The development of multiple conditions has a significant effect on a patient’s health. In the discussed case, M.K., a 45-year-old female has a history of Type II diabetes mellitus (T2D) and hypertension. Her current diagnosis is chronic bronchitis, as the patient experiences chronic cough with sputum, excessive peripheral edema, nocturia, and other symptoms related to the disease. This report will examine the case study and discuss the clinical findings of such conditions as chronic bronchitis, heart failure, hypertension, heart disease, and the patient’s current health history.
Chronic Bronchitis
The development of chronic bronchitis is an inflammatory process that affects one’s bronchial tubes and lungs. M.K’s arterial blood gas assessment is the main part of the clinical findings that pertain to the diagnosis. This test is used for determining the occurrence of COPD (chronic obstructive pulmonary disease). It measures the level of oxygen in one’s blood and the process of removing carbon dioxide from the body (Hogan & Gingrich, 2014). The results of this particular diagnostic show the severity of one’s COPD and the need for oxygen therapy.
According to the case study, the value of PaCO2 is 52 mm Hg, and PaO2 is 48 mm Hg. The first number shows the amount of carbon dioxide in M.K.’s blood. Its levels have to be in the range of 35-45 mm Hg for the blood to be considered normal. The patient’s results are higher, indicating the increased acidity of the blood and supporting the patient’s diagnosis of COPD. Moreover, the normal range for PaO2 is usually between 80 and 100 mm Hg, while the patient’s analysis shows 52 mm Hg. Such a small amount signifies hypoxemia – a low concentration of oxygen caused by hypoventilation (Hogan & Gingrich, 2014). The combination of these results is also indicative of a specific condition. Both PaCO2 and PaO2 are not in normal ranges, pointing one to a disease of the airways (Hogan & Gingrich, 2014). Thus, the arterial blood gas assessment is one of the reasons for the patient’s diagnosis of chronic bronchitis.
The treatment plan for the patient has to include pharmacotherapy as well as lifestyle changes. The primary objectives of this therapy are to relieve symptoms, slow the disease’s progression, and lower the risk of complications. First of all, smoking cessation is vital for M.K.’s health outcomes – it is an integral part of any lung disease therapy (Charbek, Espiritu, Nayak, & Morley, 2018). If M.K. continues to smoke with chronic bronchitis, it may undermine any therapeutic efforts and put further pressure on her airways. Second, the patient should review her diet and ensure that she receives appropriate hydration (Saleem, Sardar, & Javed, 2018). Third, oxygen supplementation may be necessary if the patient finds it difficult to breathe on her own. Oxygen therapy with a device that can be used at home can be prescribed to the patient. Another part of lifestyle alteration is proper breathing. M.K.’s education has to include breathing exercises and techniques, and a strategy for light exercising that would account for the patient’s current limitations in breathing and movement.
Finally, several types of pharmacological treatment will ease the patient’s symptoms. Saleem et al. (2018) recommend prescribing bronchodilators, parenteral steroids, and antibiotics. Bronchodilators open the airways and help the patient breathe, inhaling more oxygen, and stabilizing the blood’s pH (Hogan & Gingrich, 2014). Steroids can provide the same effect, but their prolonged use can lead to a variety of adverse effects. Thus, their prescription has to be discussed with the patient before including them in the plan. Antibiotics are used to fight infections, which may be common in patients with chronic bronchitis. For example, if the patient experiences an exacerbation of chronic bronchitis, then one should consider adding antibiotics to the treatment. Saleem et al. (2018) find that oral moxifloxacin is useful in these instances. If the patient does not have exacerbations, she should adhere to the set of lifestyle changes and take bronchodilators as prescribed.
Heart Failure
Analyzing the patient’s symptoms and clinical findings, one may suggest that M.K. has right-sided heart failure. The first sign is the distended neck veins, which signify the increased pressure in the veins of the upper body (Ponikowski & Jankowska, 2015). The heart’s right ventricle pumps blood to the lungs to collect oxygen, and its performance is impacted by the left ventricle which is responsible for pumping blood to other organs (Hogan & Gingrich, 2014). Thus, a person with suspected right-sided heart failure is likely to have experienced left-sided heart failure as well. The second argument for right-sided heart failure is excessive peripheral edema. The buildup of fluid can explain the swelling in the legs and other parts of the body. In turn, the development of sputum and M.K. breathing problems indicate a possible left-sided heart failure (Ponikowski & Jankowska, 2015). Since most cases of heart failure start on the left side, one may assume that both ventricles were affected.
