Evaluate the Health History and Medical Information.

Evaluate the Health History and Medical Information.


Evaluate the Health History and Medical Information for Mrs. J., presented below. Evaluate the Health History and Medical Information.
Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below. Evaluate the Health History and Medical Information.
Health History and Medical Information
Health History


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. Evaluate the Health History and Medical Information. Evaluate the Health History and Medical Information.
Subjective Data
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 exhausted and cannot eat or drink by herself.
Objective Data
1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, 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. Evaluate the Health History and Medical Information.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
The following medications administered through drug therapy control her symptoms:
1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC
Critical Thinking Essay
In 750-1,000 words, critically evaluate Mrs. J.\’s situation. Include the following:
1. Describe the clinical manifestations present in Mrs. J.
2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed. Evaluate the Health History and Medical Information. Evaluate the Health History and Medical Information.
3. 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.
4. 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 a rationale for each of the interventions you recommend. Evaluate the Health History and Medical Information.
5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients\’ transition to independence. Evaluate the Health History and Medical Information.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale. Evaluate the Health History and Medical Information.
7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.\’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.
You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. Evaluate the Health History and Medical Information. Evaluate the Health History and Medical Information.


This paper analyzes the case of a 63-year-old patient named Mrs. J. it discusses her clinical manifestations, appropriates of nursing interventions, cardiovascular conditions that can lead to heart failure, potential triggers of COPD, and health promotion and restoration teaching plan. Evaluate the Health History and Medical Information.

Clinical Manifestations Present In Mrs. J.

Clinical manifestations include the patient’s subjective data and clinician’s objective data. In the case of Mrs. J, the clinical manifestations are a racing heart, fever, malaise, hypotension, a productive cough, shortness of breath (SOB), and tachycardia. Additional clinical manifestations present in Mrs. J include decreased right lower lobe breath sounds, pulmonary crackles, hepatomegaly, and a productive blood-stained cough. The findings of a distant S1, S2, and S3 where the latter I highly suggestive of cardiac pathology is also a clinical manifestation. Evaluate the Health History and Medical Information.

The extent of Appropriateness of Nursing Interventions

Upon admission, the nurse intervened by administering several medications to control her symptoms. One of the drugs administered was furosemide, a loop diuretic that was appropriate for the management of fluid retention.  Furosemide increases the urinary secretion of excess salts and fluids. The nurse also administered Vasotec, an ACE inhibitor that lowers blood pressure by decreasing fluid volume in blood by inhibiting the production of ACE and angiotensin II (Barberio & Gomella, 2015). Metoprolol, a beta-blocker used in the management of angina, hypertension, and heart failure was appropriately administered to decrease cardiac output by relaxing blood vessels during rest and exercise to reduce chest pains. Evaluate the Health History and Medical Information.

Morphine sulfate is an opioid analgesic. It acts by inhibiting neurotransmitters release to relieve anxiety, pain, and restlessness. However, in patients experiencing anxiety and SOB, morphine s effective for managing the effects of decreased myocardial oxygen demand. ProAir HFA, an albuterol inhaler, is a short-acting inhaled bronchodilator that relaxes airway smooth muscles to improve airflow and quick relief at a time when she was experiencing an acute exacerbation of COPD (Barberio & Gomella, 2015). The nurse also administered supplemental oxygen to decrease the severity of the SOB experienced by the patient evidenced by an oxygen saturation level of 92%. Flovent HFA, an inhaled corticosteroid that decreases inflammation of the airway in COPD patients was appropriately administered to help relieve her symptoms of a productive cough, and SOB. Evaluate the Health History and Medical Information.

Cardiovascular Conditions That May Lead to Heart Failure

Four major conditions that can result in heart failure include hypertension, MI (myocardial infarction), CAD (coronary artery disease), heart defects, or abnormal heart valves. Nurses can counsel patients with abnormal heart valves to consider undergoing surgery on valve replacement. For hypertensive patients, nurses should encourage them to comply with medications, and lifestyle modification (regular physical exercise, and healthy nutrition including a DASH diet) (Inamdar & Inamdar, 2016). For MI, nurses should encourage patients to engage in routine physical activity while in coronary artery disease, nurses should educate patients about quitting tobacco smoking to decrease the risk of atherosclerosis and subsequent heart failure. Evaluate the Health History and Medical Information.

Nursing Interventions to Prevent Problems with Multiple Drug Interactions

Most older adults take multiple drugs due to multiple underlying comorbidities. Similarly, Mrs. J has more than two chronic conditions which increase her risk of non-compliance and an adverse drug event. To reduce the likelihood of an adverse drug event, American Geriatrics Society et al (2015) suggest that, healthcare providers should use the Beers Criteria. Besides, the clinician should schedule Mrs. J for regular follow-up visits when drug reviews will be conducted before eliminating drugs with no therapeutic effect. Education should emphasize the need to appropriately organize all the drugs to prevent overdosage or under-dosage. Evaluate the Health History and Medical Information.

Health Promotion and Restoration Teaching Plan

Managing chronic illnesses such as hypertension, asthma, type 2DM, and COPD requires patient involvement in several activities. Louvaris et al (2015) recommend that, in patients with COPD, it is important to consider cardiac rehabilitation with a focus on compliance to medications, maintaining healthy nutrition, and engaging in regular physical activity to promote independence. For Mrs. J, the most significant health promotion activities are; smoking cessation, behavior change (lifestyle, nutrition, and physical activity), education about medication compliance, and maintaining an updated immunization schedule. Evaluate the Health History and Medical Information.


Successful outcomes in the management of COPD requires that patients strictly adhere to prescribed drugs. Education is one of the best and most effective strategies that healthcare providers can use to promote adherence since it improves their knowledge and awareness. The best education strategy is thus personalization where the provider assesses and addresses Mrs. J’s needs and knowledge gaps. The COPD Foundation provides authentic resources that providers can use with appropriate demonstration diagrams and videos. These resources cover a wide range of subjects such as breathing techniques for patients with COPD, physical limitations, and consequences of tobacco smoking. Evaluate the Health History and Medical Information.

COPD Triggers

Potential triggers that can result in an acute exacerbation of COPD symptoms are tobacco smoke, pollen, strong odors, and extreme temperatures. In this patient’s case, tobacco smoke is the most probable trigger that caused COPD exacerbations and the best smoking cessation method based on the recommendation provided by Louvaris et al (2015)  is a combination of psychotherapy (CBT) and nicotine replacement therapy. Examples of nicotine therapy are nicotine patch and nicotine gum which helps to decrease the urge for the pleasurable feeling of smoking and craving for tobacco. Evaluate the Health History and Medical Information.