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M.K. Case Study | Homework Help Online

  1. K. is a 45-year-old woman who stands 5’5″ and weighs 225 pounds. She has a 22-year smoking history and inadequate nutrition, coupled with type II diabetes and primary high blood pressure. She recently received a diagnosis of chronic bronchitis. Her prevailing signs include a persistent cough with sputum, drowsiness, protruded neck veins, excessive peripheral edema, and nighttime urinary incontinence. Her prescription treatments entail Lotensin and Lasix for high blood pressure and Glucophage for type-2 Diabetes. M.K. has a persistent cough, hypoxemia PaO2 of 48mmHg, hypercapnia PaCO2 of 52mmHg, and peripheral edema, which all indicate right-sided heart involvement. M.K. does not appear to be very active, so a lack of physical activity may also be contributing to her health status. Her current health situation is a direct outcome of her personal choices. M.K.’s only risk factor that she cannot alter is her age. She has complete control over everything else in an attempt to improve and inhibit further health degradation.

Medical Findings Correlated with Chronic Bronchitis and Treatment Recommendations

M.K.’s increased smoking is the principal cause of chronic bronchitis, leading to a rise in the number and size of bronchial mucous glands, resulting in excessive mucosal production and continuous coughing. Her productive cough with sputum, particularly in the morning due to overnight accumulation, is highly suggestive of her diagnosis. The patient lab results show hypoxemia, which is characterized as an unusually low PaO2 in arterial blood, and hypercapnia, which is characterized as an increased vascular PaCO2, both of which are prevalent in people with chronic obstructive pulmonary disease (COPD) due to a ventilation-perfusion disparity within the respiratory system (Medline Plus, 2017). Also, M.K has highly anisotropic edema, which is not generally characterized by chronic bronchitis. Still, it complicates pulmonary hypertension’s ailment, suggesting right-sided heart disease engagement.

Obesity, according to studies, is usually associated with COPD and asthma in certain circumstances. M.K’s obesity, coupled with poor diet preferences, puts her in greater danger and adds to the irrevocability of her illness. The treatment goals are to help relieve her symptoms and avert complications from advancing. Because she is a regular smoker, quitting is unquestionably necessary before initiating therapy. It is crucial to educate the patient about the disease. Health education can significantly enhance one’s well-being and capacity to handle the ailment (Medline Plus, 2017). M.K. should be fully aware that there is no cure for COPD and that no therapies can radically alter or halt it. On the other hand, medication is used to alleviate symptoms, avert exacerbations, reduce disability, and raise the ability to exercise and participate in activities.

M.K. should begin treatment with a long-acting bronchial dilator and an inhaled corticosteroid. Long-acting bronchodilators are used to cure COPD over time to improve breathing gradually. Corticosteroids, including fluticasone and prednisolone, could be used to minimize inflammation and increase airflow in the respiratory system. Short-acting bronchodilators including albuterol and ipratropium might well be recommended in case of emergencies or for instant relief to try and open her air passages. Because her PaO2 level is less than 55 mm Hg, it is suggested that she receive respiratory support that has been shown to enhance her quality of life. A better diet, proper water intake, and exercise can help her living standard. A pulmonary treatment program that combines education, exercise training, nutrition advice, and counseling services is necessary. She will also necessitate chest physiotherapy to aid in the clearing of her airways. Separately prescribed exercise, intense exercise, respiration, efficient cough methodologies, comfort, and coping strategies are the cornerstones of remediation.

Type of Heart Failure Suspected

COPD could have an immediate impact on the right side of the heart. Because of the deficient levels of oxygen in the vessels of the lungs, the blood pressure within the arterial walls rises, culminating in pulmonary arterial hypertension. Hypoxia induces the production of red blood cells, leading to polycythemia, which raises blood viscosity and exacerbates hypertension (Medline Plus, 2017). Due to the sheer increase in pulmonary vasoconstriction and the resulting rise in pulmonary artery pressure, the right ventricle’s workload intensifies. This makes it increasingly challenging for the blood to flow to the lungs and stresses the right side, resulting in corpulmonale. In this situation, M.K most presumably already had right-sided heart problems, as demonstrated by her extreme peripheral edema and bulging neck blood vessels.

