness and breathlessness. Chronic heart failure: Characterized by infective pumping of the blood, resulting to the fluid buildup in the lungs.  Elevated blood pressure: A condition that results to elevation of the force of the blood that pushes against the walls of arteries, causing the risk of stroke and other conditions (Bollmeier & Hartmann, 2020). COPD: It is marked by the disruption of airflow into the lungs, which causes one to struggle with breathing. Discuss any comorbidities Mrs. R. displays. Hypertension is one of the comorbidities that are seen with the patient. As comorbidity in this case, the elevated blood pressure increases the patient’s chances of experiencing worsened heart failure.    How do these conditions increase her chance of heart failure? Atrial fibrillation: The heart failure worsens due to the spike in myocardial oxygen demand which is linked to the unbalanced ventricular rate. Chronic heart failure: Her heart failure problem has progressively deteriorated. Elevated blood pressure: Buildup of pressure causes the left ventricles’ heart muscles to thicken, resulting to more workload which eventually causes heart failure. COPD: With worsening COPD, the pulmonary pressure increases, straining the left ventricle (Bollmeier & Hartmann, 2020). What can be done by way of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions. Using antihypertensive pharmacological agents like olmesartan to stabilize and maintain normal blood pressure. To address the heart failure, routinely administer furosemide or any other diuretic to improve cardiac performance by reducing the workload on the heart (Bollmeier & Hartmann, 2020). Administer atenolol or any beta-blocker to prevent the heart from straining in atrial fibrillation. This drug works by controlling the heart’s rhythm. Encourage the use of bronchodilator to help aerate the lungs. Also educate the patient about smoking and COPD risk. 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 were appropriate for the patient. Considering Mrs. R’s hypotension and hypoxemia that she presented with, it makes sense to examine whether her cardiac and respiratory body functions are stable. Thus, monitoring the saturation of oxygen including collecting vital signs was helpful. The physical exam in which the patient was examined for hepatomegaly was also beneficial in the sense that it helped determine fluid overload. The information drawn from this assessment helped inform whether using diuretics was necessary. The initial assessment also involved identifying atrial fibrillation which was necessary in terms of identifying the risk of heart failure.    Discuss changes to any of the initial assessments or interventions you would make to ensure patient independence and prevent readmission. I would adjust the flow of oxygen, ensuring that the patient receives adequate oxygen. To lessen the breathing problems linked to anxiety, I would administer buspirone. This drug reduces the clinical manifestations of anxiety.  Because fluid overload impairs breathing and oxygen circulation by hampering cardiac output, I would administer bumetanide, a diuretic that controls this clinical issue. I would monitor electrolytes due to the bumetanide’s role in release of electrolytes through urine. In addition to making changes to the interventions, I would stress the importance of adherence to the prescription information.     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). As a loop diuretic, furosemide triggers the production of urine by reabsorbing chloride, and with this mechanism of action, it helps ease breathing, optimizing cardiac output. This is because it lessens pulmonary edema by reducing fluid overload. A beta-blocker like Metoprolol blocks adrenoceptors, lessening the ability of the heart muscles to contract while decreasing the pulse rate (Cong et al., 2023). This helps normalize the heart rhythm, calming myocardial contractility. Enalapril is part of the medications known as ACE inhibitors which helps control blood pressure, reducing the amount of work the heart does. It does this through a process of conversion of angiotensin II from angiotensin I. Given the impact of this drug on blood pressure, it prevents exacerbations linked to the spike in blood pressure (Cong et al., 2023). Being an opioid analgesic, morphine acts on receptors linked to opioid, a mechanism that causes the blood vessels to widen, resulting to optimal flow of blood. Because the circulation of oxygen is adequate with normal blood pressure, one is able to experience normal breathing. ProAir HFA classifies as a SABA. This medication triggers the increase in the aeration of the lungs by stimulating the lungs’ beta-2 receptors. This implies that it addresses breathing problem resulting from COPD (Zhu et al., 2023). As a corticosteroid, Flovent HFA prevents COPD-based complications considering that it prevents airways from being inflamed. The supplemental oxygen, 2L/NC supplements the already administered oxygen to better aerate the lungs, and address the breathing difficulties.          