Question 1 M.K. is a 45 year-old female weighing inat 225lbs and measuring 5’5″ tall. She has a history of smoking for 22 yearswith a poor diet.
M.K. has a history of primary hypertension and type IIdiabetes mellitus and has recently been diagnosed with chronic bronchitis. Her currentsymptoms include light-headedness, chronic cough, more severe sputum in the morning,excessive peripheral edema, distended neck veins, and increased urination atnight. The medication M.K. is using for the hypertension include both Lotensinand Lasix along with Glucophage for the type II diabetes mellitus.
Question 2Chronic bronchitis is the hypersecretionof mucus and a chronic productive cough that last for 3 months of the year andoccur for at least 2 consecutive years (Davis, 2017). Chronic bronchitis is an inflammationof the bronchi caused by infection or irritants that has a distinguishedcharacteristic of airflow obstruction. The irritants inflame in the tracheobronchial tree leading to narrowedor blocked airways and increased mucus production. As the inflammationcontinues, it results in hypertrophy and hyperplasia of the mucus glands, ciliarydamage, chronic leukocytic infiltration of bronchial walls, and increasedgoblet cells. The clinical findings that correlate with M.K.’s chronicbronchitis include high hematocrit level, low PaO2, high PaCO2, chronic cough,more severe sputum in the morning, distended neck veins, and excessiveperipheral edema. Her lab findings for hematocrit are coming in abnormally highat 57%.
Hematocrit is expressed as a percentage by volume of the blood thatconsists of packed red blood cells in the body. The normal hematocrit valuesfor a 45-year-old woman are 36%-48% (Haldeman-Engler,2017). Since M.
K has 57%, there was no surprise that she was diagnosed withchronic bronchitis. PaO2 stands for thepartial pressure of 02 in arterial blood, whereas PaC02 is the partial pressureof carbon dioxide in the blood. The normal range for PaO2 in the body isanywhere from 75 mm Hg to 100 mm Hg arterial and anywhere from 35-45 mm Hg forPaC02 (Hadjiladis, 2016). M.K. has two abnormal values for both of these comingin over the average with 52 mm Hg for PaC02 and under the average with 48 mm Hgwith PaO2. A high PaC02 and a Low arterial Pa02 are both associated withchronic bronchitis; hence why both of these finding were found in M.K.
‘s COPD. Herother clinical findings including her chronic cough, severe sputum in themorning, distended neck veins, and excessive peripheral edema, are all each acommon clinical manifestation for chronic bronchitis. Weighing in at 225 lbs.might also correlate with chronic bronchitis, as weight gain due to edema is acommon sign of this type of inflammation. AsM.K. appears to be in stage 2 COPD, the type of treatment appropriate for MK’schronic bronchitis is bronchodilators medications, steroids, and antibiotics.
The bronchodilators will be a successful treatment as it will help to relivethe symptoms by relaxing the smooth muscles in the bronchioles which will thendilate the bronchi decreasing resistance in the reparatory airway andincreasing the airflow to the lungs. With this medication, it will also relievebronchospasms and facilitate mucociliary clearance making it a reversibleprocess. The antibiotics and steroids will be used to treat recurringinfections and reduce the inflammation. To treat and reduce her excessiveperipheral edema, we may also give her a diuretic like the one she is using forher hypertension. As for some recommendations, the first thing M.K. should dois stop smoking cigarettes considering its one of the main causes of COPD.
Smoking damages the air sacs, airways, and the lining of your lungs, which areinjuring the lungs making it harder to breathe (Laura, 2017). It is alsorecommended that we provide her with a high-calorie, protein rich diet. We mustoffer M.K. small and frequent meals to conserve her energy and prevent fatigue.Lastly, we may recommend warning M.K.
that exposures to blasts of cold air mayprecipitate bronchospasms. We can suggest she avoid the windy weather, thecold, or to cover her nose and mouth with a scarf before going outside. Theselifestyle changes have been shown to help improve COPD with the specialconsiderations she’s having.
Question 3Heart failure may my categorizedaccording to the side of the heart that is affected (left or right sided heartfailure) or by the cardiac cycle involved (systolic or diastolic dysfunction).Left-sided heart failure occurs as the result of the ineffective leftventricular contractile function. As the pumping ability of the left ventriclefails causing low cardiac output, blood is no longer effectively pumping outinto the body which gets backed up into the left atrium and finally in thelungs (Williams & Wilkins, 2011). Left sided heart failure can cause dyspnea,pulmonary congestion, and activity intolerance. If the conditions persist, itmay result in hypertension, left ventricular infarctions, and aortic and mitralvalve stenosis.