The pathogenesis of the patient’s health failure depends on whether it was caused by her chronic lung condition or by the failure of the left ventricle. In the first scenario, lung problems lead to pulmonary hypertension, causing the lungs to receive and distribute less oxygen. As a result, the body increases the blood pressure and increases the workload of the right ventricle. With time, the continuous stress put on the right ventricle causes it to fail and lose its performative ability. Thus, the blood, previously pumped by the right ventricle into the heart, stays in the veins, which causes edema in the legs, feet, and abdomen and neck veins’ distention.
The process for this condition that is caused by both ventricle’s failure is somewhat different. If the left ventricle is affected first, it fails to pump the blood out to the rest of the body, changing the circulation. As a result, the body does not receive enough oxygen, and the blood backs up in the lungs (Hogan & Gingrich, 2014). After sufficient buildup accumulates in the lungs and behind the left ventricle, it moves into the right ventricle, which works under the pressure of fluid and insufficient oxygen supply. It fails due to the increased workload and pressure, resulting in the symptoms mentioned above. As one can see, the result of these processes is the same – the patient’s blood and oxygen circulation processes are abnormal, leading to further problems and requiring urgent medical help.
Hypertension
The latest guidelines introduced by the American Heart Association in 2017 change the way people with and without hypertension are defined. Whelton et al. (2018) suggest four types of blood pressure (BP) – normal, elevated, and state 1 and 2 hypertension. Normal BP is less than 120/80 mm Hg, elevated is around 120-129 in systolic BP (SBP) and less than 80 in diastolic BP (DBP). Furthermore, stage 1 hypertension is declared when a person’s SBP is 130-139 mm Hg, or DBP is 80-89 mm Hg. Finally, stage 2 hypertension is diagnosed in people whose SBP is higher than 140 mm Hg, or whose DBP is higher than 90 mm Hg. In the present case study. M.K.’s BP is 158/98 mm Hg. Both her SBP and DBP numbers are higher than those listed as minimal for stage 2 hypertension. This means that the patient has a severe case of stage 2 hypertension, which requires immediate attention and poses a serious risk of cardiovascular disease (Hogan & Gingrich, 2014). The patient’s medications have to be reviewed to confirm their effectiveness.
Currently, M.K. takes Lotensin and Lasix to control her hypertension. Lotensin (benazepril) is an ACE (angiotensin-converting enzyme) inhibitor (“Lotensin,” 2019). ACE inhibitors lower blood pressure by relaxing blood vessels and easing the blood flow, thus resolving the problem of backed-up veins. This medication is required for the patient since her heart is likely failing to carry the blood to all organs and back successfully. The symptom of edema suggests that blood flow has to be adjusted using medication. Lasix (furosemide) is a loop diuretic the main objective of which is to prevent the body from absorbing too much salt, which causes edema (“Lasix,” 2019). This medication can be used to treat heart failure as well, thus making it a valuable part of the patient’s therapy plan. Since M.K. has a heart impairment, the use of both an ACE inhibitor and a diuretic is essential to stabilizing her blood and oxygen circulation.
Hypertension has a severe impact on people in the United States. The guideline, proposed by the AHA in 2017, further exposes the problem of high BP in the country since it lowers the threshold for hypertension (Khera et al., 2018). As an outcome, it becomes apparent that a significant part of the population has hypertension, coming close to 70% of all adults between the ages of 45 to 75 years (Khera et al., 2018). Such a significant prevalence is alarming for the country, suggesting that almost three in four adults have elevated blood pressure. They face such conditions as cardiovascular disease, stroke, heart failure, pulmonary embolism, chronic kidney disease, and others (Hogan & Gingrich, 2014). The new guideline makes more people eligible for antihypertensive treatment and may potentially increase lifestyle modifications and prevent high-risk problems from progressing.
