Chronic Bronchitis and Heart Failure Diagnostics


Addressing the issue of blood pressure and high cholesterol levels implies introducing a multifaceted framework that can help to improve a patient’s well-being. The specified idea applies to the case under analysis, in which a patient, M. K., a 45-year-old woman, suffers from high blood pressure and faces several serious health issues. To address the specified concern, one will have to deploy several frameworks for reducing health risks, the issue of cholesterol, and preventing another heart failure being the essential ones. Since the heart failure problem is directly linked to the BP concern and the cholesterol levels, a complex approach including patient education, administering medications, and monitoring changes in the patient’s health is required.

Treatment and recommendations for chronic bronchitis

According to the current information about the patient’s condition, there is the presence of bronchitis that requires immediate attention. Particularly, one should consider the clinical findings that show the presence of an abnormal level of gases in the patient’s blood. Specifically, the patient’s partial oxygen blood pressure levels currently reach 40 mmHg shows an evident problem (Jakkula et al., 2017).

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Furthermore, the current rate of carbon dioxide BP levels (52 mmHg) makes one admit that the patient suffers from the unreasonably high level of gases in her blood (Nagurka et al., 2014). Particularly, the combination of high carbon dioxide levels and the lack of oxygen in the patient’s lungs as the sign of abnormality leads to the possible development of hypercapnia, resulting in the imbalance between CO2 and oxygen (Jakkula et al., 2017).

Hypercapnia is not necessarily a reason for concern in most cases. Still, it poses a threat to the patient’s well-being in the identified scenario. It is combined with low levels of oxygen and, thus leads to the disproportional levels of blood gases in the patient’s body, hence the need to address the subject matter. The specified findings correlate with the presence of chronic bronchitis in the patient since the inadequate blood pressure gases levels sustain the current condition (Nagurka et al., 2014).

The latter, in turn, can also be characterized as abnormal due to its current levels (158/98), which do not align with the existing standards (60-90 mmHg-90-140 mmHg) (Jakkula et al., 2017). Finally, the levels of hematocrit concentration, which reach 57% at present, are unreasonably high for the patient given her age and gender (46% maximum) (Nagurka et al., 2014). Therefore, it is strongly recommended that the patient should stop smoking since the specified habit affects the development of chronic bronchitis to the greatest extent (Jakkula et al., 2017).

Also, it is critical to provide the patient with the medication that will alleviate the current condition and prevent further aggravation thereof. Specifically, a combination of Bronchodilators, Steroids, Antibiotics, and Oxygen Therapy should be provided. In case the situation does not improve, surgical intervention may be recommended to reduce the current lung volume (De la Rosa et al., 2016). As a result, the patient will become less susceptible to irritators that cause the rapid development of bronchitis (Nagurka et al., 2014). The following change in the patient’s condition will create the opportunity for improving her well-being.

Type of heart failure and its pathogenesis

Given the current information, it is reasonable to assume that the patient is suffering from left-sided heart failure (LSHF). LSHF is a subcategory of congestive heart failure, which occurs when the heart muscle cannot pump blood properly (Rosenkranz et al., ‎2016). Consequently, the patient’s lungs suffer extensively, which leads to the development of additional respiratory issues and triggers pulmonary edema (Centers for Disease Control and Prevention, n.d.). Also, according to the outcomes of the patient examination, the patient suffers from peripheral edema, whereas her neck veins are characterized as distended.

The specified phenomena are the symptoms of an instance of an LSHF (Rosenkranz et al., ‎2016). Although the presence of a chronic cough along with excessive mucus cannot be seen as direct effects of LSHF, they are also linked with the specified condition, which indicates that the patient currently suffers from LSHF (Centers for Disease Control and Prevention, n.d.). A drop in daily urination levels is also characteristic of LSHF since the specified phenomenon also causes malfunctioning of kidneys (Centers for Disease Control and Prevention, n.d.). Particularly, the patient’s kidneys cannot handle the excessive amount of fluid that causes edema (Rosenkranz et al., ‎2016).

