Comprehensive Case Study on COPD, Heart Failure, Hypertension and Diabetes Mellitus

Comprehensive Case Study on COPD, Heart Failure, Hypertension and Diabetes Mellitus
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Comprehensive Case Study on COPD, Heart Failure, Hypertension and Diabetes Mellitus
Question 1
The clinical findings that correlate with the chronic bronchitis that MK has include a high hematocrit level, a low PaO2 and a high PaCO2. As per the lab findings, MK has hematocrit and HbA1c levels of 57% and 7.3% respectively. Female patients whose hematocrit is greater than 47% have a higher likelihood of being diagnosed with chronic bronchitis or COPD (Santibáñez et al., 2016). Since MK has 57%, it is not surprising that she was diagnosed with COPD/chronic bronchitis. PaO2 is used to assess gas exchange or perfusion, whereas PaCO2 is used to assess the sufficiency of breathing pattern or ventilation. Normal PaO2 is 80 mm Hg to 100 mm Hg arterial. PaO2 of less than 80 mm Hg indicates hypoxemia. Normal PaCO2 is 35-45 mm Hg arterial (Santibáñez et al., 2016). MK has PaCO2 of 52 mm Hg which is abnormal, and her PaO2 is 48 mm Hg which is also not normal. A low arterial PaO2 and a high PaCO2 are associated with chronic bronchitis; hence these clinical findings in fact correlate with MK’s COPD.
Since MK appears to be in Stage II/moderate obstruction, the type of treatment appropriate for MK’s chronic bronchitis is long-acting bronchodilators, short-acting bronchodilator, and cardiopulmonary rehabilitation. It is recommended that MK should stop cigarette smoking considering that the main cause of COPD is smoking or exposure to smoke from tobacco. Santibáñez et al. (2016) reported that cigarette smoking accounts for nearly 90 percent of Chronic Obstructive Pulmonary Disease risk. It is also recommended that she should seek psychological support, chest and respiratory physiotherapy, and she should be provided with education regarding the illness and be encouraged to participate actively in therapy.
Question 2
The type of heart failure that MK is likely to have is right-sided heart failure. Common symptoms of this sort of heart failure include fainting, weakness, shortness of breath, irregular fast heartbeat, pronounced veins in the neck and frequent urinations at night. Other symptoms include swelling of ankles and feet, and palpitations; that is, sensations of feeling the heart beating (Copstead & Banasik, 2014). In the case study, the patient pointed out that she experiences increased urination at night-time and has distended neck veins. These are clear symptoms of right-sided heart failure. With regard to pathogenesis of right-sided heart failure, this condition arises when the heart’s right ventricle loses its function of pumping blood or has difficulty in pumping blood to the lungs, and the blood might back up into other body areas such as in the blood vessels, which in turn produces congestion (Andersson et al., 2010). The congestion affects the limbs, gastrointestinal tract and liver. Additionally, the right ventricle might fail to pump blood to the lungs and left ventricle efficiently. The main causes of this kind of heart failure are heart valve disease, pulmonary hypertension, clots in pulmonary arteries, congenital heart ...