Other Conditions and Medications
In the lipid panel, one can see such measures as cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides. The patient’s level of total cholesterol is 242 mg/dL, which is higher than the desired result of 200 mg/dL (Stock et al., 2016). High cholesterol can be caused by an improper diet, excessive weight, lack of exercise, smoking, and diabetes (Stock et al., 2016). HDL, otherwise known as “good” cholesterol, signifies one’s consumption of healthy foods that lower the risk of cardiovascular disease and similar conditions (Stock et al., 2016). In contrast, LDL is considered to be “bad” cholesterol – the number of this measure has to below.
The patient’s HDL is 32 mg/dL which is less than the regular 50 mg/dL, meaning that she is at increased risk of cardiovascular disease (CVD) (Stock et al., 2016). M.K. has LDL of 172 mg/dL – it is a high level of cholesterol that greatly increases one’s risk factors for CVD as well. Finally, the patient’s level of triglycerides is 1000 mg/dL, which is exceptionally high, exceeding the “very high” mark of 500 mg/dL (Stock et al., 2016). Such an increase in triglycerides demonstrates the risk of CVD, stroke, metabolic syndrome, and hypothyroidism.
The patient’s levels of cholesterol, LDL, and triglycerides need to be lowered to decrease her risk of CVD. Apart from lifestyle changes, medication may be necessary to help M.K. avoid complications. First-line treatment for high cholesterol is statins, such as lovastatin (Mevacor), which lowers LDL and increases HDL in one’s blood. The initial dose for this drug is 20 mg once daily, but it can be adjusted up to 80 mg a day (“Mevacor dosage,” 2019). If statins are ineffective, other types of drugs should be considered, including bile acid-binding resins and fibrates. The final type may be considered for the patient in this case, as it also lowers triglycerides – Lopid (gemfibrozil) in a dosage of 1200 mg daily in two doses can help the patient as well (“Lopid dosage,” 2018). Overall, either statins or fibrates should be a part of M.K.’s therapy to prevent CVD.
Metabolic syndrome is a set of conditions that increase one’s risk of CVD and other diseases. The patient’s increased blood pressure, high triglyceride level, low rate of HDL, and elevated glucose level indicate the presence of hypertension and T2D as well as their influence on each other (Stock et al., 2016). Moreover, the patient’s increased weight and the risk of her developing a CVD are impacted by both conditions.
Glycosylated Hemoglobin
The measuring of HbA1c (glycosylated hemoglobin) is performed to determine whether a patient has diabetes and how well the condition is controlled. Individuals with diagnosed diabetes have to perform the test regularly to ensure that it is within the normal range. M.K.’s HbA1c result is 7.3%, and it can be compared to normal ranges for people with and without diabetes. For individuals who do not have diabetes, the normal range is between 4% and 5.6% (Liu et al., 2017). People with diabetes are diagnosed in their HbA1c is higher than 6.5% (Liu et al., 2017). However, after the diagnosis, it is recommended for them to maintain a level of less than 7%. As can be derived from these standards, the patient’s current hemoglobin level is higher than desired, meaning that she does not respond to the medication or follow a lifestyle that supports her treatment. The level of HbA1c at 7.3% implies that the current plan for treating T2D is not sufficient for M.K. Nonetheless, the fact that triglycerides are increased as well may indicate that HbA1c levels are falsely displayed since hypertriglyceridemia affects the results of a hemoglobin test.
Conclusion
The patient’s comorbidities strongly affect her test results and indicate an intricate link between the diagnoses of T2D and hypertension and the potential risks of CVD. M.K.’s chronic bronchitis is demonstrated in the arterial blood gas assessment. The patient’s symptoms indicate a right-sided heart failure caused by the combination of elevated pressure, smoking, poor diet, and lung disease. The vitals’ measurement reveals a stage 2 hypertension that is controlled by medication. M.K.’s lipid panel shows high levels of cholesterol, LDL, and triglycerides that increase her risk of CVD. The patient has to take statins or fibrates to control this issue. Finally, her HbA1c measurement means that her T2D is uncontrolled or that the test results are influenced by hypertriglyceridemia.
References
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Khera, R., Lu, Y., Lu, J., Saxena, A., Nasir, K., Jiang, L., & Krumholz, H. M. (2018). Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in United States and China: Nationally representative cross sectional study. BMJ, 362, k2357.
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