Description
Review the following case study and complete the questions that follow. For this assignment, write your responses to each question as one narrative rather than separating your responses by question number. Include an introduction and a conclusion. Submit your answers using APA format, well-written sentences, and detailed explanations. Your analysis must be scientifically sound, necessary, and sufficient. Paper must be a minimum of 8 pages, plus references and title page.
You must also include a bibliography of at least 3 sources (with at least one non Internet source). Your textbook may not be included as a source for this assignment. Refer to the rubric for more information on how your assignment will be graded.
Case Study
M.K. is a 45-year-old female, measuring 5’5” and weighs 225 lbs. M.K. has a history of smoking 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 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 the 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 |
1000 mg/dL |
- What clinical findings correlate with M.K.’s chronic bronchitis? What type of treatment and recommendations would be appropriate for M.K.’s chronic bronchitis?
- Which type of heart failure would you suspect with M.K.? Explain the pathogenesis of how this type of heart failure develops.
- According to the American Heart Association 2017 new guidelines, and M.K.'s B.P. value, what stage of hypertension is she experiencing? Explain the rationale for her current medications for her hypertension. Also, discuss the impact of this disease in the U.S. population.
- According to the lipid panel, what other condition is M.K. at risk for? According to this case study, what other medications should be given and why? What additional findings correlate for both hypertension and Type II diabetes mellitus?
- Interpret the lab value for HbA1c and explain the rationale for this value in relation to normal/abnormal body function?
Explanation & Answer
Attached.
Running head: M.K COMPREHENSIVE CASE STUDY
M.K Comprehensive Case Study
Student’s Name
Institutional Affiliation
1
M.K COMPREHENSIVE CASE STUDY
2
Introduction
The case study encompasses a 45-years old woman, M.K, who has a poor diet and a
history of smoking. M.K. suffers from primary hypertension and diabetes mellitus. Currently,
she has been diagnosed with chronic bronchitis. She has a severe chronic cough in the mornings
with distended neck veins, sputum, peripheral oedema, lightheadedness, and urinates more at
night. She is recently under medication for type two diabetes and hypertension. Healthcare
providers have conducted various laboratory tests on her, including complete blood count, vital
signs, arterial blood gas assessment, glycosylated haemoglobin, and lipid panel. This paper will
determine the clinical findings, which correlate to chronic bronchitis of M.K., treatment type,
and recommendations necessary for her. Besides, the paper will cover the heart failure that M.K
is likely to suffer, hypertension stage that she is in and the medication she is utilizing. She is
expected to confront various risks based on results from her panel lipid and new drugs she is
possibly to be provided needs illumination. Lastly, the value of the laboratory for the HBA1c
will be interpreted and explanation of the rationale given to the proper working of the body.
Pertinent to this case, below are lab findings:
Vitals
BP
158/98 mm Hg
CBC
Hematocrit
57%
Glycosylated haemoglobin
(HbA1c)
7.3 %
Arterial Blood Gas Assessment
PaCO₂
52 mm Hg
PaO₂
48 mm Hg
M.K COMPREHENSIVE CASE STUDY
3
Lipid Panel
Cholesterol
242 mg/dL
HDL
32 mg/dL
LDL
173 mg/dL
Triglycerides
184 mg/dL
Based on the history of smoking, the investigation of the M.K. case was concluded that
she is suffering from chronic bronchitis. The conclusion was due to the history of her prominent
cigarette smoking for 22-years. The leading bronchitis cause is cigarette smoking because of its
potential to release various types of cytokines. According to Yoshida & Tuder (2007), cytokines
are minute signalling proteins, which causes the airway lining to thicken as well as causing
airways inflammation. Besides, Yoshida and Tuder (2007) argue that smoking cigarette can lead
to overproduction of mucus in cells.
Other clinical findings, which correlate to chronic bronchitis of M.K., are chronic cough
with abnormal blood gas levels, excessive peripheral oedema, sputum, increased hematocrit, and
high levels of glycosylated haemoglobin. The unnatural arterial blood gasses of M.K like the
partial pressure of carbon dioxide of 52mm Hg is very high, having a reasonable range of 35-45
mmHg. However, the inadequate gas exchange in the lungs, carbon dioxide accumulates in the
blood (Labtestonline, 2017). Besides, the low partial oxygen pressure is 48mmHg in the blood
while the normal range is between 80-100 mmHg. According to Copstead and Banasik (2013),
low partial oxygen pressure is caused by decreased ling sufficiency as a result of chronic
bronchitis inflammation. She has a high level of hematocrit concentration (57%), which is
another finding, which correlates to the chronic bronchitis of M.K. The normal range of
hematocrit according to Labtestonline (2017) is 24.9 to 44.5 %. The increased concentration of
M.K COMPREHENSIVE CASE STUDY
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hematocrit in women is correlated with decreased tissue perfusion that leads to high production
of erythrocyte in the bone marrow for compensation.
The treatment of chronic bronchitis for M.K can be initiated with a bronchodilator
together with glucocorticoids and oxygen therapy followed by cessation of smoking. It can be
performed via counselling and treatment for her to stop smoking (King, 2017). It would be
beneficial to achieve suspension of smoking if the patient refrained from being in a dusty
atmosphere and away from the pollution of the air. According to Chronic Bronchitis (n.d.), the
induced cough by smoking can be treated with taking mild cough syrups, and oxygen therapy
offered to clear passages of air. Besides, it will be crucial to administer antibiotics to treat any
secondary infections. Exercises of coughing will be vital for M.K. to clear the airways and expel
sputum.
Based on the case of M.K., the type of heart failure that she might have is right sided
heart failure. The induced chronic bronchitis by smoking causes a direct effect on the right
ventricle of the heart that causes pulmonary hypertension. According to Types of Heart Failure
(2017), the pathogenesis of the right-sided heart failure is because of the buildup of the fluid on
an individual’s body. Blood backs up in the veins of the body and leads to swellings in the
ankles, legs, and swelling within the abdomen, such as the liver and GI tract. Copstead and
Banasik (2013) point out that congestion of the bronchi by sputum makes it challenging for an
individual to breathe, which can lead to hypertension and overworking of the heart that can cause
cardiac muscle hypertrophy leading to the failure of the heart.
Besides, the distended neck veins of M.K. and excessive peripheral oedema is a clear
indication that she is suffering from Cor pulmonale or right-sided heart failure. The condition
occurs when there is extreme local hypoxia that causes constriction of vessels and the
M.K COMPREHENSIVE CASE STUDY
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inflammation in bronchial walls with vasoconstriction of pulmonary arteries and pulmonary
blood vessels. According to Copstead and Banasik (2013), right-sided heart failure can be caused
by high blood pressure. However, from the case of M.K., she has a high blood pressure in the
arteries known as pulmonary hypertension and very common to the condition. Together with the
chronic bronchitis of M.K. and high blood pressure, it can cause Cor pulmonale and eventually
right-sided heart failure. High blood pressure in the pulmonary arteries results to the right-sided
heart failure, which increases the workload of the right ventricle of the heart. This explains the
systematic congestion with backpressure from inferior and superior vena cava leading to
excessive peripheral oedema and distended neck veins. Based on the case of M.K., she has a long
account of hypertension and diabetes, which indicates that there is a long history of lon...
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