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Free «Comprehensive Case Study: Chronic Bronchitis» UK Essay Paper

Free «Comprehensive Case Study: Chronic Bronchitis» UK Essay Paper

Chronic Bronchitis is an infection that causes difficulty in breathing due to narrowing the airways in the respiratory system. According to Kim and Criner (2013), the disease is associated with inflammation of the bronchi. The problem with this disorder is that it does not possess any action to deal with smooth muscle because it is associated with bronchi. Therefore, it is safe to state that the disease is irreversible. This kind of bronchitis is also linked to the swelling of bronchial mucosa that consequents to the hyperplasia of bronchial mucous glands and goblet cells, increased fibrosis of the mucous membrane, and enhanced bronchial wall thickness (Kim & Criner, 2013). These features play significant roles in the patient's airway obstruction. For instance, the hyperplasia of the bronchial mucous gland and the goblet cells intensify the production of the mucus. Mucus in combination with the purulent exudates to form a mucous plug that prevents dust particles and other tiny substances from reaching the internal respiratory system (Cheung & Li, 2012). Besides, hyperplasia increases the bronchial wall thickness. These effects ensure smooth breathing by causing restrictions of the gas exchange in the respiratory system. The differential factor that classifies such type of bronchitis as a chronic disorder is based on the signs and the symptoms it possesses. The main sign that reveals the disorder is a severe cough with productive sputum.

According to the case study, the reason for M.K. being at a high risk of chronic bronchitis is her excessive smoking for about twenty-two years. As Kim and Criner (2013) state, any bronchial irritant can lead to chronic bronchitis. However, physicians have determined that cigarette smoking is the most common irritant that accounts for nearly 90% of the cases (Cheung & Li, 2012). For that reason, smoking is one of the primary etiologic causes of chronic bronchitis. In particular, it creates the opportunity for the increase in size and number of bronchial mucous glands, which leads to the production of excessive mucous within the bronchial tree (Kim & Criner, 2013). When this production occurs, the persistent productive cough follows. The adverse effect of smoking in this scenario is that it makes the cilia and the respiratory system become paralyzed. This affects the breathing process of the patient since the cilia appears to be non-functional. According to Kim and Criner, (2013), when the hair-like cells are non-operative, it becomes hard for them to remove mucus and dirt out of the lungs. In the process, the bronchi become more inflamed, thus, making breathing more difficult. The other cause of chronic bronchitis revealed in the case of M.K. is being overweight. Based on the lab findings, the patient has developed chronic bronchitis and hypertension that are caused by overweight, poor diet, and excessive smoking.

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Clinical Findings that Correlate with M.K.'s Chronic Bronchitis

Some of the clinical results that correspond with M.K.'s chronic bronchitis include her permanent cough accompanied by productive sputum, which is more severe in the morning, and excessive edema. These are the three most likely clinical manifestations associated with the infection. Essentially, it is imperative for the patient to seek immediate medication before it leads to other conditions like apnea, difficulty in breathing and pulmonary hypertension (Cheung & Li, 2012). Once the patient attracts pulmonary hypertension, the result would be inflammation of bronchial walls with vasoconstriction of pulmonary blood vessels like pulmonary arteries. It also increases the resistance of the pulmonary artery, which results in cor pumonale (Kim & Criner, 2013). The existence of cor pulmonale may lead to the failure of the right-sided heart due to the occurrence of the hypertension-related complications at the right ventricle of the heart.

The other significant clinical finding to determine chronic bronchitis in the case of M.K. is the arterial gas assessment data. Kim and Criner (2013) state that the arterial gas evaluation may reveal increased PaCO2, and decreased PaO2 when testing for chronic bronchitis (Cheung & Li, 2012). In this case, their levels would be less than 65 mm Hg and 45 mm Hg respectively (Cheung & Li, 2012). This is indeed shown in the findings of the arterial gas assessment of M.K. It is worth noting that these specific measurements are the partial pressure of carbon (ii) oxide and oxygen in the arterial blood. In M.K.’s case, the PaO2 level is 48mm Hg, and the PaCO2 level is 52 mm Hg. These clinical lad findings indicate that M.K has chronic bronchitis. 

