Question

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?

Answer 1

Clinical findings corelate with MK's chronic bronchitis

1. Chronic cough, more severe in the morning with sputum

Chronic bronchitis is characterised with the chronic cough and production of sputum due to the inflammation of bronchi of the lungs. Other symptoms include dyspnea, tight chest and tiredness.

Treatment and recommendations for MK 's bronchitis

Bronchitis can be treated with :

bronchodilators( to dilate the bronchioles)eg. theophylline, albuterol.

Steroids for reducing the inflammation of bronchi thereby decreases swelling and relieve dyspnea .eg: corticosteroids ( nasal sprays, inhalers)

Oxygenation ; In severe cases oxygen therapy is recommended.

Recommendations:

a) regular physical exercise helps the person to be fit and helps to come mucous out of the lungs.

b) Avoid smoking: smoking is one of the main cause of chronic bronchitis. patient should avoid active and passive smoking.

c) Breathing exercises; Deep breathing exercise and pursed lip breathing can be helpful for the patient.

Type of heart failure

Congestive heart failure : Failure of the heart to pump blood to all parts of the body effectively. It is a syndrome marked by weakness, shortness of breath, oedema due to the inability of the heart to circulate the blood adequately to the lungs and other tissues of the body. Left side heart failure is the more commonly occuring form of heart failure.

Pathogenesis

One of the main cause of Congestive heart failure is hypertension. Hypertension results in increased pressure and overload for the heart leads to the systolic and diastolic dysfunction. Chronic Hypertension even may results in weekend and narrowed coronary arteries due to the accumulation of plaques because of increased cholesterol level. Overload in the left ventricle leads to the hypertrophy of the heart and leads to the failure of heart . Failure of heart some time may cause due to the inadequate blood supply to the heart also.

stage of Hypertension

Mk has stage 2 hypertension. According to AHA systolic pressure more than 140 and diastolic pressure above 90 is stage 2 hypertension.

current medication for hypertension

Lotensin ( Benazepril): Antihypertensive drug . It is an Angiotensin converting enzyme Inhibitor. It helps in relaxation of blood vessels. It can be used CCF to reduce the blood pressure

Lasix( lasix): it is a diuretic, increases the urine output there by decreases the fluid retention in the body. helps in reducing blood pressure and edema and shortness of breath. widely used in CCF cases.