Abstract
The paper examines the medical history of M.K., 45 years old, and comments on necessary treatment and medication options. The development and clinical findings or chronic bronchitis are explained, while probable treatment is offered. This case study analysis attempts to predict what type of heart failure M.K. is more likely to experience. Hypertension is also addressed, and the paper stipulates its stage according to the American Heart Association 2017 new guidelines. Furthermore, the paper draws attention to lipid panel results and explains that these values make M.K. subject to additional health issues. M.K.’s HbA1c test value proves that the patient suffers from Type II diabetes mellitus, which also exposes her to heart problems. Finally, it is supposed that a comprehensive treatment approach that combines both lifestyle change and medication can improve the state of M.K.’s health.
Introduction
M.K. is a 45-year-old woman who is experiencing severe health issues. She suffers from multiple symptoms, including chronic cough with sputum, distended neck veins, light-headedness, increased urination at night, and excessive peripheral edema. Her current history includes Type II diabetes mellitus, primary hypertension, and chronic bronchitis. These health problems are explained by a 22-year history of smoking together with a poor diet. M.K. tries to improve her health, and her current medications consist of Lotensin and Lasix for hypertension along with Glucophage for Type II diabetes mellitus. That is why the principal purpose of this paper is to analyze M.K.s laboratory findings, offer additional treatment and drugs for the patient, comment on her current medications, and foresee her future health issues.
Addressing Chronic Bronchitis
To begin with, one should emphasize that M.K. does not have any treatment for her chronic bronchitis according to the statement of the problem above. Firstly, it is necessary to explain what clinical findings correlate with the given disease. One should note that chronic cough with sputum is a valid symptom. Since M.K. is a smoker with rich experience, she is more subject to the health condition under consideration. However, it is reasonable to draw attention to clinical findings to make the correct diagnosis. In this case, it is rational to focus on arterial blood gas assessment. According to Family Practice Notebook (2020), markedly reduced PaO2 and elevated PaCO2 are signs of chronic bronchitis. Global RPh (2017) indicates that the standard PaO2 value is 80-100 mm Hg, and that of PaCO2 is 35-45 mm Hg. As for M.K., her level of PaO2 is 48 mm Hg, and that of PaCO2 is 52 mm Hg. Consequently, the combination of all these facts makes it possible to diagnose chronic bronchitis.
Once the diagnosis is made, it is reasonable to comment on treatment and recommendations for M.K. When it comes to medicines, the first step is to take bronchodilators, including Serevent, Tudaorza, or others (Medline Plus, n.d.). These drugs relax individuals’ airways and make breathing easier. They are taken through inhalers, and some of them contain steroids when it is necessary to reduce inflammation. Furthermore, antibiotics should be prescribed if a patient has “a bacterial or viral lung infection” (Medline Plus, n.d., para. 10). In addition to that, a suitable intervention for M.K. is to change her lifestyle. It relates to quitting smoking, breathing fresh air, eating healthy food, and doing physical exercise. This comprehensive approach will help the patient overcome the disease.
Suspected Hearth Failure
Since the information above has explained that M.K. is suffering from multiple health conditions, it is not a surprise that her heart is also going to experience some issues. There are four basic types of heart failure, including left-sided, right-sided, systolic, and diastolic ones. All of them imply shared causes that are suitable for M.K. They include smoking, poor diet, and being overweight, but the patient is more likely to experience right-sided heart failure. Even though it is usually encouraged by a left-sided health failure, Moore and Roth (2017) argue that lung disease can cause the health condition under consideration. The data below will present the pathogenesis of how this type of heart failure develops if one wants to understand a connection between chronic bronchitis and right-sided heart failure.
According to Bottrell (2017), this health problem is a result of the fact that a person’s heart “receives unoxygenated blood from the body and pumps it through” the lungs (para. 5). Since this organ is affected by chronic bronchitis, specific areas of the lungs do not obtain sufficient oxygen. The lack thereof cannot be compensated because of obstructed airways. In this case, the body decides that it is necessary to send more blood to the lungs to provide them with the required oxygen. That is why the affected areas increase in volume, and the “heart is forced to work extra hard to pump blood through diseased lungs” (Bottrell, 2017, para. 5). This condition results in elevated pulmonary blood pressure that, in turn, leads to hypertrophy of the heart. As a result, the heart becomes enlarged and fails to pump blood adequately. Consequently, this information stipulates that M.K. should invest some efforts in preventing the health condition under consideration from developing.
