Health History

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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

Is very anxious and asks whether she is going to die.
Denies pain but says she feels like she cannot get enough air.
Says her heart feels like it is “running away.”
Reports that she is exhausted and cannot eat or drink by herself.
Objective Data

Height 175 cm; Weight 95.5kg.
Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
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.
Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.
Intervention

The following medications administered through drug therapy control her symptoms:

IV furosemide (Lasix)
Enalapril (Vasotec)
Metoprolol (Lopressor)
IV morphine sulphate (Morphine)
Inhaled short-acting bronchodilator (ProAir HFA)
Inhaled corticosteroid (Flovent HFA)
Oxygen delivered at 2L/ NC
Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

Describe the clinical manifestations present in Mrs. J.
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.
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.
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.
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.
Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.

Sample Solution

Process maps provide an overview of the sequence of all process activities and tasks involved in the creation of a product or in the delivery of a service (Heinrich, Henneberger, Leist and Zellner 2009). For managers and decision-makers, process maps provide a way for analyzing and assessing the service delivery process (Kubiak 2007). In relation, O’Donnell and O’Donnell (2008) noted that process maps helps managers and decision makers by placing interrelating systems into perspective and showing how each task, system, and team members relates in a manner that is easy to understand. This paper details the process map for providing services to customers in a typical restaurant. In addition, this paper discusses the layout used for the process.

Process Flow in the Restaurant

The process flow for the restaurant is shown in Figure 1. The process starts when customers enter the restaurant. Near the entrance is the temporary holding area where the receptionist gets the names of the customers. Afterwards, customers are directed to the waiting area where they will wait while the table is being prepared. Then, the receptionist directs the customers to their table. Once seated, the customers begin to review the menu and waits for the waiter for the placement of the order. The waiter then takes the order and afterwards confirms to the customers whether all orders were taken. When the customers confirm the order, the waiter then places the order on the order board, otherwise ask the customers to repeat the orders. The chef then takes the order and reviews it. If there are no clarifications to make, the chef proceeds to cooking the food, otherwise call the attention of the waiter to verify the orders. After cooking the food, the chef prepares the food and places it on the designated area and rings the bell to call the attention of the waiter. The waiter then picks up the prepared food and serves it to the customers. The customers then eat the food and subsequently ask for the check. After a certain period, the waiter arrives with the check. The customer then reviews the check. If there are no concerns, the customer pays

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