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.

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

Health History and Medical Information

Health History

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

  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
  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.

Study Material:

-Read Chapter 1 in Pathophysiology: Clinical Applications for Client Health.

“Patient Perceived Impact of Nurse-Led Self-Management Interventions
for COPD: A Systematic Review of Qualitative Research,” by Baker and
Fatoye, from International Journal of Nursing Studies (2019).

-Read “Atrial Fibrillation Symptom Perception,” by Streur, from Journal for Nurse Practitioners (2019).

-Read “Congestive Heart Failure and Congenital Defects,” located on the American Heart Association website.

“Evaluating the Effectiveness of an Online Cardiac Rehabilitation
Resource ( in Improving Knowledge and
Confidence for Patients With Newly Diagnosed Cardiac Conditions: A
Pre-Experimental Pilot Study,” by Molan, Emmanuel, Langley and Holloway,
from Heart, Lung and Circulation, 2019.