Case Study: Mrs. R.
Directions: Read the case study below. Evaluate the information and formulate a
conclusion based on your evaluation. Complete the critical thinking table and submit this
completed template to the assignment dropbox.
Case Study: Mrs. R.
It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the
pathophysiological processes of disease, the clinical manifestations and treatment protocols, and
how they affect clients across the life span.
Evaluate the Health History and Medical Information for Mrs. R., presented below.
Health History and Medical Information
Mrs. R. is a 68-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.
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
5. Height 175 cm; Weight 95.5kg.
6. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
7. 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.
8. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing
frothy blood-tinged sputum; SpO2 82%.
9. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention
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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 Table
Clinical Manifestations
Describe the clinical manifestations present in Mrs. R., focusing on the normal and abnormal
findings and how this relates to his current condition.
Subjective
Objective
Cardiovascular Conditions Leading to Heart Failure
Describe cardiovascular conditions in which Mrs. R. is at risk.
Describe four cardiovascular
conditions in which Mrs. R. is
at risk and that may lead to
heart failure.
Discuss any comorbidities
Mrs. R. displays.
How do these conditions
increase her chance of heart
failure?
What can be done by way of
medical/nursing interventions
to prevent the development of
heart failure in each of the
presented conditions.
Evaluation of Nursing Interventions at Admissions
Discuss the initial assessments and interventions provided to Mrs. R.
According to the nursing
process, were the initial
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assessments and interventions
at the time of admission
beneficial for Mrs. R?
Discuss changes to any of the
initial assessments or
interventions you would make
to ensure patient
independence and prevent
readmission.
Medications and Prevention of Problems Caused by Multiple Drug Interactions
Explain each of the seven medications listed in the case study and increase the incidence of
polypharmacy.
Explain each of the seven
medications listed in the case
study. Include the
classification, action, and
rationale for each of these
medications as they stem from
pathophysiology for this
patient's condition (e.g.,
consider morphine use
outside of pain management).
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.
Health Promotion and Restoration Teaching Plan
Develop a multidisciplinary health promotion and restoration teaching plan for Mrs. R.
Discuss the steps needed to
move the patient from acute
care to subacute care, before
discharging home and
beginning a rehabilitation
process.
Discuss alternative discharge
options and qualifications to
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facilitate a smooth transition
to the next level of care.
Explain how the
rehabilitation resources,
including medication
management, and
modifications will assist the
patient's transition to promote
independence and prevent
readmission.
Pathophysiological Changes
Discuss the pathophysiological changes that come with Mrs. R.'s long-term tobacco use.
COPD Triggers and Options for Smoking Cessation
Discuss options for smoking cessation education.