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Appropriate Treatment for M.K.’s Chronic Bronchitis

As stated earlier, chronic bronchitis is irreversible and results in breathing problems. Therefore, it is essential to treat the patient immediately after noticing that she or he has this disorder. The aim of proper treatment and recommendation about the disease is to help M.K. return to healthy respiratory functioning. Regarding treatment, Cheung and Li (2012) have found that different medication can be used to treat chronic bronchitis, although it cannot be cured entirely. For that reason, inhaled short-acting B2 agonists and inhaled anticholinergic bronchodilators drugs can be administered to the patient (Kim & Criner, 2013). They are sympathetic drugs that help reverse the constriction of the airways. 

The other drugs that can be used to treat the disorder are cough suppressants or antitussive drugs, including Dextromethorphan (Cheung & Li, 2012). It is recommended to use these medications during the nights when the patient is experiencing sleeping problems because of a cough. Further, frequent coughing is encouraged since it helps to eliminate sputum that may obstruct the airway (Kim & Criner, 2013). Besides, the antimicrobial agents can be used mainly if the patient is found to have a bacterial infection. Nonetheless, it is not clear in the case of M.K. whether or not she has it. To identify the truth, further diagnosis should be conducted.

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Appropriate Recommendations for M.K.’s Chronic Bronchitis

For M.K. to minimize the risk associated with chronic bronchitis, she should seize from smoking because it is one of the etiologic agents that cause this disease. Smoking can also increase the progression of the disorder to the extent when it creates breathing difficulty (Kim & Criner, 2013). Other important recommendations for M.K. would be having proper physical exercising, diet, rest, and hydration. By doing so, the patient could lower the chances of apnea and progression of the infection (Kim & Criner, 2013). Another recommendation is that the patient should be given a low dose oxygen therapy since her PaO2 is lower than 55 mm Hg (Cheung & Li, 2012). This implies that there is the shortage of enough oxygen in the patient's bloodstream. The other guidance is that M.K. should reduce her exposure to bronchial irritants.

Type of Heart Failure and Its Development in the Case of M.K

The type of heart failure that M.K. may experience is right-sided heart one because of chronic bronchitis that has led to the development of hypertension. When this heart failure develops, the patient’s heart pumping action moves use blood that gets back to the heart through the veins (Cheung & Li, 2012). The right ventricle then pumps blood into the lungs. Once the patient attracts pulmonary hypertension, the result would be inflammation of bronchial walls with vasoconstriction of pulmonary blood vessels like pulmonary arteries (Cheung & Li, 2012). The effect also increases the resistance of the pulmonary artery, which results in cor pumonale. Its existence may lead to the failure of the right-sided heart due to the occurrence of the hypertension-related complications at the right ventricle of the heart. (Cheung & Li, 2012) According to Florkowski ( 2013), this type of a failure is accompanied by edema in the lower limbs, distended neck veins, and breathing difficulty, as in the case of M.K.

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The right-sided heart failure could also occur in connections with the left-sided failure. In this case, the left ventricle loses power and fails to deliver blood to the whole body (Kim & Criner, 2013). When the left ventricle cannot function properly, the increased fluid pressure is transported back via the lungs, ultimately damaging the right-side of the heart (Kim & Criner, 2013). When the right side of the heart loses pumping power, the patient’s blood backs up in the veins. The result of this is swelling in the limbs, ankles, and the abdomen. 

The other cause of the right-sided heart failure is the coronary artery disease. The infection blocks the main arteries that transport blood to the right ventricle of the heart. Additionally, certain lung diseases such as pulmonary fibrosis could provoke the right-sided heart failure (Cheung & Li, 2012). According to Cheung and Li (2012), the signs and the symptoms of this heart failure range from mild to severe. They include the increased urge to urinate, coughing, dizziness, and difficulty in breathing, especially at night. The other signs are the sudden weight gain (225 lbs.), nausea, the loss of appetite, the lack of concentration, the difficulty in doing physical exercise, fatigue, wheezing; and fluid retention (Cheung & Li, 2012). Most of these symptoms are present in the case of M.K.

