Case Study on COPD, Heart Failure, Hypertension, and Diabetes Mellitus

The body has several processes that interact to bring equilibrium and prevent disease. Failure of one system to maintain homeostasis can adversely affect the other. This leads to the occurrence of two or more disorders at the same time. Such disorders further complicate the management and require holistic management of the patient to address all of them simultaneously and prevent serious complications. This paper provides an analysis of a Case Study on COPD, Heart Failure, Hypertension, and Diabetes Mellitus. The paper shows the correlation between this disease using M.Ks symptoms and provides a recommendation for the management of all.

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Characteristics of chronic bronchitis displayed by M.K include a history of a chronic cough with sputum that is more severe in the morning from overnight accumulation (NHS, 2016). Also, M.Ks arterial blood gasses are indicative of chronic obstruction of the airways, restricting free gaseous exchange. Her PaO2 is 48mmHg, which is lower than the normal levels of 75 - 100 mmHg. She also has elevated PaCO2 of 52 mmHg far above the average range of 38 - 42 mmHg. These symptoms result from the obstruction of the airways limiting gaseous exchange (NHS, 2016). This leads to the lightheadedness witnessed by M.K. The hematocrit is also elevated to 57% above the normal levels of 37% - 48% as a compensatory mechanism.

M.K should be managed by using an inhalational bronchodilator to open up the airways. Oral steroids may be used in case the bronchodilator fails (NHS, 2016). A cough syrup can help can get rid of the excess sputum. M.K should also take lots of fluid to thin out the sputum for easy expectoration. Supplemental oxygen should be administered to raise PaO2 to normal and reduce the PaCO2. . She should avoid exposure to environmental irritants and quit smoking to prevent irritation of the bronchial mucosa which initiates an inflammatory response (Hinkle & Cheever, 2014). Finally, it is advisable to be immunized against pneumonia as COPD patients are highly predisposed to bacterial infections owing to the impaired clearance of microorganisms.

M.K is more likely to be suffering from congestive heart failure (CHF) as she has distended neck veins and excess peripheral edema. CHF results from an impairment of the ability of the ventricles to receive and eject blood. As a result, the contractility of the heart is reduced leading to circulatory congestion (Hinkle & Cheever, 2014). The cardiac muscles hypertrophy as a compensatory mechanism to increase cardiac output. Reduced blood supply to the kidneys activates the renin-angiotensin system causing excess water and sodium retention leading to peripheral edema (Hinkle & Cheever, 2014). Accumulation of fluid in the lungs leads to pulmonary hypertension which causes difficulty in breathing and production of excess mucus.

The blood pressure value reveals that M.K has stage 1 hypertension. Her antihypertensive medications include Lotensin and Lasix. Lotensin is an Angiotensin Converting Enzyme (ACE) inhibitor. It blocks ACE from converting inactive angiotensin I to a vasoconstrictor Angiotensin II which also stimulates the secretion of aldosterone promoting sodium reabsorption. Lasix is a loop diuretic that promotes fluid excretion by blocking the action of the sodium-potassium-chloride cotransporter in the loop of Henle (Hinkle & Cheever, 2014). This creates an osmotic gradient that inhibits water reabsorption, edema, congestive heart failure and hypertension. Hypertension has a high prevalence in the U.S with 29% of people having the disease. It is accountable for over 400, 000 every year deaths in America. Hypertension costs the country $46 billion every year.

M.K lipid profile indicates an increased risk of heart attack and stroke due to clogged blood vessels. The excess lipids collect in the walls of the blood vessels (atherosclerosis). This leads to the hardening of the arteries (arteriosclerosis). The clogged blood vessels can occlude blood to major organs such as the heart and the brain causing heart failure and stroke (Sowers, 2013). Therefore, she should take have a dietary change and take less saturated fats. She should also be actively involved in the physical exercise to lower the LDL levels to below 100 mg/dl. Medications to lower the cholesterol levels such as Atorvastatin should also be prescribed as they reduce the chances of having a cardiovascular attack. Hypertension and diabetes mellitus are comorbid conditions. Both reveal findings of obesity, high fat, and increased sodium levels (Jovinelly, 2016). M.K has a high BMI of 35 indicating of class 2 obesity. Her lipid profile is also elevated as is usually the case for both hypertension and diabetes mellitus.

HbA1c refers to the value of glycosylated hemoglobin. It is used to assess how well diabetes is controlled over the past six to eight weeks (Sowers, 2013). Average HbA1c is indicative of normal blood glucose levels. Patients with elevated glucose levels have a higher range of HbA1c. M.K has a high HbA1c above the normal range of below 6% indicating poor control of diabetes. Her HbA1c of 7.3% is indicative of blood glucose of about 10mmol/l in the past two months higher than the recommended levels of below 7.8mmol/l. High glucose levels pose a risk of diabetic ketoacidosis and coma. It can also lead to hypertension, diabetic retinopathy, neuropathy, and nephropathy (Jovinelly, 2016).

In conclusion, dual diagnosis of M.K helps in the proper management of all her conditions. Her chronic bronchitis should be managed using bronchodilator and cough syrup. Her blood pressure and sugar levels should be maintained within the normal ranges to prevent complications. Also, she should take some lifestyle adjustments such as avoiding smoking and exposure to environmental irritants, taking less saturated fats and reducing her weight to normal levels. Such a holistic management will lead to a good outcome and improve her quality of life.References

Hinkle, J. & Cheever, K. (2014). Brunner & Suddarth's textbook of medical-surgical nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Jovinelly, J. (2016). Type 2 Diabetes and Hypertension. Healthline. Retrieved 9 June 2016, from http://www.healthline.com/health/type-2-diabetes/hypertension

NHS, (2016). Bronchitis - NHS Choices. Nhs.uk. Retrieved 9 June 2016, from http://www.nhs.uk/Conditions/Bronchitis/Pages/Introduction.aspx

Sowers, J. (2013). Diabetes Mellitus and Vascular Disease. Hypertension, 61(5), 943-947. http://dx.doi.org/10.1161/hypertensionaha.111.00612