Abstract
M.K. is a 45-year-old female; measuring 5’5″ and weighing 225 lbs. M.K. has a history of smoking for about 22 years along with a poor diet. She has a history of Type II diabetes mellitus along with primary hypertension. M.K. has recently been diagnosed with chronic bronchitis. Her current symptoms include a chronic cough, more severe in the mornings with sputum, light-headedness, distended neck veins, excessive peripheral edema, and increase urination at night. Her current medications include Lotensin and Lasix for hypertension along with Glucophage for the Type II diabetes mellitus. The following are lab findings that are pertinent to this case:
| Vitals | |
| BP | 158/98 mm Hg |
| CBC | |
| Hematocrit | 57% |
| Glycosylated hemoglobin (HbA1c) | 7.3 % |
| Arterial Blood Gas Assessment | |
| PaCO₂ | 52 mm Hg |
| PaO₂ | 48 mm Hg |
| Lipid Panel | |
| Cholesterol | 242 mg/dL |
| HDL | 32 mg/dL |
| LDL | 173 mg/dL |
| Triglycerides | 184 mg/dL |
Comprehensive Case Study on COPD, Heart Failure, Hypertension, and Diabetes Mellitus
The report indicates the patient is suffering from chronic bronchitis which is reported by some of the patient’s clinical findings. M.K’s chronic bronchitis correlates with clinical outcomes like abnormal blood gasses in the artery indicated by the partial blood pressure of oxygen at 40 mmHg and the partial blood pressure of carbon dioxide at 52 mmHg. The chronic inflammation of the lungs due to bronchitis reduces lung sufficiency attributing to low partial oxygen pressure, below normal rate (75-100 mmHg) in the blood. Also, carbon dioxide is high in the blood, above normal rates (38-42 mmHg), due to insufficient gaseous exchange in the lungs caused by chronic bronchitis. Also, M.K’s blood pressure at 158/98 is higher than 60-90 mmHg and 90-140 mmHg, which are the blood pressure levels associated with an individual of M.K’s age and thus an indicator of the affliction. The clinical findings also indicate high hematocrit concentration (57%) above the normal levels (35-46%) for a female. The initial recommendation for M.’s bronchitis would be to quit smoking which is the main cause of the problem(B.A Forey, A.J Thompton & P.N Lee, 2011). For treating the problem, M.K can use bronchodilators like Vospire, AccuNeb albuterol, and formoterol among others which can assist in relaxing the bronchi muscles allowing the expansion of the central airways(UCSF Medical Center, 2017). Also, M.K can use steroids like methylprednisolone and prednisone which will work at reducing the bronchial secretions and swelling by decreasing the inflammatory reaction.(UCSF Medical Center, 2017),
An analysis of M.K’s physical conditions and clinical findings reveal that she is more susceptible to left-sided heart failure which is a branch of congestive heart failure (the heart is unable to sufficiently pump blood)(Matt Vera, 2011). M.K’s blood is low in oxygen at 48 mmHg, according to the clinical findings on oxygen at 48 mmHg, which reduces the capacity of blood containing oxygen that flows to the left side of M.K’s heart. Oxygen insufficiency causes failure of the left side of the heart which subsequently causes blood congestion in the lungs resulting in respiratory symptoms and the development of pulmonary edema(Health Guide, 2017). M.K’s report also indicates she has excessive peripheral edema and distended neck veins, both of which present the possibility of left-sided heart failure. M.K’s physical also shows that she’s experiencing chronic cough which is producing mucus, a sign associated with left-sided heart failure(FAARC, 2006). This type of heart failure is also associated with decreased urination, especially during the day which means increased urination during the night(Health Guide, 2017). The left-sided heart failure has associated with systolic failure where the left chamber loses the ability to push blood due to a lack of oxygen.
Four categories of measurements are usually used to categorize hypertension or blood pressure. The four measurements include normal blood pressure (120/80 mmHg), prehypertension (120-139 mmHg/80-89 mmHg), stage 1 hypertension (140-159 mmHg/90-99 mmHg), and stage 2 hypertension (160 or higher mmHg/100 mmHg or higher)(Neil R. Poulter, Dorairaj Prabhakaran & Mark Caulfield, 2015). As it stands, M.K is suffering from stage 1 hypertension. M.K takes Lotensin and Lasix to control hypertension. These drugs are necessary because at this stage; the patient must take drugs that not only reduce or control high blood pressure but also drugs that significantly curtail the threat of a stroke or a heart attack(Neil R. Poulter, Dorairaj Prabhakaran & Mark Caulfield, 2015). Lotensin and Lasix are ACE inhibitors and are thus suited to function as inhibitors of a heart attack and high blood pressure. Like ACE inhibitors, the drugs function by relaxing blood vessels to allow easier flow of blood. Hypertension is rife among adults in the United States, 32% (72 million) of American adults suffer from high blood pressure which is 1 in every three individuals(CDC, 2015). As of 2014, 410,000 people were dying due to high blood pressure annually with only 54% of people with hypertension in the United States having it under control(CDC, 2015). These statistics illustrate the significance of high blood pressure in the US, the number of people affected by the problem means the affliction should be taken seriously.
