Running head: CASE STUDY 1

Case Study

Tyna Domond

August 23rd, 2019

Grand Canyon University

CASE STUDY 2

Case Study

The case study discusses a mature adult who is 63-years-old and goes by Mrs. J, she has

quite an extensive medical history and came into the clinical seeking support because she is

unable to commitment to activities of daily living (ADLs). Mrs. J was recently admitted to the

intensive care unit (ICU) and is now worried she is going to die due to her not taking her

medications, in combination with her signs and symptoms and medical history. Throughout this

scholarly essay, the author will discuss and critically evaluate Mrs. J with respect to her

admission assessment.

Clinical Manifestations

There are a few clinical manifestations occurring for Mrs. J. The first noted manifestation

is the flu-like symptoms that are occurring, which include fever, malaise, productive cough, and

nausea[ CITATION Mog17 \l 1033 ]. These manifestations can display the onset diagnosis of many

potential illnesses, such as influenza, pneumonia, and even the common cold. However, Mrs. J.

is also unable to perform ADLs and now requires assistance to walk short distances, which can

be considerably a clinical manifestation as well, especially if the individual feels her heart is

“running away;” however, this can be a manifestation of many illnesses, such as COPD, heart

failure, and pneumonitis[ CITATION Ina16 \l 1033 \m Mog17]. Additionally, in the subjective

portion of the assessment, the nurse noted Mrs. J. had feelings of anxiety and asking if she was

going to die, which can derive from the clinical manifestation of generalized anxiety disorder at

an older age. Furthermore, Mrs. J. discusses how she cannot catch her breath, which can also

circulate pneumonitis, COPD, or even shortness of breath.

Appropriate Nursing Interventions

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The nursing interventions are appropriate for the patient. The patient is taking

furosemide, which can help reduce edema and enalapril to help with the patient’s blood pressure,

which can help with the decompensated heart failure[ CITATION Ina16 \l 1033 ]. However, the

patient’s blood pressure is already low, but the information does not say if this was prior to the

enalapril. Inhaled short-acting bronchodilator is a commonly prescribed medication for

individuals who are experiencing COPD, as well as inhaled corticosteroid, which can help

mitigate inflammation properties[ CITATION Jen17 \l 1033 ]. The 2L nasal cannula is appropriate if

the patient is feeling shortness of breath. The morphine is appropriate as a method to help

mitigate pain.

Cardiovascular Conditions

Four conditions that may lead to heart failure are, uncontrolled hypertension, coronary

artery disease (CAD), high cholesterol, and abnormal heart rhythms[ CITATION Ina16 \l 1033 ].

Reducing these manifestations requires preventative care. A nurse may be able to instruct a

patient on weight management, dietary habits, regular exercise, quit smoking, reduce alcohol

intake, reduce sodium and caffeine, and stress – all of which can help prevent the development of

high cholesterol and uncontrolled hypertension[ CITATION Ina16 \l 1033 ]. However, when

preventing CAD, one can stop smoking, control ones’ blood pressure, exercise, eat healthy, and

take a daily dose of aspirin[ CITATION Ina16 \l 1033 ]. The prevention of irregular heart rhythms

requires control over high cholesterol and high blood pressure, along with losing weight, eating

healthy, exercising, and catering to smoking cessation.

Nursing Interventions for Drug Interactions

The discussion of four nursing interventions to help prevent problems with taking

multiple medications begins with education. Four interventions are: information, instructions,
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organization, and keeping a journal/log. The information will tell the patient about the

medication, such as frequency, dosage, names, and date of prescription to help keep the

documentation[ CITATION Gra14 \l 1033 ]. The instructions will teach patients about each

medication, how to prevent adverse effects, importance of talking to health care providers if

concerns come up, and importance of using the same pharmacy[ CITATION Gra14 \l 1033 ]. The

organization will help provide insight to not share medication, how to safely store medication,

how to dispose of medication, and how to divide the medication in weekly tabs to help with day-

to-day prescriptions[ CITATION Gra14 \l 1033 ]. The journal intervention is to keep all of this

information handy for the nurse and doctor, which can empower the patient for self-care and

self-management.

Health Promotion and Restoration Teaching Plan

The health promotion and restoration teaching plan will begin with enabling, mediating,

and advocating, which will help with multidisciplinary resources for rehabilitation. Enabling a

patient is the first step in proper and appropriate rehabilitation. The rehabilitation center will help

Mrs. J. gain independence again by helping her sustain medication compliance through the four

nursing interventions listed to prevent multiple drug interactions, while using a multidisciplinary

approach including occupational therapy and physical therapy[ CITATION Nis16 \l 1033 ].

Education for Mrs. J.

The best education for Mrs. J. is empowerment, displaying the proper and appropriate

techniques and methods to acquire self-management and self-care sustainability[ CITATION

Gra14 \l 1033 ]. The education will include how to execute each of the four steps in the nursing

medication intervention, such as how to read the information, how to organization the

medication, and how to document the process for a daily journal. The ideology here is to foster
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independence through empowerment of self-care and self-management. The nurse will engage in

the teach-back method to help ensure a full and keen understanding is present.

COPD Triggers

Common COPD triggers begins with smoking tobacco. Smoking tobacco is the number

one irritate for COPD and with the history of Mrs. J., she may not want to stop smoking,

especially if she is continually smoking and on 2L NC at home. However, there are other

triggers, such as dust, animal dander, indoor and outdoor pollution, and chemical fumes, all of

which were not significant during Mrs. J. admission assessment. As an elder adult, the options

for smoking cessation can begin with self-help information, group or individual counseling,

nicotine patches, and even help and support lines[ CITATION Nat19 \l 1033 ].

Conclusion

Conclusively, Mrs. J. is in need of assistance with health promotion, and the first step is

to provide medication organization and support, allowing her to become independent and thrive

through cultivated self-care and self-management techniques that were displayed by the

registered nurse, the multidisciplinary team, and rehabilitation center. The intervention and plan

of care can help mitigate readmissions to the hospital due to medication noncompliance.
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References

Grady, P. (2014). Self-Management: A Comprehensive Approach to Management of Chronic

Conditions. American Journal of Public Health, 104(8), e25-31.

doi:10.2105/AJPH.2014.302041

Inamder, A. (2016). Heart failure: Diagnosis, management, and utilization. Journal of Clinical

Medicine, 5(7), e62. doi:10.3390/jcm5070062

Jenkins, C. (2017). Drugs for chronic obstructive pulmonary disease. Australian Prescriber,

40(1), 15-9. doi:10.18773/austprescr.2017.003

Moghadami, M. (2017). Narrative review of influenza. Iran Journal of Medical Sciences, 42(1),

2-13.

National Institute of Health. (2019, January 7). Quit smoking for older adults. Retrieved from

National Institute on Aging: https://www.nia.nih.gov/health/quitting-smoking-older-

adults

Nishi, S., & Zhang, W. (2016). Pulmonary rehabilitation. Journal of Cardiopulmonary

Rehabilitation Prevention, 36(5), 375-82. doi:10.1097/HCR.0000000000000194