Question

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 184 mg/dL

1. 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?

2. Which type of heart failure would you suspect with M.K.? Explain the pathogenesis of how this type of heart failure develops.

3. According to the B.P. value, what stage of hypertension is M. K. experiencing? Explain the rationale for her current medications for her hypertension. Also, discuss the impact of this disease in the U.S. population.

4. 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?

5. Interpret the lab value for HbA1c and explain the rationale for this value in relation to normal/abnormal body function

Answer 1

Q. No. 1. Answer :

Clinical findings correlates with M. K's chronic bronchitis are

* history of smoking along with poor dietary.

* chronic cough,

* severe cough in the morning with the sputum.

* light headedness due to decreased oxygen supply to brain.

These are clinical findings correlates with Mrs. M. K's.

Treatment and recommendations :

* broncho dilators like aerosol sprays and oral brochodilators. Ex. Theophyllin.

* Nebulization with asthaline, budecort,

* steam inhalation ect.

* oxygen therapy.

Q. No. 2. Answer :

The congestive heart failure may suspect in M. K's.

Pathologies of this :

Due to reduction to the efficiency of heart muscle through overload in the heart.

There is reduced stroke volume due to failure of systole or diastole.

And it leads to end systolic valume,

And it may leads to failure of working of heart leads to distended neck veins.

Q. No. 3. Answer :

Mrs. M. K's suffering from stage ll hypertension, because the blood pressure comes in between range of 140/ 90 to 159/ 99 mm of hg called as stage ll hypertension.

So here patient is having 158/ 98 mm of hg.

Rationale for current medication:

1.Lotensin : it is an angio tensin converting enzyme inhibitor, by inhibiting this, the reabsorption of fluids may decreases and blood pressure may decreases.

2. Lasix : it acts like diuretics, blocking the absorption of sodium, chloride and water from the filtered fluid in the kidney tubules, increased output of the urine.

This congestive heart failure is more impact on USA population because of there life styles, food habits, and there negligence and by genetics.

Q. No. 5. Answer :

HBA1C is high that is 7.3 %.

Up to 6 % only normal.

If it increases the diabetes mellitis is confirmed and there is no proper insulin production.

Due to decreased insulin production the absorption of glucose may decreases from the blood vessels, so blood glucose levels may increases, it leads to the investigations shows high blood glucose levels.