Question 1


M.K. is a 45 year-old female weighing in
at 225lbs and measuring 5’5″ tall. She has a history of smoking for 22 years
with a poor diet. M.K. has a history of primary hypertension and type II
diabetes mellitus and has recently been diagnosed with chronic bronchitis. Her current
symptoms include light-headedness, chronic cough, more severe sputum in the morning,
excessive peripheral edema, distended neck veins, and increased urination at
night. The medication M.K. is using for the hypertension include both Lotensin
and Lasix along with Glucophage for the type II diabetes mellitus.

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Question 2

Chronic bronchitis is the hypersecretion
of mucus and a chronic productive cough that last for 3 months of the year and
occur for at least 2 consecutive years (Davis, 2017). Chronic bronchitis is an inflammation
of the bronchi caused by infection or irritants that has a distinguished
characteristic of airflow obstruction. 
The irritants inflame in the tracheobronchial tree leading to narrowed
or blocked airways and increased mucus production. As the inflammation
continues, it results in hypertrophy and hyperplasia of the mucus glands, ciliary
damage, chronic leukocytic infiltration of bronchial walls, and increased
goblet cells. The clinical findings that correlate with M.K.’s chronic
bronchitis include high hematocrit level, low PaO2, high PaCO2, chronic cough,
more severe sputum in the morning, distended neck veins, and excessive
peripheral edema. Her lab findings for hematocrit are coming in abnormally high
at 57%. Hematocrit is expressed as a percentage by volume of the blood that
consists of packed red blood cells in the body. The normal hematocrit values
for a 45-year-old woman are 36%-48% (Haldeman-Engler,
2017). Since M.K has 57%, there was no surprise that she was diagnosed with
chronic bronchitis.  PaO2 stands for the
partial pressure of 02 in arterial blood, whereas PaC02 is the partial pressure
of carbon dioxide in the blood. The normal range for PaO2 in the body is
anywhere from 75 mm Hg to 100 mm Hg arterial and anywhere from 35-45 mm Hg for
PaC02 (Hadjiladis, 2016). M.K. has two abnormal values for both of these coming
in over the average with 52 mm Hg for PaC02 and under the average with 48 mm Hg
with PaO2. A high PaC02 and a Low arterial Pa02 are both associated with
chronic bronchitis; hence why both of these finding were found in M.K.’s COPD. Her
other clinical findings including her chronic cough, severe sputum in the
morning, distended neck veins, and excessive peripheral edema, are all each a
common clinical manifestation for chronic bronchitis. Weighing in at 225 lbs.

might also correlate with chronic bronchitis, as weight gain due to edema is a
common sign of this type of inflammation.

M.K. appears to be in stage 2 COPD, the type of treatment appropriate for MK’s
chronic bronchitis is bronchodilators medications, steroids, and antibiotics.

The bronchodilators will be a successful treatment as it will help to relive
the symptoms by relaxing the smooth muscles in the bronchioles which will then
dilate the bronchi decreasing resistance in the reparatory airway and
increasing the airflow to the lungs. With this medication, it will also relieve
bronchospasms and facilitate mucociliary clearance making it a reversible
process. The antibiotics and steroids will be used to treat recurring
infections and reduce the inflammation. To treat and reduce her excessive
peripheral edema, we may also give her a diuretic like the one she is using for
her hypertension. As for some recommendations, the first thing M.K. should do
is 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 are
injuring the lungs making it harder to breathe (Laura, 2017). It is also
recommended that we provide her with a high-calorie, protein rich diet. We must
offer 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 may
precipitate bronchospasms. We can suggest she avoid the windy weather, the
cold, or to cover her nose and mouth with a scarf before going outside. These
lifestyle changes have been shown to help improve COPD with the special
considerations she’s having.

Question 3

Heart failure may my categorized
according to the side of the heart that is affected (left or right sided heart
failure) or by the cardiac cycle involved (systolic or diastolic dysfunction).

Left-sided heart failure occurs as the result of the ineffective left
ventricular contractile function. As the pumping ability of the left ventricle
fails causing low cardiac output, blood is no longer effectively pumping out
into the body which gets backed up into the left atrium and finally in the
lungs (Williams & Wilkins, 2011). Left sided heart failure can cause dyspnea,
pulmonary congestion, and activity intolerance. If the conditions persist, it
may result in hypertension, left ventricular infarctions, and aortic and mitral
valve stenosis. Right-sided heart failure is in result from the ineffective
right ventricular contractile function. The blood is not pumped effectively
through the right ventricle causing blood to back up into the right atrium and
the peripheral circulation. While this is occurring, the patient gains weight
and develops peripheral edema and enlargement of the kidney and other organs.

