Critical Thinking Applied to Patient’s Health History

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Table of Contents

Subjective and Objective Data
Cardiovascular Conditions
Interventions Evaluation
Medication Explanation
Health Promotion and Restoration Teaching Plan
Smoking Cessation
References

Subjective and Objective Data

Subjectively, the patient, Mrs. J., is anxious and nervous upon admission due to the fear of dying because of her critical condition. She does not report any pain but states that she finds it hard to breathe and her heart is racing. The patient states that she is weak and cannot independently consume food or drinks. Objectively, the patient’s heart rate is increased and irregular, body temperature is elevated, and blood pressure is low. Mrs. J.’s bodily parameters indicate that the patient is obese. Her oxygen saturation is low (82%), her pulse is barely detectable, and her arterial rate is low.

Cardiovascular Conditions

The patient’s health history helps identify potential cardiovascular diseases that Mrs. J. might be at risk of. Coronary heart disease is a potentially risky condition for the patient due to her excessive body mass, age, and concurrent heart and lung issues (Fuchs & Whelton, 2020, p. 285). This disease is characterized by the obstruction of blood flow through the coronary arteries due to fatty tissue buildup; high-pressure lowering medications and lifestyle adjustments might reduce the risk for this disease (Fuchs & Whelton, 2020, pp. 287-288). The patient is at risk of valvular heart disease manifested via heart valve dysfunction that bilateral jugular vein distention might cause; balanced physical exercise, a healthy diet, and smoking cessation are effective prevention measures (Fuchs & Whelton, 2020, p. 285). Hypertensive cardiomyopathy is another at-risk condition characterized by changes in coronary arteries due to chronic hypertension; prevention includes blood pressure-lowering medications and interventions (Fuchs & Whelton, 2020, p. 288). The patient is also at risk of myocardial infarction, characterized by the failure of heart function due to insufficient blood supply; COPD and hypertension treatment regimens might prevent the disease (Brassington et al., 2019, pp. 891-892).

Interventions Evaluation

Overall, the interventions conducted with Mrs. J. upon her admission to the hospital were beneficial and relevant to the observed symptoms. The medications for the ongoing conditions were administered to increase the patient’s independence. However, the administration of morphine was pointless due to the lack of reported pain from the patient’s side (Ignatavicius, 2020, p. 57). Moreover, the patient reported a high level of anxiety, which was under-addressed within the scope of initial interventions but should have been introduced in the form of consolation or medication.

Medication Explanation

The medications administered to the patient upon diagnosis included multiple intravenous and inhaled items. Intravenous furosemide is a diuretic acting by reducing liquid build-up; its use is justified by the presence of fluid concentration in the patient’s heart (Manandhar et al., 2020, p. 31). Enalapril is an angiotensin-converting enzyme inhibitor (ACEI), which acts by relaxing blood vessels to improve blood flow; the patient’s high blood pressure validates the use of this drug (Manandhar et al., 2020, p. 30). Metoprolol is a β-blocker that functions by blocking beta-receptors and improving heart function. However, researchers state that Metoprolol is “not the guideline-recommended drug for the treatment of heart failure,” thus, it might have been substituted for the patient by a recommended β-blocker (Manandhar et al., 2020, p. 31). Morphine is an opiate analgetic that functions as a pain relief medication; its use for Mrs. J. is unjustified due to the lack of pain (Ignatavicius, 2020, p. 57). ProAir HFA is a bronchodilator, and Flovent HFA is a corticosteroid, both administered for breathing improvement. Oxygen is a gas administered to increase the patient’s saturation level since it was critically low.

The administration of multiple drugs to an elderly patient should be accompanied by drug interaction preventative interventions. Indeed, the first intervention might be patient education manifested via an explanation of doses and schedules of drug intake, which is validated by the importance of the patient’s understanding of risks associated with drug-drug interaction (Hoel et al., 2021, p. 245). Deprescribing might be used to minimize the ongoing intake of non-compatible drugs (Hoel et al., 2021, p. 244). The substitution of medications with alternative therapies might help reduce the number of drugs. Finally, the selection of non-interacting agents might be a favorable intervention to reduce the risks of medication incompatibility.

Health Promotion and Restoration Teaching Plan

When discharged, the patient should obtain proper health promotion interventions and materials to be able to lead independent living. The teaching plan proposed for Mrs. J. is as follows:

Nurse-led patient education on the concurrent conditions, the importance of medication intake, and the risks of failure to follow the regimen;
Scheduling a follow-up appointment (Falvey & Ferrante, 2020, p. 440);
Acknowledging possible challenges in the patient’s socio-economic status that might jeopardize her recovery (Falvey & Ferrante, 2020, p. 440);
Explanation of polypharmacy prevention strategies;
Scheduling home visits and telehealth options.
Multidisciplinary rehabilitation resources should be provided in the form of flyers, online publications, video materials, and guidelines for cardiovascular disease management so that the obtained knowledge allows the patient to make informed decisions on the path toward independence.

Smoking Cessation

Smoking cessation is a pivotal aspect of COPD management and the minimization of risks of heart failure. Since the patient is a smoker, and tobacco smoking is regarded as a significant COPD trigger alongside fumes and gasses inhalation, it is recommended that Mrs. J. limits her exposure to these exacerbating-inducing factors to minimize the readmission possibility (Brassington et al., 2019, p. 885). The recommended smoking cessation interventions might include guided self-change (GSC) and nicotine replacement therapy (NRT), which are effective evidence-based approaches to combating tobacco use habits (Zarghami et al., 2019, p. 10). Therefore, either the combination of GSC and NRT or GSC alone should be implemented to help Mrs. J. quit smoking and reduce her risks of exacerbation frequency.

References

Brassington, K., Selemidis, S., Bozinovski, S., & Vlahos, R. (2019). New frontiers in the treatment of comorbid cardiovascular disease in chronic obstructive pulmonary disease. Clinical Science, 133(7), 885-904.

Falvey, J. R., & Ferrante, L. E. (2020). Flattening the disability curve: Rehabilitation and recovery after COVID-19 infection. Heart & Lung: The Journal of Cardiopulmonary and Acute Care, 49(5), 440-441.

Fuchs, F. D., & Whelton, P. K. (2020). High blood pressure and cardiovascular disease. Hypertension, 75(2), 285-292.

Hoel, R. W., Connolly, R. M. G., & Takahashi, P. Y. (2021). Polypharmacy management in older patients. Mayo Clinic Proceedings, 96(1), 242-256.

Ignatavicius, D. D. (2020). Developing clinical judgment: For professional nursing and the next-generation NCLEX-RN examination. Elsevier Health Sciences.

Manandhar, R., Bogati, A., Prajapati, D., Aslam, S., Choudhary, T., Mahat, S., Tamrakar, B., Neupane, P., & Adhikari, C. M. (2020). Adherence to guideline-directed medical therapy among left ventricular systolic dysfunction patients in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Nepalese Heart Journal, 17(1), 29-32.

Zarghami, M., Taghizadeh, F., Sharifpour, A., & Alipour, A. (2019). Efficacy of guided self-change for smoking cessation in chronic obstructive pulmonary disease patients: A randomized controlled clinical trial. Tobacco Induced Diseases, 17, 1-11.

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