Patient Hypertension Explained
At the same time, it is also necessary to focus on M.K.’s hypertension. The laboratory findings stipulate that the patient’s blood pressure is 158/98 mm Hg. According to the American Heart Association 2017 new guidelines, these values qualify for stage 2 hypertension. The American College of Cardiology (2017) explains that this stage is diagnosed when systolic tension is at least 140 and diastolic one is more than 90 mm Hg. Since the guidelines were adopted to increase “the detection, prevention, management, and treatment of high blood pressure,” one should draw attention to blood pressure measuring (American College of Cardiology, 2017, para. 1). It relates to the fact that a single measurement is not sufficient to make a diagnosis. That is why home blood pressure monitoring is of significance here. If M.K. repeatedly shows similarly elevated blood pressure values, it is possible to confirm that she is experiencing stage 2 hypertension.
The information above stipulates that M.K. needs specific treatment to improve her health condition. The health study indicates that her hypertension medication includes Lotensin (Benazepril) and Lasix (Furosemide). The use of these two drugs is justified by their action. On the one hand, Lasix is a diuretic that is a typical treatment for high blood pressure (Allen, 2020). It is so because this drug clears excess fluid from the body because it increases the amount of urine that people remove from their kidneys (Allen, 2020). On the other hand, Lotensin is an angiotensin-converting enzyme inhibitor (Mayo Clinic Staff, 2018b). This drug relaxes blood vessels since it blocks the creation of a natural chemical that can narrow them. Consequently, the two drugs contribute to lowering hypertension, and Lotensin prevents the kidney from failure because of excess urination.
In addition to that, one should emphasize that hypertension is a severe problem for the United States. Thousands of people of various ages, genders, and origins are diagnosed with this disease every year, but specific groups are at higher risk. According to Marshall et al. (2016), it relates to ages and body-mass indexes. The researchers indicate that overweight and obese individuals of 65-74 years old are more subject to hypertension (Marshall et al., 2016). Increased vascular resistance and arterial stiffness explain that state of affairs. Consequently, this health issue is a nationwide problem, and that is why individuals should adequately monitor and treat their blood pressure to prevent dangerous outcomes from happening.
Commenting on the Lipid Panel
At this point, it is rational to draw attention to the lipid panel because it can tell essential information about M.K.’s health. It is so because this laboratory test can determine the amount of cholesterol and triglycerides in her blood. According to Ross and Sarachick (2016), standard lipid panel results are 200 mg/dL cholesterol, 40-60 mg/dL HDL, 70-130 mg/dL LDL, and 10-150 triglycerides (para. 13). As for M.K., however, her results are far from ideal. The elevated values of cholesterol, LDL, and triglycerides, as well as a decreased HDL level, indicate that M.K. is at a higher risk of heart disease, stroke, and atherosclerosis (Ross & Sarachick, 2016). The probability of these health outcomes is also supported by the fact that the patient is a smoker and follows an unhealthy diet. The latter phenomenon results in the case that her body stores excessive calories in fat cells, which contributes to overweight and diabetes.
According to the information above, it is reasonable to consider what other medications M.K. needs. It is possible to choose among multiple variants of treatment, but statins are the most widespread. Rosenson and Cannon (2019) explain that these drugs, including Lipitor and Crestor, minimize the probability of heart attack, stroke, and death. It is so because these medications can “decrease the body’s production of cholesterol and increase the removal of cholesterol by the liver” (Rosenson & Cannon, 2019, para. 17). In addition to that, the drugs can lower the number of triglycerides. Another possible option is to use PCSK9 inhibitors that imply almost the same action and consequences as statins (Roseonson & Cannon, 2019). Finally, Zetia can be given to M.K. if she does not tolerate statins. Thus, there are possible solutions to how to lower an abnormal cholesterol level.
In addition to that, it is reasonable to comment on whether there are any additional findings the correlate with both hypertension and Type II diabetes mellitus. Even though these two health conditions seem to affect various parts of the body, the same factors can cause them. For example, Barhum (2019) admits that obesity is one of the most significant signs that a person is subject to the two problems. Although it is not mentioned whether M.K. suffers from obesity, her weight of 225 lbs. indicates that she is at risk. Furthermore, if M.K. notices that her vision has deteriorated, it is another feature that is typical for both hypertension and Type II diabetes mellitus. Consequently, this information means that M.K.’s health problems are interconnected, which stipulates that it is not reasonable to treat any of them in isolation. A comprehensive approach can only improve the state of the patient’s health.
