Cardiorespiratory complexities include a wide range of disorders affecting the cardiovascular and respiratory systems. They commonly occur in elderly patients due to cardiac and lung physiologic functioning (Riley & Masters, 2016). Common cardiorespiratory conditions include chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, emphysema, congestive cardiac failure (CCF), pneumonia, hypertension, and myocardial infarction. This paper will discuss Mrs. J, a patient with cardiorespiratory conditions, and analyze the nursing interventions provided. I will also outline a health promotion teaching plan and options for smoking cessation for Mrs. J.
Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.
Mrs. J has a history of hypertension, chronic heart failure, and COPD. She presents with a sudden onset of flu-like symptoms such as fever, nausea, productive cough, and malaise and could not perform ADLs. On physical exam, she has a BMI of 31.2, categorized as obesity. She has a low-grade fever of 37.6C, tachycardia with an irregular rhythm, tachypnea, and hypotension. The cardiovascular exam reveals S gallop, with faint PMI at 6th ICS, which points to left ventricular hypertrophy. The patient also has bilateral jugular vein distention, which points to congestive heart failure, a ventricular rate of 132, and atrial fibrillation. On respiratory exam, there were pulmonary crackles, decreased breath sounds on the right lower lobe, frothy blood-tinged sputum cough, and SpO2 82%. This suggests excessive airway secretions, fluid in the lungs with limited perfusion of the lungs, and inadequate body tissue perfusion. GI examination reveals hepatomegaly of 4cm below the costal margin.
The nursing intervention implemented include administration of Oxygen 2L through a nasal cannula. The intervention was appropriate because the patient had low oxygen saturation levels of 82%, and it would enhance tissue perfusion. In addition to oxygen therapy, other nursing interventions included administration of IV furosemide, Enalapril, Metoprolol, IV morphine, ProAir HFA, and Flovent HFA. Furosemide was appropriate for this patient since it is a loop diuretic that acts by inhibiting reabsorption of sodium and chloride at the proximal tubules. This results in the elimination of water and sodium, thus lowering blood volume and preload as well as correcting congestive heart failure (Aronow, 2018). Enalapril inhibits angiotensin-converting enzyme, which facilitates the conversion of angiotensin I into angiotensin II. Angiotensin II is a potent vasoconstrictor and thus lowers blood pressure (Aronow, 2018). Administering Enalapril was inappropriate because the patient had a low blood pressure of 90/58.
Metoprolol was not an appropriate medication since it lowers cardiac output through negative inotropic and chronotropic effects. It is also contraindicated in decompensated heart failure and hypotension, present in Mrs. J (Aronow, 2018). Morphine was not an appropriate medication since the patient denied having pain, and morphine depresses the brain’s respiratory centers and increases the risk of respiratory depression. A safer sedative such as nonbenzodiazepines should have been administered. ProAir HFA was an appropriate drug to relieve COPD exacerbations. It relaxes bronchial smooth muscles and relieves acute bronchospasms (Rosenberg & Kalhan, 2017). Flovent HFA is an anti-inflammatory corticosteroid and is used for long-term maintenance prevention of bronchospasms caused by COPD (Rosenberg & Kalhan, 2017). It should not have been administered to relieve acute COPD exacerbations but rather be prescribed as a
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