Case Scenario
Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.
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 so exhausted she cannot eat or drink by herself.
Objective Data
1. Height 175 cm; Weight 95.5 kg
2. Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58
3. Cardiovascular: Distant S1, S2, S3, S4 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 4 cm below costal margin
Critical Thinking Questions
What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications?
1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
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 rationale for each of the interventions you recommend.

Ms. G., a 23-year-old diabetic, is admitted to the hospital with a cellulitis of her left lower leg. She has been applying heating pads to the leg for the last 48 hours, but the leg has become more painful and she has developed chilling.
Subjective Data
Complains of pain and heaviness in her leg.
States she cannot bear weight on her leg and has been in bed for 3 days.
Lives alone and has not had anyone to help her with meals.
Objective Data
Round, yellow-red, 2 cm diameter, 1 cm deep, open wound above medial malleolus with moderate amount of thick yellow drainage
Left leg red from knee to ankle
Calf measurement on left 3 in > than right
Temperature: 38.9 degrees C
Height: 160 cm; Weight: 83.7 kg
Laboratory Results
WBC 18.3 x 10¹² / L; 80% neutrophils, 12% bands
Wound culture: Staphylococcus aureus
Critical Thinking Questions
1. What clinical manifestations are present in Ms. G and what recommendations would you make for continued treatment? Provide rationale for your recommendations.
2. Identify the muscle groups likely to be affected by Ms. G’s condition by referring to “ARC: Anatomy Resource Center.”
3. What is the significance of the subjective and objective data provided with regard to follow-up diagnostic/laboratory testing, education, and future preventative care? Provide rationale for your answer.
4. What factors are present in this situation that could delay wound healing, and what precautions are required to prevent delayed wound healing? Explain.