M.K is a female, 45 years old with 5.5” height and 225 lbs. weight and has a history of smoking for 22 years and poor diet. The history of Type II diabetes mellitus and primary hypertension is also observed with the recent diagnosis of chronic bronchitis. She has been observed with chronic cough with sputum, light headedness, excessive peripheral edema, distended neck veins and increased urination during the night. She has been using the medications comprising of Lotensin and Lasix to treat hypertension and Glucophage for diabetes mellitus.
Vitals and Lab Results
The patient is observed chronic cough with sputum and the cough is observed to be severe at night, which indicates the lack of oxygen and problem breathing. Moreover, the clinical findings indicate that the PaO2 is 48mgHg, which is considered low because the normal values of PaO2 range from 75mgHg to 100mgHg. The low PaO2 level indicates low arterial oxygen pressure and determines the prevalence of pulmonary disease. Similarly, the clinical findings for PaCO2 indicate the value of 52 mmHg, whereas the normal value ranges between 35mmHg to 45mmHg. The high value indicates the increased partial pressure of carbon dioxide which eventually indicates the prevalence of an obstructive lung disease. The observation of cough and sputum secretion confirms that the patient has chronic bronchitis (Pauwels & Rabe, 2004).
What type of treatment and recommendations would be appropriate for M.K’s chronic bronchitis?
The chronic bronchitis is required to be treated by pulmonary rehabilitation, in which the patient will be assisted with the physical exercise to incorporate the breathing techniques. It will help the patient to overcome the stress that is related to the breathing problem. The patient will be provided with the adequate information about the negative effects of smoking on his medical condition and hence, the cessation of smoking will take place (Lacasse, et al., 2006). Moreover, the patient will be prescribed with Metaproterenol by inhalation mechanism every 3 hour up to 5 days. The inhalation solution will be made with 10 mg Metaproterenol with 0.2 ml of 5% solution. Moreover, the antibiotic dosage of Tetracycline 500 mg will be administered every 6 hours up to 5 days.
What type of heart failure would you suspect with M.K?
The patient is highly prone to developing the Congestive Heart Failure due to the observation of excessive peripheral edema.
Explain the pathogenesis of how this type of heart failure develops.
The occurrence of CHF takes place when the heart becomes unable pump the adequate quantity of blood in order to maintain the blood flow in accordance with the need of the body. In CHF, the outflow of blood reduces due to which excessive blood backs up in the veins and develops congestions in the body tissues. It results in the occurrence of edema, in which the swellings in limbs and other body parts takes place. It also causes the collection of fluids in the lungs which results in the shortness of breath which is known as pulmonary edema and when it not treated in an effective manner, then it causes the respiratory disorder. The patient is observed to have shortness of breathing and peripheral edema which eventually indicates the possible occurrence of Congestive Heart Failure (Poppas & Rounds, 2002).
According to the B.P. value, what stage of hypertension is M. K. experiencing?
The blood pressure level of patient is observed to be 158/98 mmHg, which is considered as the stage 1 hypertension.
Explain the rationale for her current medications for her hypertension.
The patient has been prescribed with Lotensin, which is used to treat the prevalence of hypertension by means of reducing the blood pressure. It works as an ACE inhibitor and hence, it relaxes the blood vessels in order to ease the blood flow. Moreover, the patient is also using Lasix, which is a diuretic supplement and helps in passing out the excessive salt from the body in urine. However, this medication is usually used to reduce the occurrence of congestive heart failure among the patients with edema, but in current case, the medication is used to remove the extra salt from the body in order to remove the strain from the blood vessels and ease the blood flow.
Discuss the impact of this disease in the U.S. population
It is estimated that heart diseases are the most leading cause of death in the world and accounts for 30 percent of deaths in the world. The stage 1 hypertension can cause damage to the coronary arteries due to the increased flow of flood, which can also result in the congestive heart failure, heart stroke and heart diseases. It is estimated that nearly 610,000 individuals die due to the heart disease in the United States every year and hence, it is considered as a leading cause of death in the United States. Therefore, it is concluded that the occurrence of stage 1 hypertension is the major cause of heart disease in the United States and also possesses the high mortality rate (Mattace-Raso et al., 2006).
According to the lipid panel, what other condition is M.K. at risk for?
The cholesterol level is observed high whereas, the HDL level is observed low. The HDL is considered as good cholesterol which provides defense to the body towards the coronary heart diseases. The LDL level is also observed high, but the triglyceride level is observed low. The prevalence of high cholesterol can increase the risk towards the occurrence of chronic heart diseases whereas, the low level of HDL, often known as good cholesterol, has reduced the patient’s defense towards the occurrence of heart disease. Moreover, the LDL level indicates the bad cholesterol which negatively effects the heart condition and increases the risk of heart problems. The low triglyceride level indicates the consumption of insufficient calories and are considered as a consequence of patient’s poor diet (Sharrett et al., 2001). Therefore, high cholesterol is observed due to the high level of LDL and hence, this condition makes M.K at the risk of developing coronary artery disease, ischemic attack and heart attack.
According to this case study, what other medications should be given and why?
The lipid level is required to be maintained by administering Atorvastatin 20 mg once in a day. It will help in increasing the HDL while reducing the LDL level and hence, the optimum level of cholesterol will be achieved.
What additional findings correlate for both hypertension and Type II diabetes mellitus? 5.
The patient is feeling lightheadedness which can be the cause of hypertension whereas, the patient is also feeling the urge of frequent urination which eventually indicates the high glucose level.
Interpret the lab value for HbA1c and explain the rationale for this value in relation to normal/abnormal body function?
The normal range for HbA1c is found to be between 4% to 5.6%, whereas it is observed 7.3% in the patient which is excessively high. The value of HbA1c that is found between 5.7% to 6.4% indicate the risk of diabetes whereas, the HbA1c level of 7.3% indicates the prevalence of diabetes. It also indicates that the blood sugar is above 7.8 mm/ol and hence, the risk of organ damage due to high sugar level prevails for M.K.
Reference
Lacasse, Y., Goldstein, R., Lasserson, T. J., & Martin, S. (2006). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev, 4(4).
Mattace-Raso, F. U., van der Cammen, T. J., Hofman, A., van Popele, N. M., Bos, M. L., Schalekamp, M. A., & Witteman, J. C. (2006). Arterial stiffness and risk of coronary heart disease and stroke the rotterdam study.Circulation, 113(5), 657-663.
Pauwels, R. A., & Rabe, K. F. (2004). Burden and clinical features of chronic obstructive pulmonary disease (COPD). The Lancet, 364(9434), 613-620.
Poppas, A., & Rounds, S. (2002). Congestive heart failure. American journal of respiratory and critical care medicine, 165(1), 4-8.
Sharrett, A. R., Ballantyne, C. M., Coady, S. A., Heiss, G., Sorlie, P. D., Catellier, D., & Patsch, W. (2001). Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein (a), apolipoproteins AI and B, and HDL density subfractions the atherosclerosis risk in communities (ARIC) study. Circulation, 104(10), 1108-1113.