This may also result from an acute right ventricular infarction, pulmonary
embolus, or pulmonary hypertension. However, the most common cause of
right-sided heart failure is the backward flow due to the left-sided heart
failure. The signs and symptoms of right-sided heart failure include weight
gain, development of peripheral edema, edema associated with fluid excess, and
elevated 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 is
having right-sided heart failure. The first type of treatment I would give M.K.

would be an angiotensin-converting enzyme (ACE) inhibitor to reduce the
production of angiotensin II, resulting in preload and afterload
reduction.  ACE is a type of vasodilator
that 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. The
next type of treatment I would give M.K. is a beta-blocker. Not only will this
reduce her blood pressure and slow down the heart rate, but will also
limit/reverse some of the damages done to the heart since it’s having high systolic
heart pressure as well.

Question 4

Hypertension is an elevation in the
diastolic or systolic blood pressure and occurs in two major types. The most
common form is called stage 1 hypertension. Some of the most common causes of
stage 1 hypertension may include obesity, sedentary lifestyles, and tobacco
use.  The one that results from renal
disease or an unidentifiable cause is called stage 2 hypertension. The causes for
stage 2 hypertension may include brain tumor, excessive alcohol consumption,
and coarctation of the aorta. Malignant hypertension is a severe fulminant form
of both types of hypertensions. To qualify for stage 1 hypertension, the
systolic blood pressure must be in the range of 140-159 mm Hg or your diastolic
blood pressure must be in the range of 90 – 99 mm Hg. To qualify for secondary
hypertension, the systolic blood pressure must be in the range of 160 mm Hg or
higher or your diastolic blood pressure must be in the range of 100 mm Hg or
higher. According to M.K’s blood pressure of 158/98 mm Hg, she falls under the
category of stage 1 hypertension. When hypertension is prolonged, it increases
the heart’s workload resistance to the left ventricular ejection, which creates
the left ventricle hypertrophy raising the hearts oxygen demand and workload.

Failure and cardiac dilation may occur when hypertrophy can no longer maintain
the sufficient cardiac output. Since hypertension increases the chance of
coronary 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 some
signs and symptoms that may occur in the body. One of the main clinical
manifestations of primary hypertension is occipital headache. The headache may
worsen on rising in the morning as a result of increased cranial pressure
resulting from vascular changes. If headaches are severe, it may result to nausea
and vomiting. In addition, dizziness, fatigue, and confusion may be caused by
decreased tissue diffusion due to vasoconstriction.  As for her treatments, the first thing I
would recommend is her lifestyle changes. Knowing that she is 225 lbs. and only
measuring 5’5″ tall, use of dietary approaches involving an increase in
vegetables, fruits, and low-fat dairy products including a moderation of
alcohol intake with exercise would be a good start in getting her back in
shape. 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 main
types of medication I would prescribe would be a beta-adrenergic to relax the
muscles, an ACE inhibitor to decrease the production of angiotensin II, a
diuretic to increase the amount of water and salt expelled from the body as
urine, or a calcium blocker to prevent calcium from entering cells of the heart
and blood vessel walls resulting in lower blood pressure. The medication
Lotensin and Lasix she is currently taking for her hypertension could explain
why she is feeling light-headed as some of its common side effects include
dizziness, headache, and drowsiness.  Each
one of these medications will ultimately lower her systolic blood pressure
making it back to the normal range of anything less than 120 mm Hg and lowering
her diastolic blood pressure anything less than 80 mm Hg.

