Pathophysiology: Clinical Application for Client Health CASE STUDY: MRS. J. 2023

Pathophysiology: Clinical Application for Client Health CASE STUDY: MRS. J. 2023. Mrs. J. has a medical history of hypertension (HTN), chronic pulmonary obstructive disease (COPD), and chronic heart failure (CHF). She continues to smoke cigarettes, which has been found to harm every bodily organ that leads to preventable disease such as the ones she currently has (Rostron, Chang, Pechacek, 2014). Since Mrs. J. never ceases to stop smoking, this could have potentially contributed to the exacerbation of her chronic conditions as well as the acute illness. During this time of the acute illness, she was unable to continue her medication regimen for the chronic diseases, which caused her condition to worsen. Mrs. J height is 175 cm and her weight is 95.5kg, which puts her BMI at 31.2 in the obese range (National Heart, Lung, and Blood Institute, n.d.). Mrs. J. temperature is slightly elevated. It is noted that she has bilateral jugular vein distention, and reports that she is exhausted and not able to eat or drink by herself. Mrs. J is tachycardic with the heart rate of 118, and irregular due to the presence of S3 sound. The telemetry monitor shows atrial fibrillation with a ventricular rate of 132. Blood pressure is 90/58, which puts her MAP greater than 65 meaning she has adequate perfusionShe voices her concern by stating she feels as though her heart is “running away.” She is tachypneic, with the respirations of 34 and states that she is unable to get enough air. Her oxygen saturation (Sp02) reads 82% and is very anxious with the feeling of impending doom. On Auscultation, there are pulmonary crackles and diminished breath sounds on the right lower lobes. She presents with a cough and frothy blood tinged sputum. On her abdominal assessment, bowel sounds are present. Upon palpation of her abdomen, it is noted hepatomegaly with a 4cm below costal margin. Nursing Interventions Evidence suggests that both HF and COPD can be interpreted as a systemic disorder associated with low-grade inflammation, endothelial dysfunction, vascular remodeling and CASE STUDY: MRS. J. 3 skeletal muscle atrophy (Celutkiene, Baliciunas, Kablucko, Vaitkeviviute, Blasciuk, & Danilla, 2017). When Mrs. J. arrives at the hospital, the nurse should suggest labs be drawn such a complete metabolic panel with magnesium and phosphorus added, complete blood count, lactate, and arterial blood gases. By drawing labs, one is able to assess the overall health of the patient. Chest x-ray also should be ordered to give a quick assessment of her lungs and heart. During that time electrocardiogram should additionally be ordered. Individuals who have CHF, often have pulmonary edema. With pulmonary edema, bibasilar crackles are often heart due to the inability to pump blood through the heart which causes retention of blood within it causing fluid to collect in the lungs. In Mrs. J.’s condition, furosemide (lasix) should be given because it removes fluid in the lungs. Lasix is the most common oral loop diuretic given, because of their potent natriuretic action (Felker, O’Connor & Braunwald, 2009). This will be able to manage some of Mrs. J’s congestion. Administering enalapril and metoprolol is an appropriate measure to give during this exacerbation. These medications have the potential to reduce airway obstruction, decrease pulmonary inflammation and pulmonary vascular constriction and improve alveolar member gas exchange (Celutkiene et al., 2017). While giving lasix, metoprolol, and enalapril close monitoring of blood pressure should be advised, Mrs. J.may become hypotensive while trying to correct the issues. During this time, the nurse should question the order of inhaled short-acting bronchodilator and inhaled corticosteroid because depending on if suspected dominating airway obstruction or dominating congestion. Many cases, Beta2-agonist is reported to increase tachycardia which may increase myocardial oxygen consumption and electrical instability (Celutkiene et al., 2017). Mrs. J. already is tachycardic with an irregular heart beat, giving these two medications may potentially cause acute ischaemic events (Celutkiene et al., 2017). If the