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Finally, the presence of the systolic failure observed in the patient is also linked directly to the LSHF since the latter implies the inability of the left chamber to maintain the blood flow consistent due to low oxygen levels (Centers for Disease Control and Prevention, n.d.). The specified type of heart failure is also known as the one with reduced ejection fraction (HFrEF) (Rosenkranz et al., ‎2016).

Consequently, pulmonary capillary oncotic pressure leads to the rapid growth of the pulmonary pressure, causing the patient to experience heart failure (Centers for Disease Control and Prevention, n.d.). Therefore, it can be concluded that the patient suffers from severe LSHF and requires the corresponding medications. Unless unattended, the problem may entail a rapid loss of myocytes and the development of necrosis, which will ultimately cause the patient’s death (Centers for Disease Control and Prevention, n.d.). Thus, immediate intervention is needed to sustain the patient’s life.

The stage of hypertension and prescribed medications

As a rule, the presence and severity of hypertension are categorized based on the existing taxonomy that incorporates four types of BP rate measurement. Specifically, the following categories are traditionally distinguished when evaluating the BP rates in a patient and determining the presence of high BP: regular BP, prehypertension, hypertension, stage 1, and hypertension, stage 2 (Talaei, Hosseini, Koh, Yuan, & Koh, 2018).

The first stage is within the 120/80 mmHg rates, and the second one ranges from 120-139 mmHg to 80-89 mmHg). Hypertension, stage 1 is registered at the HP levels of 140-159 mmHg to 90-99 mmHg, and hypertension, stage 2 occurs at 160 or higher mmHg or 100 mmHg or higher) (Talaei et al., 2018). At present, the patient has stage 1 hypertension since her BP rates are at 158/98 mm Hg. Since the patient has developed a rather serious case of hypertension, medications that will reduce the impact thereof on her well-being will be needed.

Specifically, it is strongly advised that the patient should continue taking Lotensin and Lasix as the main strategy for controlling the levels of BP. The rationale behind the choice of the specified drugs is linked directly to the fact that, at the stage 1 hypertension level, the patient faces a serious threat of heart failure due to the changes in the blood flow. Therefore, drugs that reduce the probability of a stroke, such as Lotensin and Lasix, are required.

Indeed, according to the description thereof, both Lotensin and Lasix belong to the class of ACE inhibitors, which make blood vessels wider and more relaxed (Proctor et al., 2016). As a result, the blood flow becomes less strained, which causes the patient to experience a drop in BP rates and the subsequent decrease of the levels of stress put on her heart (Talaei et al., 2018).

Therefore, the probability of a stroke is reduced significantly. The threat that the patient faces is not uncommon among U.S. residents. Around 33% (75,000,000) of American citizens have to deal with high BP levels (Centers for Disease Control and Prevention, 2018). Furthermore, out of all these people, only 54% of them can manage their BP levels successfully, whereas the rest face the consistent threat of a rapid rise or drop in BP (Centers for Disease Control and Prevention, 2018). The specified situation calls for a health program that could help build awareness among the target population and introduce people to the opportunities of taking control over their BP levels.

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Other condition that present risks

In addition to the issues described above, the patient is also facing the risk of developing other complications that may affect her condition to an even greater degree. For instance, the current data of the patient’s lipid panel shows that her cholesterol levels are quite high (242 mg/dL). Specifically, the HDL levels, which indicate the ability of the patient’s body to expel the cholesterol from her body through her liver, are unreasonably low (Centers for Disease Control and Prevention, 2017).

As a result, there is a threat that the amount of cholesterol in the patient’s liver will accumulate and will not be released at the necessary rate. The LDL rates, which, in turn, imply the levels of cholesterol in the patient’s arteries, resulting in their further clogging and the development of arterial plaques that will contribute to a rise in BP rates, are very high (173 mg/dL).