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. Patient education: Educate the patient about the significance of each of the prescribed medication, stressing the importance of adherence including the effective use of medications. This helps improve effective use of drugs. Reconcile the drugs: Verify every medication, ensuring that the patient received the right drugs. The goal is to prevent the duplication of drugs, which can worsen the side effects (Bories et al., 2021). Routinely monitor Mrs. R’s progress, examining signs of adverse drug events like sedation or change in mood. This allows the provider to intervene before the side effects cause major health events. Engage a pharmacist in preparing a plan of care. With their knowledge in pharmacy, they can be resourceful in preparing an effective treatment plan.   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. Start by stabilizing the cardiac and respiratory symptoms. Prepare a plan, detailing the medications and the frequency of the dosage. Prepare the patient for physiotherapy to help her manage ADLs. Work with social workers to help the patient access support like homecare services.   Discuss alternative discharge options and qualifications to facilitate a smooth transition to the next level of care. Connect the patient with programs and social services to provide them with further support including rehabilitation. The goal is to improve the patient’s recovery. These services include: Cardiopulmonary rehabilitation programs. Home health services. Nursing home.   Explain how the rehabilitation resources, including medication management, and modifications will assist the patient's transition to promote independence and prevent readmission. Linking the patient with resources with information on how to manage medications can help her understand why it is important to follow prescription information when taking her medications (Cross et al., 2020). Information related to nutrition and lifestyle can compel the patient to make changes to their diet.   Pathophysiological Changes Discuss the pathophysiological changes that come with Mrs. R.'s long-term tobacco use. Prolonged smoking compromises Mrs. R’s immunity, predisposing her to the risk of infections like tuberculosis. This behavior causes erosion of the blood vessels, weakening the heart’s ability to control blood pressure. This in turn exacerbates high blood pressure. With excessive smoking, the lungs inflame, causing further exacerbation of the COPD.   COPD Triggers and Options for Smoking Cessation Discuss options for smoking cessation education. What options for smoking cessation should be offered to Mrs. R? Mrs. R can benefit from a wide range of treatment options for her smoking problem. The use of bupropion in management of cravings is one of these options. The other option is introducing nicotine replacement therapy. Explain the COPD triggers that can increase exacerbation frequency, resulting in readmission. Exposure of Mrs. R to cold weather coupled with allergens can trigger COPD. A respiratory infection can also trigger the COPD-based symptoms.   References Bollmeier, S. G., & Hartmann, A. P. (2020). Management of chronic obstructive pulmonary disease: A review focusing on exacerbations. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 77(4), 259–268. https://doi.org/10.1093/ajhp/zxz306. Bories, M., Bouzillé, G., Cuggia, M., & Le Corre, P. (2021). Drug-Drug Interactions in Elderly Patients with Potentially Inappropriate Medications in Primary Care, Nursing Home and Hospital Settings: A Systematic Review and a Preliminary Study. Pharmaceutics, 13(2), 266. https://doi.org/10.3390/pharmaceutics13020266. Cong, L., Ren, Y., Hou, T., Han, X., Dong, Y., Wang, Y., Zhang, Q., Liu, R., Xu, S., Wang, L., Du, Y., & Qiu, C. (2020). Use of Cardiovascular Drugs for Primary and Secondary Prevention of Cardiovascular Disease Among Rural-Dwelling Older Chinese Adults. Frontiers in pharmacology, 11, 608136. https://doi.org/10.3389/fphar.2020.608136. Cross, A. J., Elliott, R. A., Petrie, K., Kuruvilla, L., & George, J. (2020). Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. The Cochrane database of systematic reviews, 5(5), CD012419. https://doi.org/10.1002/14651858.CD012419.pub2.  Zhu, J. Z., Manne-Goehler, J., Agarwal, A., Bahendeka, S. K., Damasceno, A., Marcus, M. E., Saeedi Moghaddam, S., Vollmer, S., Huffman, M. D., Flood, D., & Global Health & Population Project on Access to Care for Cardiometabolic Disease (HPACC) (2023). Medication Use for Cardiovascular Disease Prevention in 40 Low- and Middle-Income Countries. Journal of the American College of Cardiology, 81(6), 620–622. https://doi.org/10.1016/j.jacc.2022.12.003.

