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

At the time of Mrs. J’s admission to the hospital ICU with acute decompensated heart failure, several nursing interventions are appropriate. Firstly, the nurse should assess Mrs. J’s anxiety level and provide emotional support. It is crucial to address her fears and concerns about her condition and potential outcomes. This can help alleviate anxiety and improve the patient’s overall well-being.

Secondly, the nurse should closely monitor Mrs. J’s respiratory status. Given her complaint of feeling like she cannot get enough air and the presence of pulmonary crackles, it is important to ensure she is receiving adequate oxygenation. The nurse should administer supplemental oxygen as necessary and monitor the patient’s oxygen saturation levels.

Thirdly, Mrs. J’s cardiac status should be continuously monitored. The nurse should assess her heart rate, rhythm, and blood pressure regularly. The presence of an irregular heart rate and atrial fibrillation indicates the need for close monitoring and potential intervention to restore normal cardiac function.

Fourthly, due to Mrs. J’s reported exhaustion and inability to eat or drink by herself, the nurse should provide assistance with activities of daily living, including feeding and hydration. Ensuring proper nutrition and hydration is essential for the patient’s overall recovery.

In terms of drug therapy, several medications are administered to control Mrs. J’s symptoms and manage her condition. The rationale for the administration of each medication is as follows:

1. IV furosemide (Lasix): Furosemide is a loop diuretic that helps eliminate excess fluid from the body, reducing fluid overload and relieving symptoms of heart failure such as edema and difficulty breathing.

2. Enalapril (Vasotec): Enalapril is an angiotensin-converting enzyme (ACE) inhibitor that helps reduce blood pressure and workload on the heart. By blocking the conversion of angiotensin I to angiotensin II, enalapril prevents vasoconstriction and aldosterone release, leading to vasodilation and decreased fluid retention.

3. Metoprolol (Lopressor): Metoprolol is a beta-blocker that helps reduce heart rate and blood pressure. By blocking beta-adrenergic receptors, metoprolol reduces the workload on the heart and improves its efficiency.

4. IV morphine sulfate (Morphine): Morphine is administered to relieve the patient’s pain and alleviate anxiety. By acting on opioid receptors in the central nervous system, morphine reduces pain perception and induces a sense of calmness.

Now let us discuss four cardiovascular conditions that may lead to heart failure and potential medical/nursing interventions to prevent their development.

1. Hypertension: Uncontrolled high blood pressure can lead to heart failure. To prevent the development of heart failure, it is essential to manage hypertension effectively. Nursing interventions may include patient education about lifestyle modifications (e.g., adopting a low-sodium diet, engaging in regular exercise), medication adherence, and regular blood pressure monitoring.

2. Coronary artery disease (CAD): CAD can result in ischemia and damage to the heart muscle, leading to heart failure. Preventive interventions may include promoting a healthy diet, encouraging physical activity, and managing risk factors such as smoking cessation, blood pressure control, and cholesterol management.

3. Valvular heart disease: Conditions such as aortic stenosis or mitral regurgitation can cause increased pressure or volume overload on the heart, potentially leading to heart failure. Medical interventions may involve surgical repair or replacement of the affected valve. Nursing interventions include close monitoring of cardiac function, assessment of valve function, and patient education about medication adherence and follow-up care.

4. Cardiomyopathy: Cardiomyopathy refers to structural or functional abnormalities of the heart muscle. It can be caused by various factors, including genetic disorders, infections, or alcohol abuse. Nursing interventions may involve patient education about lifestyle modifications, medication adherence, and regular follow-up appointments with a healthcare provider to monitor cardiac function and manage symptoms.

Considering the risk of multiple drug interactions in older patients who often take several medications, several nursing interventions can help prevent potential problems:

1. Medication reconciliation: The nurse should conduct a thorough review of all the medications the patient is currently taking, including prescription drugs, over-the-counter medications, and supplements. This helps identify any potential drug interactions and facilitates appropriate adjustments or discontinuation of medications.

2. Patient education: The nurse should educate the patient about the importance of medication adherence and understanding potential side effects or interactions. This enables the patient to take an active role in their medication management and report any concerns or changes promptly.

3. Collaboration with healthcare providers: The nurse should communicate with other members of the healthcare team, including pharmacists and physicians, to ensure comprehensive medication management. Ongoing collaboration helps identify and address any potential drug interactions or contraindications.

4. Regular monitoring and assessment: The nurse should closely monitor the patient’s response to medications and regularly assess for any adverse effects or changes in therapeutic effectiveness. This enables early detection and intervention for any medication-related problems.

In summary, appropriate nursing interventions for Mrs. J at the time of admission include emotional support, respiratory monitoring, cardiac monitoring, and assistance with activities of daily living. The rationale for the administration of the prescribed medications includes diuresis to reduce fluid overload, blood pressure control, heart rate control, pain relief, and anxiety reduction. Cardiovascular conditions that may lead to heart failure can be prevented through various medical/nursing interventions, such as lifestyle modifications, medication adherence, and surgical interventions when necessary. To prevent problems caused by multiple drug interactions in older patients, nursing interventions include medication reconciliation, patient education, collaboration with healthcare providers, and regular monitoring and assessment. These interventions are crucial in promoting optimal patient outcomes and preventing complications associated with heart failure and polypharmacy.