Question 5

According to the lipid panel, M.K. is in serous risk of
having a heart attack. Heart failure is a syndrome rather than a disease, which
occurs when the heart can’t pump enough blood to meet the body’s metabolic
needs. Heart failure results in interstitial and intravascular volume overload
with poor tissue perfusion. Although the most common cause of heart failure is
coronary heart disease, it still occurs in children, infants, and adults with
acquired heart defects. The likely-hood of getting heart failure is directly
proportion with age. One of the main causes of getting a heart attack is having
high cholesterol, fats, and LDL in the body. According to her lipid panel, her
cholesterol, triglycerides, and LDL are all abnormally higher than the normal
range.  As for her high-density lipoprotein
(HDL), it is below the normal range it should be. M.K. is also in risk of
forming coronary artery disease resulting from atherosclerotic plaque that
fills the lumens of the coronary arteries and obstructs the blood flow leading
to ischemia. Atherosclerosis is the deposit of cholesterol and plaque within
the walls of the arteries (Williams & Wilkins, 2011). These deposits may
become large enough to narrow the lumen and decrease the blood flow while also
causing the artery to lose its elasticity. She is also at risk for getting
ischemic strokes which results from sudden occlusion of cerebral artery
secondary to thrombus formation or embolization (Copstead
& Banasik, 2013). The treatment goals for these types of situations are to
minimize and prevent further cerebral damage. An example of this would be
thrombolytic therapy (urokinase, reteplase, streptokinase) within the first 3
hours after the onset of symptoms to dissolve the clot, remove occlusion, and
restore the normal blood flow. We can also treat her with an antihypertensive
such as nitroglycerin paste, enalapril, or labetalol to treat the hypertension
since she is a candidate for thrombolytic therapy. Lastly, anticoagulant
therapy (warfarin, heparin) should be given to prevent further clot formation
and maintain vessel patency. Additional finding that correlate for both
hypertension and type II diabetes mellitus is kidney failure. High blood
pressure can damage the blood vessels that are in the kidney reducing the
ability to work properly. In the United States, high blood pressure is the
second leading cause of kidney failure after diabetes. Some common symptoms of
kidney failure that is due to excess fluid and build-up waste products include
shortness of breath, weakness, and swelling. The diagnosis of kidney failure
usually is made by blood tests measuring BUN, creatinine, and glomerular
filtration (Williams & Wilkins, 2011).

Question 6

is a test that tells you your average level of blood sugar in your body over
the past 2-3 months. People
with diabetes need this test regularly to check if their levels are within the
normal range. It also tells you if you need to adjust the medicines you are
taking for you diabetes. How this test works is by measuring the amount of
glucose that binds to the hemoglobin in our red blood cells, which live for
about 3 months in our body. The higher amount of glucose that is bound to our
hemoglobin, the higher the number of our HbA1c test will be. The normal range
for the HbA1c test is anything below 5.7% (Haldeman-Engler, 2017). M.K.’s lab results for M.K.’s test
were at a 7.3% confirming that she has diabetes. Having abnormally high levels
of HbA1c indicate poorer control of diabetes that can cause problems with most
of our body systems. Excess blood sugar in our body decreases the elasticity of
our blood vessels causing them to narrow which can lead to atherosclerosis and
eventually heart failure. Other common causes of having high blood sugar can
include nerve damage causing painful fold or insensitive feet, stomach and
intestinal problems such as diarrhea and chronic constipation, or damage to
your eyes, kidneys, and skin. As for the medication she is currently taking for
type 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. Some
natural ways to reduce blood sugar levels include exercise, staying hydrated,
and controlling your carbohydrate intake. Exercise helps increase our insulin
sensitivity and helps our muscles pick up the sugars in our blood, which will
then reduce our blood sugar levels. As we monitor our hydration and carbohydrate
intake, we will be able to reduce the amount of glucose in our body and
increase the amount of water to reduce blood sugar levels and help prevent

Question 7


When looking into M.K.’s lab chart, we
found that the symptoms that correlated with M.K.’s chronic bronchitis included
a chronic cough, more severe sputum in the morning, distended neck veins,
excessive peripheral edema, high hematocrit level, high PaCo2, low Pa02, and
weight gain due to edema. The type of treatments she needs for chronic
bronchitis includes bronchodilators medications, steroids, and antibiotics. As
for her recommendations, M.K. needs to stop smoking cigarettes and should start
eating 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 lungs
causing blood to be backed up into the right atrium. According to M.K.’s blood
pressure, she is in stage 1 hypertension needing treatments like thiazide-type
diuretic, beta-blockers, and angiotensin receptor blocker to lower her blood
pressure. As for her lipid panel, M.K. is in serious risk for heart failure,
ischemic stroke, and atherosclerosis since she has high cholesterol and fat
within her body. When interpreting her value for her HbA1c test, we confirm her
diabetes and offer solutions like moderate exercise with watching her carbohydrate
intake and staying hydrated. M.K. is just one out of the 5.7 million adults in
the United States that have heart failure and needs to be careful with her body
if she wants to avoid being one of the 610,000 people who die of heart disease
every year. These diseases are rapidly growing in the public health of the
United States and are projected to rise by 46 percent by 2030, resulting in
more than 8 million people with heart failure (Mariell, 2017). I hope we can prevent M.K. from
getting such diseases in the future and making the world a better place, one
patient at a time.





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