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Stage of Hypertension Experienced by M.K. and the Rationale for her Current Medications for Her Hypertension

The measurement of blood pressure is divided into four categories, namely normal blood pressure, prehypertension, stage 1 hypertension, and stage 2 hypertension (Cheung & Li, 2012). An individual’s blood pressure is normal when its measures are below 120/80 mm Hg (Cheung & Li, 2012). According to Kim and Criner (2013), a person falls in the prehypertension stage when he or she has a systolic blood pressure of between 120 and 139, and a diastolic pressure of between 80 and 89 (Cheung & Li, 2012). Such patients are advised to take measures that can return their blood pressure to normal. Medication can be used as a remedy in this stage except in cases where the patient has diabetes or kidney disorder, and the recommended lifestyle changes are not functioning (Florkowski, 2013). On the other hand, in the first stage of hypertension, the level of systolic blood pressure is measured between 140 and 159, and diastolic pressure ranges from 90 to 99 (Cheung & Li, 2012). The second stage of hypertension is represented by a systolic pressure of more than 160 and diastolic pressure of higher than 100 (Cheung & Li, 2012). Patients at this stage must modify lifestyle practices and take a diuretic as well as other medications like the antihypertensive drug. 

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According to the B.P. value, it is safe to state that M.K. is experiencing the hypertension stage one because she has a blood pressure of 158/98 mm Hg. As such, she should consider lifestyle changes such as weight loss, regular exercising, refraining from smoking, eating low-fat food and taking a low-sodium diet. M.K. can also seek medication to return to normal condition. (Cheung & Li, 2012) The first medication that the doctor may recommend for her is the thiazide-type diuretic. Such a kind of medication lowers blood pressure by eliminating extra fluid and sodium particles in the body. Other medicaments include beta blockers, renin inhibitors, ACE inhibitors, calcium channel blockers, and angiotensin II receptor blockers (Kim & Criner, 2013). All this will help M.K. to establish her blood pressure at a normal level.

Impact of Hypertension in the U.S. Population

According to the American Heart Association, hypertension reveals severe threats to the US population. It can quietly damage the patient's body before the symptoms appear (Kim & Criner, 2013). If not controlled, the disorder may lead to disability, poor quality of life, and a fatal heart attack. Many people in the US have died with untreated hypertension related to ischemic heart infection whereas others have died of a stroke. As such, one effect of this disease is the heart attack. Hypertension destroys arteries by blocking them and preventing blood from flowing to tissues in the heart muscle (Florkowski, 2013). The other impact is the heart failure. The increased workload from hypertension can enlarge the heart and fail to support the movement of blood in the body.

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The other impact is the kidney disorder and failure. Hypertension can damage the arteries around the kidneys and interfere with their function to efficiently filter blood (Kim & Criner, 2013). Hypertension can also cause the stroke because the blood vessels in the brain of individuals with this condition may clog and burst. The other threat is the loss of vision due to the damage of blood cells in the eye. Besides, this disorder provokes sexual dysfunctions such as erectile dysfunction in men and low libido in women. One more consequence is the peripheral artery disease (Cheung & Li, 2012). Hypertension has led to the development of atherosclerosis that causes narrowing arteries in the legs, arms, abdomen, and head, thus creating pain and fatigue. 

Other Risk Conditions Experienced by M.K. According to the Lipid Panel

According to the lipid panel, the other risk condition for M.K. is arteriosclerosis. This is a circulatory disorder in which plaque builds up in the arteries (Cheung & Li, 2012). With its growth in the arteries’ walls, the force of the blood flow via the decreasing cross-section of the lumen rises. Eventually, this force causes the rupture of the plaque leading to the formation of thrombus, followed by the heart attack. According to Florkowski (2013), the plaque occurrence is based on the concentration of cholesterol in the blood. For instance, people with low-density lipoproteins (LDL) of more than 190mg/ dL and high lipoproteins (HDL) below 40mg/dL are at risk of acquiring arteriosclerosis (Cheung & Li, 2012). Alternatively, individuals with LDL below 100mg/dL and HDL above 50mg/dL do not have any chance of the infection (Cheung & Li, 2012). The lipid panel of M.K. is as follows: cholesterol -242mg/dL, HDL-32mg/dL and LDL-173mg/dL. The lipid panel in the M.K's body, therefore, shows that she is at a higher risk of arteriosclerosis. In general, the increased level of LDL cholesterol and the decreased concentration of HDL cholesterol are important risk factors for coronary atherosclerosis.