Right-sided heart failure is in result from the ineffectiveright ventricular contractile function. The blood is not pumped effectivelythrough the right ventricle causing blood to back up into the right atrium andthe peripheral circulation. While this is occurring, the patient gains weightand develops peripheral edema and enlargement of the kidney and other organs.This may also result from an acute right ventricular infarction, pulmonaryembolus, or pulmonary hypertension. However, the most common cause ofright-sided heart failure is the backward flow due to the left-sided heartfailure. The signs and symptoms of right-sided heart failure include weightgain, development of peripheral edema, edema associated with fluid excess, andelevated jugular vein distention due to venous congestions (Williams &Wilkins, 2011). Looking at M.K.
‘s signs and symptoms with her peripheral edema,gain weight, and distended neck veins, I came to the conclusion that she ishaving right-sided heart failure. The first type of treatment I would give M.K.would be an angiotensin-converting enzyme (ACE) inhibitor to reduce theproduction of angiotensin II, resulting in preload and afterloadreduction. ACE is a type of vasodilatorthat widens the blood vessels to lower the high blood pressure she already has.It was also improve her blood flow and decrease the workload on the heart. Thenext type of treatment I would give M.K.
is a beta-blocker. Not only will thisreduce her blood pressure and slow down the heart rate, but will alsolimit/reverse some of the damages done to the heart since it’s having high systolicheart pressure as well. Question 4Hypertension is an elevation in thediastolic or systolic blood pressure and occurs in two major types. The mostcommon form is called stage 1 hypertension. Some of the most common causes ofstage 1 hypertension may include obesity, sedentary lifestyles, and tobaccouse.
The one that results from renaldisease or an unidentifiable cause is called stage 2 hypertension. The causes forstage 2 hypertension may include brain tumor, excessive alcohol consumption,and coarctation of the aorta. Malignant hypertension is a severe fulminant formof both types of hypertensions. To qualify for stage 1 hypertension, thesystolic blood pressure must be in the range of 140-159 mm Hg or your diastolicblood pressure must be in the range of 90 – 99 mm Hg. To qualify for secondaryhypertension, the systolic blood pressure must be in the range of 160 mm Hg orhigher or your diastolic blood pressure must be in the range of 100 mm Hg orhigher. According to M.
K’s blood pressure of 158/98 mm Hg, she falls under thecategory of stage 1 hypertension. When hypertension is prolonged, it increasesthe heart’s workload resistance to the left ventricular ejection, which createsthe left ventricle hypertrophy raising the hearts oxygen demand and workload.Failure and cardiac dilation may occur when hypertrophy can no longer maintainthe sufficient cardiac output. Since hypertension increases the chance ofcoronary atherosclerosis, the heart may reduce blood flow to the myocardium,resulting in myocardial infarction or angina. Even though hypertension is usually asymptomatic, there are still somesigns and symptoms that may occur in the body. One of the main clinicalmanifestations of primary hypertension is occipital headache.
The headache mayworsen on rising in the morning as a result of increased cranial pressureresulting from vascular changes. If headaches are severe, it may result to nauseaand vomiting. In addition, dizziness, fatigue, and confusion may be caused bydecreased tissue diffusion due to vasoconstriction. As for her treatments, the first thing Iwould recommend is her lifestyle changes. Knowing that she is 225 lbs.
and onlymeasuring 5’5″ tall, use of dietary approaches involving an increase invegetables, fruits, and low-fat dairy products including a moderation ofalcohol intake with exercise would be a good start in getting her back inshape. A woman is who is 5’5″ tall weighing in at 225 lbs. is obese (BMI,2017). Knowing she has type II diabetes and primary hypertension, the maintypes of medication I would prescribe would be a beta-adrenergic to relax themuscles, an ACE inhibitor to decrease the production of angiotensin II, adiuretic to increase the amount of water and salt expelled from the body asurine, or a calcium blocker to prevent calcium from entering cells of the heartand blood vessel walls resulting in lower blood pressure. The medicationLotensin and Lasix she is currently taking for her hypertension could explainwhy she is feeling light-headed as some of its common side effects includedizziness, headache, and drowsiness. Eachone of these medications will ultimately lower her systolic blood pressuremaking it back to the normal range of anything less than 120 mm Hg and loweringher diastolic blood pressure anything less than 80 mm Hg. Question 5According to the lipid panel, M.K.
is in serous risk ofhaving a heart attack. Heart failure is a syndrome rather than a disease, whichoccurs when the heart can’t pump enough blood to meet the body’s metabolicneeds. Heart failure results in interstitial and intravascular volume overloadwith poor tissue perfusion. Although the most common cause of heart failure iscoronary heart disease, it still occurs in children, infants, and adults withacquired heart defects. The likely-hood of getting heart failure is directlyproportion with age. One of the main causes of getting a heart attack is havinghigh cholesterol, fats, and LDL in the body. According to her lipid panel, hercholesterol, triglycerides, and LDL are all abnormally higher than the normalrange. As for her high-density lipoprotein(HDL), it is below the normal range it should be.
