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Question

Write a Comprehensive Case Study on COPD, Heart Failure, Hypertension, and Diabetes Mellitus

Solution

Introduction

The present clinical scenario describes the clinical history of the patient (M.K) in relation to her recently diagnosed condition of chronic bronchitis. The treatment regimen and lab findings reveal the risk factors that predispose the patient towards the development of serious cardiovascular and metabolic co-morbid states. The below-mentioned analysis of this case study effectively correlates the clinical findings with M.K's disease complications and manifestations requiring evidence-based interventions in the context of elevating her wellness outcomes.  

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M. K's Clinical Findings and Therapeutic Recommendations for Managing the State of Chronic Bronchitis

The evidence-based research literature reveals the requirement of administering supplemental oxygen therapy to the patients affected with chronic obstructive bronchitis and PaO2 finding of less than 55 mmHg (Gupta, et al., Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations, 2013). In the present clinical scenario, the PaO2 finding of the patient attributes to 48mm Hg and resultantly she becomes the subject of oxygen administration in the context of preventing the hypoxemia episodes. PaCO2 range of 50 – 54mm Hg warrants the administration of noninvasive ventilation to the COPD patient (Gupta, et al., Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations, 2013). The pattern of patient's productive cough indicates the progression acute COPD exacerbation requiring the noninvasive intervention (while considering the PaCO2 finding of 52mm Hg) in controlling this respiratory manifestation. The research study by (Bruno & Valenti, 2012) indicates the predisposition of individuals affected with a pattern of chronic bronchitis in terms of experiencing acid-base abnormalities. The elevation in patient's PaCO2 level might disrupt the pCO2 and bicarbonate ratio leading to the development of mixed acid-base manifestations. The abnormality related to patient's pulmonary gas change predisposes him towards the development of ventilation-perfusion disorder and associated respiratory manifestations (West, 2011). The patient's smoking pattern concomitantly with the deteriorating arterial blood gas ratio predisposes him towards the development of asthmatic exacerbations, eosinophilia, and atopy (Neves, et al., 2013). Evidence-based research findings indicate the influence of disrupted glycometabolism (advocated by elevated HbA1c level) on the development of endothelial abnormalities that predominantly reduce the pulmonary functionality of the diabetic patient (Li, et al., 2015). The increased HbA1C level (i.e. 7.3%) of the patient predisposes her towards the deterioration of lung function and development of associated health hazards. Clinical findings in (Naeije, 2013) advocate reciprocal relationship between hematocrit level and efficiency of pulmonary circulation. The elevated hematocrit level of MK predisposes her towards the potential disruption of the pressure gradient across pulmonary vasculature leading to increase in vascular resistance and the subsequent development of pulmonary obstruction. 

Evidence-based research literature advocates the contention in relation to the administration of bronchodilators in the context of reducing their episodes of dyspnea and shortness of breath resulting from hyperinflation of lungs (Barrecheguren & Miravitlles, 2016).

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