Scenario questions are to be answered in bullet form. Please do not paraphrase the questions. References must be APA 7 format, and no older than 10 years old. Grading rubric is attached.
Case: Emanual Ibrahim is a 78-year-old woman who resides in an urban senior community housing complex. The building is worn down and dirty from the urban dust, cockroaches, and mold. Mrs. Ibrahim has a history of chronic obstructive pulmonary disease (COPD) and hypertension, mild age-related hearing loss, and chronic kidney disease (CKD) stage III, and requires careful home medication management. Mrs. Emanual resides alone, but her sister visits her daily to check in on her. One evening, Mrs. Ibrahim noticed increased shortness of breath while resting in her apartment. She tried using her bronchodilator but found little relief. As her breathing worsened, she began feeling dizzy and exhausted. She phoned her sister who came over to the house and noticed Mrs. Ibrahim was pale and clammy and had audible wheezing. Concerned about her condition, her sister immediately dialed 911.
Answer the following discussion questions as your initial post:
- Emanual uses a long-acting bronchodilator inhaler and a corticosteroid inhaler for the management of COPD. Explain the mechanisms of action of these drugs. How do they differ in their therapeutic effects, and what are the potential adverse reactions to monitor in an elderly patient with CKD and hypertension?
- If Emanual’s symptoms are not adequately controlled with her current medications, what additional pharmacological options might be considered?
- How might Mrs. Ibrahim’s CKD affect the pharmacokinetics (absorption, distribution, metabolism, and excretion) of her prescribed bronchodilators and corticosteroids? What specific adjustments or precautions might the nurse anticipate may be necessary in her treatment plan?
- Analyze the pathophysiological changes that occur in COPD during an acute exacerbation and how they contribute to respiratory fatigue.
- Why might Emanual become physically fatigued during a severe exacerbation of COPD?
- What potential side effects and adverse reactions should be monitored for an elderly patient with CKD and hypertension receiving treatment for a COPD exacerbation?
- One of the complications of COPD exacerbation is the development of hypercapnia and respiratory acidosis. How does the body compensate for an increase in CO2? What are the effects of hypercapnia on the central nervous system, particularly in an elderly patient
- Compare and contrast the pathophysiology and pharmacological/nonpharmacological management of COPD, integrating evidence-based nursing clinical decision-making.
- How would you address Mrs. Ibrahim’s cultural, ethical, and holistic needs when devising a plan of care incorporating pharmacological and non-pharmacological interventions?
- How might her age-related hearing loss and presbyopia affect her ability to manage her medication regimen and follow her care plan at home? What nursing interventions would you implement to ensure her safety, medication adherence, and understanding of discharge instructions?