Comprehensive Case Study on COPD, Heart Failure, Hypertension and Diabetes Mellitus (Essay Sample)

Comprehensive Case Study on COPD, Heart Failure, Hypertension and Diabetes Mellitus Student’s name Institutional Affiliation The clinical findings that correlate with M.K’s chronic bronchitis include abnormal arterial blood gasses as indicated by the partial pressure of carbon dioxide of 52 mmHg. Due to the gaseous exchange insufficiency in the lungs, the carbon dioxide accumulates in blood above the normal ranges of 38-42 mmHg. Secondly, the low partial pressure of oxygen in the blood of 48 mmHg instead of normal values of between 75-100 mmHg. This can also be attributed to the reduced lung sufficiency due to chronic inflammation with bronchitis. Thirdly, high hematocrit concentration level of 57% instead of 35-46% concentration in females is associated with the reduced tissue perfusion which stimulates an increase of erythrocyte production by the bone marrow as a compensatory mechanism hence leading to raised hematocrit concentration level. Fourthly, the blood pressure of 158/98 is slightly higher than the normal ranges for a person of M.K’s age as the standard ranges are supposed to be between 90-140 mmHg systolic and a diastolic of 60-90mmHg. The slight increase in blood pressure is attributed to a compensatory mechanism to increase tissue perfusion because of reduced gaseous exchange in the lungs. More other findings that are associated with the condition include a chronic cough and sputum production (Boyd & Tower, 2014).  Appropriate treatment for M.K’s condition could be administration of the following medications; beta2 agonist such as albuterol inhaler for bronchodilation, steroid such as hydrocortisone systematically or prednisolone orally to decrease inflammation in the airway, expectorants such as guaifenesin to liquefy secretions, empirical antibiotic therapy such as ceftriaxone for prophylaxis and treatment of any bacterial infections. Specific antibiotics can also be administered according to sensitivity lab results. Administration of H2 blockers such as ranitidine to prevent stress ulcers due to excessive production of HCL in the gastric cavity is essential. Finally, influenza and pneumonia vaccines should be administered to minimize the chances of infection as such a patient is highly susceptible. The most appropriate recommendations for Ms. M.K include stopping smoking in order to reduce exacerbation of the condition. She should avoid allergens such as dust and pollen grains that may trigger inflammation of the airway. Additionally, she should practice coughing and deep breathing exercises to enhance lung expansion and expel sputum. The client should take a balanced diet with high calories to meet body demands with straining to breathe and exercises that are necessary to reduce insulin resistance that leads to type II diabetes mellitus. This is also to rectify and prevent malnutrition (obesity) due to previous poor dietary habits from the history given (Boyd & Tower, 2014).  2 The type of heart failure suspected in Ms. M.K is right-sided heart failure due to suggestive evidence of distended neck veins due to the accumulation of fluid in the pulmonary blood vessels and peripheral edema due to systemic hypertension. Pathogenesis of right-sided heart failure occurs primarily because of increase and build up of pressure in the pulmonary system. In this case, inflammation experienced in the lungs leads to destruction and fibrosis of the lung tissues. This consequently results in the pulmonary resistance and increased pulmonary pressure. There is also increased preload on the right ventricle associated with the pulmonary resistance. As a compensatory mechanism, the contractile force of the right ventricle is increased as the preload continuously increases to overcome the pulmonary resistance and pressure. Eventually, there is right-sided heart failure as the right ventricle cannot sustain contractility and pumping energy demands. 3. According to the blood pressure value of 158/98 mmHg, Ms. M.K is experiencing stage one hypertension. Stage one hypertension has a defining characteristic of an individual having a systolic blood pressure of between 140-159 mmHg and a diastolic blood pressure of 90-99 mmHg usually recorded in more than three instances. Hypertension is as a result of chronic smoking, obesity, and right-sided heart failure. The light headedness experienced is attributed to high blood pressure (Burke, LeMone & Mohn-Brown, 2013).  The medications used for the treatment of Ms. M.K’s hypertension are Lotensin and Lasix. The reasons for the administration of Lotensin are that it is an angiotensin converting enzyme inhibitor. It inhibits the conversion of angiotensin released by the kidney from being converted to angiotensin II which is a vasoconstrictor as vasoconstriction leads to increase of blood pressure. Moreover, angiotensin II promotes the production of aldosterone that aids in the sodium and water retention in the kidney. Precisely, Lotensin caused vasodilation and prevents fluid volume increase in the cardiovascular system due to the effects of aldosterone. On the other hand, Lasix is used since it is a loop diuretic whose primary purpose, in this case, is to prevent reabsorption of sodium and water in the kidney hence preventing systemic overload and hypertension. Additionally, it aids in the relieving of peripheral edema and prevention of congestive heart failure (Adams, Holland & Urban, 2012). According to Center for disease Control (CDC), about 29% of the American adult population has hypertension. Estimates indicate that the nation approximately 46 US dollar each year in the provision of health care services, medication and days missed from work and other economic activities. In 2013, the statistics indicated that 360,000 deaths occurred due to hypertension and related conditions which were equivalent to 1000 deaths per day (Yutaka et.al, 2014). 4. According to the lipid panel findings, M.K is at a higher risk of developing additional conditions such as atherosclerosis due to building up of plaque in the arteries related to high cholesterol levels (hypercholesterolemia). Plaque formation is associated with the combination of excess cholesterol, other fats, and calcium. She is also at risk of developing coronary heart disease that is also attributed to plaque formation and low high-density lipoprotein cholesterol (LDL). Some plaque formed, attach loosely on the lumen of arteries and can be dislodged causing blood coagulation to occur within the blood vessels and eventually cause pulmonary thrombosis. Her cholesterol levels are 242 mg/dL, higher than the usual ranges of 130-200 mg/dL, low HDL level of 32 mg/dL instead of 35-150 mg/dL, high LDL of 173 mg/dL, instead of a standard range of 0-129 mg/dL and higher than normal triglyceride levels of 184 mg/dL instead of the expected 30-150 mg/dL (Burke, LeMone & Mohn-Brown, 2013).  Therefore according to this case study, M.K should be given various medications to aid in normalizing the lipid panel values in the body. She should be prescribed with statin medication such as Fluvastatin and Atorvastatin that block production of cholesterol in the body and aiding in the removal of excess cholesterol such. She can also be offered cholesterol absorption inhibitors such as Ezetimibe that reduce absorption of cholesterol present in dietary intakes. Fibrate administration such as fenofibrate is given to prevent the production of triglyceride in the liver and circulation by VLDL particles into the...