An individual’s lipid panel can be associated with several diseases. Reviewing M.K’s lipid panel, we can associate the results with other afflictions that she might be suffering. A look at M.’s lipid panel, cholesterol is at 242 mg/dL, HDL 32 mg/dL, LDL 173 mg/dL and Triglycerides 184 mg/dL. All these are either beyond or below the accepted levels placing the patient at risk of developing other complications. With cholesterol of less than 50 mg/dL, she is at risk of developing cardiovascular complications. She can also get hyperlipidemia, obesity, and possibly myocardial infarction(Kim, 2015). According to the lipid panel and the subsequent risk of heart diseases that are imposed by their anomalies, the patient should be subscribed to other medications. These irregular levels of cholesterol can be treated using “statins,” a group of drugs that function by limiting the production of cholesterol in the liver and absorbing the cholesterol in the blood. Examples of statins include fluvastatin, simvastatin, atorvastatin, and rosuvastatin(Kim, 2015). Other types of medications that she can be prescribed include “bile-acid-binding resins” and “cholesterol absorption inhibitors.” Both of these medications lower blood cholesterol.
In the clinical findings, Glycosylated hemoglobin (HbA1c) was conducted which illustrated a 7% level. A glycosylated hemoglobin test is used to diagnose whether an individual has diabetes(Christos Kalofoutis, Christina Piperi, Anastasios Kolofoutis, Fred Harris, David Phoenix & Jaipaul Singh, 2007). The body produces glucose or blood and blood sugar which can also be absorbed from external sources. The buildup of glucose in the blood leads to the glucose binding with the hemoglobin contained in the red blood cells. The red blood cells contain hemoglobin for the transport of oxygen. The HbA1c test investigates the amount of glucose bound to the blood, the amount of glucose available is measured on an average of three months, taking into account the lifespan of red blood cells which is three months. (Christos Kalofoutis, Christina Piperi, Anastasios Kolofoutis, Fred Harris, David Phoenix & Jaipaul Singh, 2007). Normal and abnormal body functions are determined by the amount of glucose in the blood, whether high or lower.
References
B.A Forey, A.J Thompton & P.N Lee. (2011). Systematic review with meta-analysis of the epidemiological evidence relating smoking to COPD, chronic bronchitis, and emphysema. BMC Pulmonary, 11(36), 36.
CDC. (2015, January 19). High Blood Pressure Fact Sheet. Retrieved February 18, 2017, from Centers for Disease Control and Prevention: https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm
Christos Kalofoutis, Christina Piperi, Anastasios Kolofoutis, Fred Harrs, David Phoenix & Jaipaul Singh. (2007). Type II diabetes mellitus and cardiovascular risk factors: Current therapeutic approaches. Experimental & Clinical Cardiology, 12(1): 17–28.
FAARC, M. S. (2006, April ). Congestive Heart Failure: Diagnosis, Pathophysiology, Retrieved from respiratory care journal: https://www.rcjournal.com/contents/04.06/04.06.0403.pdf
Health Guide. (2017, February 18). Left-Sided Heart Failure. Retrieved February 18, 2017, from The New York Times: https://www.nytimes.com/health/guides/disease/left-sided-heart-failure/overview.html
Kim, S. (2015, November 2). High Blood Cholesterol and Triglycerides (Lipid Disorder). Retrieved February 18, 2017, from Health Line: https://www.healthline.com/health/high-cholesterol/lipid-disorder#Overview1
Matt Vera, R. (2011, December 16). Congestive Heart Failure Pathophysiology & Schematic Diagram. Retrieved from Nurses labs: http://nurseslabs.com/congestive-heart-failure-chf-pathophysiology/
Neil R. Poulter, Dorairaj Prabhakaran & Mark Caulfield. (2015). Hypertension. The Lancet, http://dx.doi.org/10.1016/S0140-6736(14)61468-9.
UCSF Medical Center. (2017). Chronic Bronchitis: Treatment. Retrieved February 18, 2017, from UCSF Medical Center: https://www.ucsfhealth.org/conditions/chronic_bronchitis/treatment.html
What is HbA1c? (2016). Retrieved from Diabetes.co.uk: https://www.diabetes.co.uk/what-is-hba1c.html