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Hypertension Chronic Heart Failure and COPD Case Study

Hypertension Chronic Heart Failure and COPD Case Study

Sample Answer 

Hypertension Chronic Heart Failure and COPD Case Study

Case Study: Mrs. J

Clinical Manifestations

The patient has been admitted to the ICU due to acute decompensated heart failure and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). She presents with the following symptoms. She presents with dyspnea, as evidenced by her inability to get air. She also has decreased exercise tolerance since she cannot walk short distances without being helped. She has a cough and sputum production. She also has nausea and malaise, which can be a result of infection. She has tachycardia. The patient has irregular heartbeats and hepatomegaly.

Appropriateness of Nursing Interventions

Mrs.J presents with acute decompensated heart failure (ADHF); she also presents with symptoms of hypertension, exercabation of COPD, and chronic heart failure. People with COPD have low oxygen flow characterized by limited airflow; hence it is essential to supplement oxygen to this patient. The patient also has symptoms of cardiac failure and fluid overload, hence the prescription of anti-hypertensives.

Lasix is a loop diuretic used to treat the symptoms of fluid retention, such as shortness of breath. Enalapril is an ACE inhibitor useful in treating heart failure, usually combined with a diuretic like Lasix. Metoprolol is a beta-blocker that is used to treat heart failure. Morphine is useful in managing shortness of breath and anxiety in ADHF; this drug should not be used in this patient since morphine can cause respiratory depression and the patient already has COPD (Antohi et al., 2019). ProAir HFA contains salbutamol, a beta-agonist useful in relieving COPD symptoms such as coughing and shortness of breath. Flovent HFA contains fluticasone, decreasing swelling and irritation in the airways, thus managing breathing difficulties and coughing in COPD. People with COPD have low oxygen flow characterized by limited airflow; hence, supplementing oxygen to this patient is essential. (Lenferink et al., 2019).

Cardiovascular Conditions That May Lead To Heart Failure

Coronary artery disease

The patient should be advised on lifestyle modifications such as stopping smoking, drinking alcohol, eating healthy meals, and regular exercise. Drugs such as Lipitor, aspirin, beta-blockers, and CCBs can also be prescribed (Celano et al., 2018)

Myocardial Infarction

Medications can be prescribed to prevent myocardial infarctions (Celano et al., 2018). The drugs will include aspirin, nitroglycerin, and Lipitor.

High blood pressure

The patient can be advised on lifestyle modifications such as dietary modifications and exercise (Celano et al., 2018). Anti-hypertensives can also be prescribed to put the blood pressure under control.


The patient will be advised to avoid strenuous exercises. Antivirals and antibacterials can also be prescribed to manage the infection (Celano et al., 2018).

Nursing Interventions to Prevent Multiple Drug Interactions in Older Patients.


Discuss with the patient to keep the list of all medications they are taking and their frequencies. The patient should also have the contact of their caregiver in case the patient forgets. This intervention helps prevent confusion to the patient(Kim & Parish, 2017).


Teach the patient about all the drugs he/she is taking, including name, use adverse effects, ways of using, and the criticality of contacting your care provider if the patient forgets. This ensures appropriate dosages are taken and leads to a reduction in the risk of adverse drug effects and interactions (Kim & Parish, 2017).


Nurses can help the patient manage their medications. The nurse can caution them on the dangers of sharing medications and ways of storing them (Kim & Parish, 2017). The organization will lead to improved adherence.

Explore non-pharmacological approaches.

When necessary, nurses should explore non-pharmacologic alternatives to drug therapy, such as lifestyle modifications (Kim & Parish, 2017). Drugs have multiple side effects in older patients; hence it is vital to explore non-pharmacological options before drug therapy.

 Health Promotion And Restoration Teaching Plan

Nurses must have the skills that will enable them to become effective teachers. They have to understand the principles of learning in adults and be aware of culture’s effect on this process. The nurse should provide information to the patient in a language they can understand. The nurse should be able to direct the patients to credible patient education materials and resources (Iammarino et al., 2018). These resources will help the patient be able to take drugs correctly and on their own without help from nurses. They will also have the discipline to participate in lifestyle modifications.

Patient Education On Medications

The nurse will educate the patient on the dangers of missing any medications since it can lead to fatal consequences.  The nurse can write a list of these medications with their name, dosage, and frequency in a priority list that the patient will use (Iammarino et al., 2018). The  Patient will be educated on the importance of complying with  drug regimens, and ways of identifying unknown drugs

COPD Triggers

The triggers of COPD include allergens, pollutants in the air, and viral or bacterial infections. Smoke is a significant etiology in COPD (Lenferink et al., 2019). The patient can be enrolled in a smoke cessation program to help her treat her smoke addiction. The nurse practitioner can also prescribe nicotine patches to the patient to help manage smoke withdrawal symptoms (Syamlal et al., 2019). 


Antohi, E. L., Ambrosy, A. P., Collins, S. P., Ahmed, A., Iliescu, V. A., Cotter, G., … & Chioncel, O. (2019). Therapeutic advances in the management of acute decompensated heart failure. American journal of therapeutics26(2), e222.

Celano, C. M., Villegas, A. C., Albanese, A. M., Gaggin, H. K., & Huffman, J. C. (2018). Depression and anxiety in heart failure: a review. Harvard review of psychiatry26(4), 175.

Iammarino, N. K., & O’Rourke, T. W. (2018). The challenge of alternative facts and the rise of misinformation in the digital age: Responsibilities and opportunities for health promotion and education. American journal of health education49(4), 201-205.

Kim, J., & Parish, A. L. (2017). Polypharmacy and medication management in older adults. Nursing Clinics52(3), 457-468.

Lenferink, A., van der Palen, J., van der Valk, P. D., Cafarella, P., van Veen, A., Quinn, S., … & Effing, T. W. (2019). Exacerbation action plans for patients with COPD and comorbidities: a randomized controlled trial. European respiratory journal54(5).

Syamlal, G., King, B. A., & Mazurek, J. M. (2019). Workplace smoke-free policies and cessation programs among US working adults. American journal of preventive medicine56(4), 548-562.


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Hypertension Chronic Heart Failure and COPD Case Study

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. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

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.

Subjective Data

Hypertension Chronic Heart Failure and COPD Case Study

Hypertension Chronic Heart Failure and COPD Case Study

  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.
  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.
  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.
  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.
  6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
  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.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. Grand Canyon University

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