M.K. is also in risk offorming coronary artery disease resulting from atherosclerotic plaque thatfills the lumens of the coronary arteries and obstructs the blood flow leadingto ischemia.
Atherosclerosis is the deposit of cholesterol and plaque withinthe walls of the arteries (Williams & Wilkins, 2011). These deposits maybecome large enough to narrow the lumen and decrease the blood flow while alsocausing the artery to lose its elasticity. She is also at risk for gettingischemic strokes which results from sudden occlusion of cerebral arterysecondary to thrombus formation or embolization (Copstead& Banasik, 2013).
The treatment goals for these types of situations are tominimize and prevent further cerebral damage. An example of this would bethrombolytic therapy (urokinase, reteplase, streptokinase) within the first 3hours after the onset of symptoms to dissolve the clot, remove occlusion, andrestore the normal blood flow. We can also treat her with an antihypertensivesuch as nitroglycerin paste, enalapril, or labetalol to treat the hypertensionsince she is a candidate for thrombolytic therapy.
Lastly, anticoagulanttherapy (warfarin, heparin) should be given to prevent further clot formationand maintain vessel patency. Additional finding that correlate for bothhypertension and type II diabetes mellitus is kidney failure. High bloodpressure can damage the blood vessels that are in the kidney reducing theability to work properly.
In the United States, high blood pressure is thesecond leading cause of kidney failure after diabetes. Some common symptoms ofkidney failure that is due to excess fluid and build-up waste products includeshortness of breath, weakness, and swelling. The diagnosis of kidney failureusually is made by blood tests measuring BUN, creatinine, and glomerularfiltration (Williams & Wilkins, 2011).Question 6HbA1cis a test that tells you your average level of blood sugar in your body overthe past 2-3 months. Peoplewith diabetes need this test regularly to check if their levels are within thenormal range. It also tells you if you need to adjust the medicines you aretaking for you diabetes. How this test works is by measuring the amount ofglucose that binds to the hemoglobin in our red blood cells, which live forabout 3 months in our body. The higher amount of glucose that is bound to ourhemoglobin, the higher the number of our HbA1c test will be.
The normal rangefor the HbA1c test is anything below 5.7% (Haldeman-Engler, 2017). M.K.
‘s lab results for M.K.’s testwere at a 7.3% confirming that she has diabetes. Having abnormally high levelsof HbA1c indicate poorer control of diabetes that can cause problems with mostof our body systems. Excess blood sugar in our body decreases the elasticity ofour blood vessels causing them to narrow which can lead to atherosclerosis andeventually heart failure.
Other common causes of having high blood sugar caninclude nerve damage causing painful fold or insensitive feet, stomach andintestinal problems such as diarrhea and chronic constipation, or damage toyour eyes, kidneys, and skin. As for the medication she is currently taking fortype II diabetes, Glucophage has been known for increase urination at night,which can explain why it is one of her symptoms she is recently noticing. Somenatural ways to reduce blood sugar levels include exercise, staying hydrated,and controlling your carbohydrate intake. Exercise helps increase our insulinsensitivity and helps our muscles pick up the sugars in our blood, which willthen reduce our blood sugar levels.
As we monitor our hydration and carbohydrateintake, we will be able to reduce the amount of glucose in our body andincrease the amount of water to reduce blood sugar levels and help preventdiabetes. Question 7 When looking into M.K.’s lab chart, wefound that the symptoms that correlated with M.K.’s chronic bronchitis includeda chronic cough, more severe sputum in the morning, distended neck veins,excessive peripheral edema, high hematocrit level, high PaCo2, low Pa02, andweight gain due to edema. The type of treatments she needs for chronicbronchitis includes bronchodilators medications, steroids, and antibiotics. Asfor her recommendations, M.
K. needs to stop smoking cigarettes and should starteating a high-calorie and a protein rich diet. Her clinical finding for her heart failure is on the right side of her heart;meaning blood isn’t pumped effectively through the right ventricle to the lungscausing blood to be backed up into the right atrium. According to M.K.’s bloodpressure, she is in stage 1 hypertension needing treatments like thiazide-typediuretic, beta-blockers, and angiotensin receptor blocker to lower her bloodpressure. As for her lipid panel, M.
K. is in serious risk for heart failure,ischemic stroke, and atherosclerosis since she has high cholesterol and fatwithin her body. When interpreting her value for her HbA1c test, we confirm herdiabetes and offer solutions like moderate exercise with watching her carbohydrateintake and staying hydrated. M.
K. is just one out of the 5.7 million adults inthe United States that have heart failure and needs to be careful with her bodyif she wants to avoid being one of the 610,000 people who die of heart diseaseevery year. These diseases are rapidly growing in the public health of theUnited States and are projected to rise by 46 percent by 2030, resulting inmore than 8 million people with heart failure (Mariell, 2017).
I hope we can prevent M.K. fromgetting such diseases in the future and making the world a better place, onepatient at a time.