Interpreting HbA1c Laboratory Value
Since it has repetitively been mentioned that M.K. has Type II diabetes mellitus, it is rational to consider her HbA1c value to identify whether the diagnosis is justified. To begin with, one should explain that the A1c test measures an average blood sugar level for the past two or three months. In particular, the text draws attention to a percentage of a person’s hemoglobin that is coated with sugar (Mayo Clinic Staff, 2018a). If an individual does not have diabetes, the test result will be below 5.7 percent (Mayo Clinic Staff, 2018a, para. 9). A level of 5.7-6.4 percent is found in people who have prediabetes (Mayo Clinic Staff, 2018a, para. 9). Finally, a percentage of 6.5 or higher stipulates that a person has diabetes (Mayo Clinic Staff, 2018a, para. 9). Consequently, M.K.s HbA1c value of 7.3% proves that she has Type II diabetes mellitus.
According to the information above, it is necessary to explain the rationale for this value concerning normal or abnormal body function. Since the HbA1c test shows that that M.K. has an increased level of sugar in her blood, this condition is likely to result in further problems. According to Shervani et al. (2016), if this value is elevated, it is “an independent risk factor for coronary heart disease and stroke” (p. 95). When these conditions develop against a background of an increased sugar level, it is impossible to talk about normal body function. That is why it is not a surprise that this health condition is one of the leading causes of death in the United States. For example, Shervani et al. (2016) admit that “69,071 death certificates listed diabetes as the underlying cause of death in 2010” (p. 96). Consequently, M.K. should control the level of sugar in her blood to avoid dangerous consequences.
Concluding Thoughts
The present case study analysis has addressed 45-year-old M.K. and her medical history. It is possible to conclude that she suffers from a few health problems that were mainly caused by her lifestyle. It is so because smoking, being overweight, and following a poor diet have significantly deteriorated M.K.’s health and well-being. Since arterial gas assessment results prove that the patient has chronic bronchitis, she should change her lifestyle and take specific medication, including Serevent, Tudaorza, or others. These interventions are necessary for M.K. to avoid heart failure. It refers to the fact that lung disease is a typical cause of right-sided heart failure. Furthermore, the patient’s blood pressure indicates that she is subject to health problems because she suffers from stage 2 hypertension. Specific medications, including Lotensin and Lasix, can mitigate the risk of this dangerous condition.
In addition to that, the lipid panel results demonstrate that M.K. is subject to heart disease, stroke, and atherosclerosis. In this case, statins and PCSK9 inhibitors are suitable drugs to prevent these health problems from occurring. Finally, M.K.’s HbA1c test value justifies her diagnosis of Type II diabetes mellitus. Here, the patient’s body function is abnormal, which can result in coronary heart disease and stroke. Thus, M.K.’s problems are interconnected, and it is necessary to implement a comprehensive treatment approach to achieve positive health outcomes.
References
Allen, H. (2020). Furosemide.Patient. Web.
American College of Cardiology. (2017). New ACC/AHA high blood pressure guidelines lower definition in hypertension. Web.
Barhum, L. (2019). The link between diabetes and hypertension. Medical News Today. Web.
Bottrell, J. (2017).Links between COPD and heart failure. COPD. Web.
Family Practice Notebook. (2020). Chronic bronchitis.Web.
Global RPh. (2017). Common laboratory (lab) values – ABGs.Web.
Marshall, A., Nazroo, J., Feeney, K., Lee, L., Vanhoutte, B., & Pendleton, N. (2016). Comparison of hypertension healthcare outcomes among older people in the USA and England. Journal of Epidemiology & Community Health, 70(3), 264-270.
Mayo Clinic Staff. (2018a). A1C test.Mayo Clinic. Web.
Mayo Clinic Staff. (2018b). High blood pressure (hypertension).Mayo Clinic. Web.
Medline Plus. (n.d.).Chronic bronchitis. Web.
Moore, K., & Roth, E. (2017). Heart failure. Healthline. Web.
Rosenson, R. S., & Cannon, C. P. (2019). Patient education: high cholesterol and lipid treatment options (beyond the basics). UpToDate. Web.
Ross, H., & Sarachik, J. (2016). Cholesterol test.Healthline. Web.
Shervani, S. I., Khan, H. A., Ekhzaimy, A., Masood, A., & Sakharkar, M. K. (2016). Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomarker Insights, 11, 95-104.