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Other Medications to Be Given According to This Case Study

Treatment for atherosclerosis involves lifestyle changes such as regular exercising, weight loss, eating healthy foods, reducing stress and abandoning smoking as they all aim at decreasing the risk of heart attack. Medications such as coronary-modifying drugs including fibrates, niacin, statins and bile acid sequestrants can be administered (Cheung & Li, 2012). These drugs lower the amount of cholesterol in the bloodstream, particularly LDL. They also minimize the major materials that deposit on the coronary artery. The other drug that can be used for medication is aspirin because it reduces the tendency of the blood clot. Consequently, it prevents the obstruction of a coronary artery (Kim & Criner, 2013). The other drug is nitroglycerin. It controls chest pain by momentarily enlarging the coronary arteries. This action decreases the demand of blood by the heart (Kim & Criner, 2013). The other drug that can be administered is Angiotensin-Converting Enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) as they help reduce the level of blood pressure and inhibits the progression of coronary heart disorder (Kim & Criner, 2013). Besides, beta blockers that slow the rate at which the heart beats and decrease the blood pressure lowering the heart’s demand for oxygen can be prescribed (Cheung & Li, 2012). In case of a heart attack, beta blockers minimize the risk of developing atherosclerosis. 

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Additional Findings that Correlate for Both Hypertension and Type II Diabetes Mellitus

The other finding that corresponds to both hypertension and types 2 diabetes is that high blood pressure is a condition that is present in patients with this ailment. Although it is not clear why such a significant correlation exists between the two disorders, medical experts believe that obesity, high intake of fat and sodium and inactivity are the main contributors to the disease (Cheung & Li, 2012). According to the American Diabetes Association, the combination of type 2 diabetes and hypertension is lethal and can increase an individual’s risk of developing other diabetes-related disorders such as retinopathy and kidney illnesses. It is also evident that type 2 diabetes in conjunction with chronic hypertension can trigger the development of cognitive problems associated with aging such as Alzheimer’s disease and Dementia (Kim & Criner, 2013). It is because blood vessels that transport blood to the brain can weaken just like the heart. However, the condition of the patient with the type 2 diabetes and hypertension can be improved with lifestyle changes and proper medication.

The Lab Value for HbA1c Interpretation

HbA1c refers to glycated hemoglobin. It develops when hemoglobin combines with oxygen in the blood to become glycated. By measuring Hb1c, clinicians can identify the average blood sugar levels that have been present over a period of weeks or months (Florkowski, 2013). The research shows that normal people with HbA1c have the blood sugar level of below 42mmo/mol (below 6%) whereas the prediabetes individuals has an average of 42 to 47 mmol/mol. (6.0% to 6.4 %) (Florkowski, 2013). Patients with diabetes, however, have a blood sugar level above 48 mmol/mol (over 6.5%). Therefore, since M.K. has the history of type 2 diabetes mellitus, her lab value for glycated hemoglobin is assumed to be more than 48mmol/mol.

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The Rationale for This Value Concerning Normal/Abnormal Body Function

The rationale of this value is that it is an indication of diabetes. Thus, it is recommended as a relevant diagnosis method (Florkowski, 2013). This value also shows the presence of chronic glycaemia, eliminating the need of a test for its identification at some point. In particular, it provides glycaemia integrated index based on the lifespan of the red blood cells of 120-days (Florkowski, 2013). Nevertheless, within this period, clinicians believe that glycaemia has a tremendous influence on the HbA1c. It, therefore, appears logical that this test would be useful in diagnosing a disease associated with chronic hyperglycemia and a gradual progression to complication.

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