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	Dyspnea or breathlessness is one of the manifestations seen with Mrs. R, with worsening COPD being a potential cause of this symptom. A sensation of increased heartbeat which signifies impaired functioning of the heart. Tiredness and weakness: She needs assistance with activities of daily living.
Objective	Failure of the right side of the heart due to the enlargement of the live. 82% oxygen saturation: Signifies the deterioration of COPD, resulting to low saturation of oxygen. Normal saturation goes beyond 95%. Pulmonary congestion: Indicated by the presence of sputum that is blood-tinged. The other sign is the pulmonary crackles which could be linked to impaired respiration. Fluid overload: This is evidenced by S3 heart sound.
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.	Atrial fibrillation: A condition in which the heart beats rapidly affecting the flow of blood. It manifests as tiredness and breathlessness. Chronic heart failure: Characterized by infective pumping of the blood, resulting to the fluid buildup in the lungs. Elevated blood pressure: A condition that results to elevation of the force of the blood that pushes against the walls of arteries, causing the risk of stroke and other conditions (Bollmeier & Hartmann, 2020). COPD: It is marked by the disruption of airflow into the lungs, which causes one to struggle with breathing.
Discuss any comorbidities Mrs. R. displays.	Hypertension is one of the comorbidities that are seen with the patient. As comorbidity in this case, the elevated blood pressure increases the patient’s chances of experiencing worsened heart failure.
How do these conditions increase her chance of heart failure?	Atrial fibrillation: The heart failure worsens due to the spike in myocardial oxygen demand which is linked to the unbalanced ventricular rate. Chronic heart failure: Her heart failure problem has progressively deteriorated. Elevated blood pressure: Buildup of pressure causes the left ventricles’ heart muscles to thicken, resulting to more workload which eventually causes heart failure. COPD: With worsening COPD, the pulmonary pressure increases, straining the left ventricle (Bollmeier & Hartmann, 2020).
What can be done by way of medical/nursing interventions to prevent the development of heart failure in each of the presented conditions.	Using antihypertensive pharmacological agents like olmesartan to stabilize and maintain normal blood pressure. To address the heart failure, routinely administer furosemide or any other diuretic to improve cardiac performance by reducing the workload on the heart (Bollmeier & Hartmann, 2020). Administer atenolol or any beta-blocker to prevent the heart from straining in atrial fibrillation. This drug works by controlling the heart’s rhythm. Encourage the use of bronchodilator to help aerate the lungs. Also educate the patient about smoking and COPD risk.
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 were appropriate for the patient. Considering Mrs. R’s hypotension and hypoxemia that she presented with, it makes sense to examine whether her cardiac and respiratory body functions are stable. Thus, monitoring the saturation of oxygen including collecting vital signs was helpful. The physical exam in which the patient was examined for hepatomegaly was also beneficial in the sense that it helped determine fluid overload. The information drawn from this assessment helped inform whether using diuretics was necessary. The initial assessment also involved identifying atrial fibrillation which was necessary in terms of identifying the risk of heart failure.
Discuss changes to any of the initial assessments or interventions you would make to ensure patient independence and prevent readmission.	I would adjust the flow of oxygen, ensuring that the patient receives adequate oxygen. To lessen the breathing problems linked to anxiety, I would administer buspirone. This drug reduces the clinical manifestations of anxiety. Because fluid overload impairs breathing and oxygen circulation by hampering cardiac output, I would administer bumetanide, a diuretic that controls this clinical issue. I would monitor electrolytes due to the bumetanide’s role in release of electrolytes through urine. In addition to making changes to the interventions, I would stress the importance of adherence to the prescription information.
