Case Scenario 3 – Pulmonary and Cardiovascular
Purpose
As a nurse you will be required to think critically about patient data and make informed decisions. In this case scenario you will apply what you’ve learned in the previous modules to the following concepts (if applicable):
• Clinical decision making
• Safety Considerations
• Collaboration
• Patient assessment
• Pathophysiology
• Nutrition
• Medication Administration
• Apply their knowledge of pharmacological agents to clinical situations involving the pulmonary and cardiovascular system
• Explain the physiological effects of bronchodilators
• Explain the difference between short-acting bronchodilators and inhaled corticosteroid
• Define the nursing considerations in the use of pharmacologic agents for the treatment of pulmonary and cardiovascular disorders
• Answer the case scenario questions using your textbook and scholarly, recent (within the last five years) nursing articles. Be sure to address any of the above concepts that apply to the scenario.
Complete the concept map according to the case scenario. A concept map template is provided for you, but you can edit it to fit the case scenario as you see fit. Be sure map all medications and show relationships between the concepts listed above if it’s applicable to the scenario.
Case Scenario
Mrs. Jones, a 59-year-old white female greeted you at the door with complaints of shortness of breath after cleaning her dusty closet. You are seeing her for a home visit because she was just discharged from the hospital for exacerbation of her chronic obstructive pulmonary disease (COPD). She had similar symptoms approximately a week and a half ago from an exacerbation of her COPD. Mrs. Jones past medical history is significant for coronary artery disease, myocardial infarction, COPD, hypertension, peripheral vascular disease, tobacco usage, and obesity. You heard wheezing on expiration when you auscultated her chest. The patient has two metered dose inhalers (MDI) prescribed to her— Proventil inhaler 2 puffs every 4-6 hours and Beclomethasone Dioprionate inhaler two puffs, once daily. Her other medications aside from the MDI’s, include hydralazine 50 mg by mouth, 3 times per day, hydrochlorothiazide 25 mg by mouth daily, aspirin 81 mg by mouth daily, clopidogrel 75 mg by mouth daily, and isosorbide mononitrate 60 mg by mouth daily.
1. Which inhaler will you advise the patient to take at this moment? Why?
2. The patient asked you the difference between the two inhalers. How will you explain it to her?
3. If you must give the two inhalers together, how will you teach the patient to do it? Include the sequence, patient teaching and possible adverse effects.
4. Using a concept map, provide a graphic representation of the relationships between the patients past medical history, and the pharmacological agents that correspond to each, as listed below. Include the diagnosis, the drug class, brand name (if applicable), nursing considerations and adverse effects. Medications may correspond to more than one diagnosis (when applicable). A concept map template is provided for you. Edit it to fit the case scenario as you see fit.
References:
American Academy of Allergy, Asthma and Immunology. (2020). https://www.aaaai.org/conditions-and- treatments. Retrieved from https://www.aaaai.org/conditions-and-treatments/library/asthma-library/inhaled-asthma-medications
Ignatavicius, D. W. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. St. Louis: Elsevier.
Rosenthal, J. B. (2016). Lehne’s Pharmacology for Nursing Care. St. Louis, Elsevier.
