The case study provided for this discussion presents a 63-year-old married female patient with a history of chronic obstructive pulmonary disease (COPD), chronic heart failure, and hypertension. The patient has been using 2L of oxygen/nasal cannula for respiratory aid during activity and still smokes about 2 packs of cigarettes every day for the past 40 years. However, her present flu-like symptoms such as malaise, nausea, productive cough, and fever started about 3 days ago. During this time, the patient reports defaulting from her antihypertensives. She reports difficulties in performing routine daily activities and even requires assistance to move around the house. Her current admission to the hospital ICU is a result of acute exacerbation of COPD and acute decompensated heart failure. This discussion evaluates the case of this patient from clinical manifestations, nursing interventions, and care plans to appropriate preventive measures.
Mrs. J reports that she started having flu-like symptoms such as malaise, nausea, productive cough, and fever about 3 days ago. She also needs assistance to move around the house, with difficulties in carrying out routine daily activities. The subjective portion of information reveals symptoms such as anxiety, lack of air, fatigue, shortness of breath, palpitations. Upon conducting a physical examination, it is noted that the patient is obese with increased heart rate, irregular heartbeats, bradycardia, presence of S3 sound with diminished S1 and S2, and atrial fibrillations. The patient also displays the presence of respiratory crackles, productive cough, bloody sputum, diminished right lower lobe breathing sound, and hepatomegaly.
The patient was admitted to the ICU with an acute exacerbation of COPD and acute decompensated heart failure. The recommended nursing interventions are thus aimed at improving the patient’s heart pump function and maintaining normal blood pressure in addition to relieving respiratory symptoms such as shortness of breath (Doenges et al., 2019). It was necessary to administer furosemide given that the patient was admitted as a result of acute decompensated heart failure which is associated with leg or foot swelling that is managed by diuretics. Enalapril was administered to help manage and prevent atrial fibrillation, which is demonstrated by the patient’s irregular and elevated heart rate of 118.
Metoprolol is effective in maintaining sinus rhythm and preventing atrial fibrillation but was not necessary at the point of admission given the patient’s low blood pressure (Doenges et al., 2019). Morphine was also not necessary given that the patient was not in any kind of pain.Inhaled short-acting bronchodilator (ProAir HFA) on the other hand was necessary for quick relief of the patient’s shortness of breath and prevent COPD complications. Lastly Inhaled corticosteroid (Flovent HFA) was not appropriate, given that this drug can only be considered in long-term therapy for patients with asthma, especially when a short-acting bronchodilator has already been used.
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