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).	As a loop diuretic, furosemide triggers the production of urine by reabsorbing chloride, and with this mechanism of action, it helps ease breathing, optimizing cardiac output. This is because it lessens pulmonary edema by reducing fluid overload. A beta-blocker like Metoprolol blocks adrenoceptors, lessening the ability of the heart muscles to contract while decreasing the pulse rate (Cong et al., 2023). This helps normalize the heart rhythm, calming myocardial contractility. Enalapril is part of the medications known as ACE inhibitors which helps control blood pressure, reducing the amount of work the heart does. It does this through a process of conversion of angiotensin II from angiotensin I. Given the impact of this drug on blood pressure, it prevents exacerbations linked to the spike in blood pressure (Cong et al., 2023). Being an opioid analgesic, morphine acts on receptors linked to opioid, a mechanism that causes the blood vessels to widen, resulting to optimal flow of blood. Because the circulation of oxygen is adequate with normal blood pressure, one is able to experience normal breathing. ProAir HFA classifies as a SABA. This medication triggers the increase in the aeration of the lungs by stimulating the lungs’ beta-2 receptors. This implies that it addresses breathing problem resulting from COPD (Zhu et al., 2023). As a corticosteroid, Flovent HFA prevents COPD-based complications considering that it prevents airways from being inflamed. The supplemental oxygen, 2L/NC supplements the already administered oxygen to better aerate the lungs, and address the breathing difficulties.
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.	Patient education: Educate the patient about the significance of each of the prescribed medication, stressing the importance of adherence including the effective use of medications. This helps improve effective use of drugs. Reconcile the drugs: Verify every medication, ensuring that the patient received the right drugs. The goal is to prevent the duplication of drugs, which can worsen the side effects (Bories et al., 2021). Routinely monitor Mrs. R’s progress, examining signs of adverse drug events like sedation or change in mood. This allows the provider to intervene before the side effects cause major health events. Engage a pharmacist in preparing a plan of care. With their knowledge in pharmacy, they can be resourceful in preparing an effective treatment plan.
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.	Start by stabilizing the cardiac and respiratory symptoms. Prepare a plan, detailing the medications and the frequency of the dosage. Prepare the patient for physiotherapy to help her manage ADLs. Work with social workers to help the patient access support like homecare services.
Discuss alternative discharge options and qualifications to facilitate a smooth transition to the next level of care.	Connect the patient with programs and social services to provide them with further support including rehabilitation. The goal is to improve the patient’s recovery. These services include: Cardiopulmonary rehabilitation programs. Home health services. Nursing home.
Explain how the rehabilitation resources, including medication management, and modifications will assist the patient’s transition to promote independence and prevent readmission.	Linking the patient with resources with information on how to manage medications can help her understand why it is important to follow prescription information when taking her medications (Cross et al., 2020). Information related to nutrition and lifestyle can compel the patient to make changes to their diet.
Pathophysiological Changes Discuss the pathophysiological changes that come with Mrs. R.’s long-term tobacco use.
Prolonged smoking compromises Mrs. R’s immunity, predisposing her to the risk of infections like tuberculosis. This behavior causes erosion of the blood vessels, weakening the heart’s ability to control blood pressure. This in turn exacerbates high blood pressure. With excessive smoking, the lungs inflame, causing further exacerbation of the COPD.
COPD Triggers and Options for Smoking Cessation Discuss options for smoking cessation education.
What options for smoking cessation should be offered to Mrs. R?	Mrs. R can benefit from a wide range of treatment options for her smoking problem. The use of bupropion in management of cravings is one of these options. The other option is introducing nicotine replacement therapy.
Explain the COPD triggers that can increase exacerbation frequency, resulting in readmission.	Exposure of Mrs. R to cold weather coupled with allergens can trigger COPD. A respiratory infection can also trigger the COPD-based symptoms.

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
Objective
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.
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.
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.
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.
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.

COPD Triggers and Options for Smoking Cessation Discuss options for smoking cessation education.
What options for smoking cessation should be offered to Mrs. R?
Explain the COPD triggers that can increase exacerbation frequency, resulting in readmission.

Describe the clinical manifestations present in Mrs. R., focusing on the normal and abnormal findings and how this relates to his current condition.

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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