Stage of Hypertension

M.K has stage I hypertension and chronic bronchitis, and presumed cardiovascular disease. Her blood pressure is 158/98 mmHg. The arterial pressure at this phase can vary from 140 to 159 mmHg, with a diastolic pressure of 90 to 99 mmHg. Individuals with stage I hypertension frequently may not exhibit signs, but the ailment will likely advance and cause significant harm if the underlying issues are not resolved (Lewis et al.,2017). Headache, difficulty breathing, and fainting are some of the symptoms witnessed during this phase. M.K is already feeling a little dizzy due to her high blood pressure. In this case, therapy aims to lower blood pressure to avert further health problems, mainly since the patient has diabetes. Lotensin and Lasix have been recommended for her. Lotensin is an ACE inhibitor that inhibits the growth of angiotensin II, thus lowering vasoconstriction and blood pressure (Medline Plus, 2017). In addition to high blood pressure, this prescribed medication is frequently recommended for patients with heart failure, diabetes, or kidney problems.

On the other hand, Lasix is a loop diuretic that will aid M.K with his edema and hypertension. This diuretic causes small vessel vasodilatation and enhances the withdrawal of liquid and sodium from the bloodstream. M.K. should be informed about her ailment. She should comprehend that high blood pressure is a silent killer that enhances the risk of cardiovascular disease and stroke, two of the primary causes of death among Americans. Chronic diseases such as diabetes, high blood pressure, COPD, and coronary heart disease affect more than 40% of the total population in the United States (Chronic Disease Prevention and Health Promotion, 2020). This figure is projected to grow. In addition to medical therapy, as stated previously, M.K should consider some lifestyle changes to handle her high blood pressure and avoid additional health problems. Some viable suggestions include to stop smoking, staying active, losing weight, lowering nutritional sodium, and obeying the DASH diet. Her power to manage her hypertension may be seriously impacted without such adjustments, particularly given her medical problems.

Risks, Medications, and Additional Findings

M.K’s lipid panels exhibit a low HDL, a high LDL, a high level of cholesterol, and a high triglyceride level. Hyperlipidemia and hypercholesterolemia significantly raise the patient’s chance of developing heart problems such as coronary heart disease, peripheral arterial disease, and peripheral vascular disease. These situations have the potential to cause heart attacks. Moreover, because of her Type II diabetes, hypertension, tobacco consumption, unhealthy nutrition, and sedentary lifestyle, she is at an increased risk of developing these health problems (Lewis et al., 2017). Based on these risk factors, M.K should start taking cholesterol-lowering medicine. Statin drugs such as Lovastatin, Pravastatin, and Simvastatin ought to be recommended. These treatments reduce cholesterol in the liver, and LDL and triglyceride levels, while gently raising HDL cholesterol levels(Medline Plus, 2017). Changes in M.K’s everyday lifestyle will also assist in the reduction of her lipid levels. Some viable suggestions include eating a diet low in saturated fats and high in fruits and veggies, weight loss, and engaging in aerobic activity.

HbA1c interpretation and rationale for this value in relation to normal/abnormal body function.

Her glycosylated hemoglobin (HbA1c) level of 7.3 percent is also abnormal, indicating poor blood glucose control over the last three months. This test helps determine glycemic levels over time and evaluate how well the treatment plan, including medicines, exercise, or dietary changes, is working. The test measures the level of glucose tied to hemoglobin over time, which is dependent on the total sugar content in the program. The average HbA1c level is less than 5.7 percent (Medline Plus, 2017). According to the American Diabetes Association, the main objective for people with diabetes is to preserve HbA1c levels of 7% or lower to reduce diabetes-related complications such as neuropathy and retinopathy.


M.K’s doctor should recommend a statin, a daily prenatal vitamin, and COPD medications, and the prescription drugs she already has. A nutritionist and a cessation program should be preferred to the patient. M.K. should be informed of the required lifestyle modifications to regulate her blood sugar and cholesterol levels. Recognizing her disease progression is critical to avoid further challenges. M.K. is one of a growing number of individuals who have more than one chronic illness. Chronically sick patients only obtain approximately half of the preventative health care services. Health care providers must aid patients and their families in recognizing the disease process, therapeutic interventions, and ways to preserve and enhance the quality of life.

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