Furthermore, given that the Triglycerides levels are presently at 184 mg/dL, there is a very high risk of the patient developing cardiovascular disease (CVD) with the subsequent possibility of another heart failure (Centers for Disease Control and Prevention, 2017).

Specifically, M. K. may have myocardial infarction unless the current condition is not managed appropriately (Rallidis et al., 2016). Furthermore, given the current information, M. K. also faces the risk of acquiring hyperlipidemia, or an increase in the number of fats in her body (Rallidis et al., 2016).In addition, the probability of other conditions such as obesity is very high (Centers for Disease Control and Prevention, 2017). The specified problem also may entail a sharp rise in cholesterol levels in her blood (Rallidis et al., 2016). Therefore, it is critical to address the specified concern by prescribing the appropriate patient medications.

Because of the intrinsic connection between the specified conditions, it is imperative to introduce the intervention that will allow embracing each of the specified concerns and create a comprehensive treatment plan. As a result, the patient will avoid further aggravation of her condition. Specifically, it is strongly recommended that M. K. should consider consuming the drugs that allow inhibiting the levels of cholesterol production in the patient’s body (Lloyd-Jones et al., 2016). For instance, the medications such as atorvastatin (Lipitor), which help both inhibit cholesterol production and reduce the present levels thereof, should be administered to the patient (Gierman et al., 2014). As a result, a gradual positive change is expected.

The Glycosylated hemoglobin (HbA1c) test results also indicate that the patient may face the threat of diabetes. Therefore, further tests for evaluating the current level of threat are required. The specified information correlates to the information regarding the cholesterol levels. Due to the threat of obesity that the patient faces, the probability of diabetes mellitus type II becomes increasingly high, which calls for a series of actions aimed at preventing the specified condition (Paul et al., 2016). Particularly, the patient may need to reconsider her diet along with taking the proposed medications.

The lab value for HbA1c in relation to body function

According to the specifics of the case, the Glycosylated hemoglobin (HbA1c) test resulted in a 7% outcome. The specified diagnostic tool allowed determining the presence of diabetes in the patient. Due to the drastic effects that the specified disorder has on an individual, it is critical to locate the problem at its early onset in order to introduce an appropriate set of tools for managing it respectively.

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Otherwise, a significant deterioration in the rates of health can be expected (Fu, Wong, Chin, & Luk, 2015). The results of the test indicate that there is a serious reason for concern since the outcomes that are within the approved norm range from 4% and 5.6% (“Hemoglobin A1C (HbA1c) test,” 2018). Although the current level of HbA1c in the patient does not indicate the early stage of diabetes, it shows that M. K. is exposed to a significant threat of acquiring the specified disease (Fu et al., 2015). Therefore, an appropriate intervention is required to address the situation and introduce a set of tools for the management of the patient’s needs.

The rationale for the value in question concerns the presence of high levels of cholesterol in the patient’s body. Due to the identified factor, the necessity for introducing a comprehensive treatment plan emerges. It could be argued that the HbA1c rates discovered in the patient during the test can be described as slightly above the norm yet not actually indicating the presence of diabetes. Indeed, the HbA1c level of 7% does not even reach the level at which the early onset of diabetes occurs (Fu et al., 2015).

Therefore, arguably, the outcomes of the test could be interpreted as mainly positive (Fu et al., 2015). As a result, the health of the patient is expected to improve significantly, whereas the danger of acquiring diabetes is likely to subside.

Conclusion

Because of the multiple factors that affect the patient’s well-being and that are interconnected tightly, an intervention comprised of several approaches is needed to manage the patient’s needs. M. K. requires a strategy that could focus on patient education and a change in her lifestyle. At the same time, the therapy that could allow reducing the levels of cholesterol and the BP rates is advised. Thus, one will be able to avert the threat of diabetes, at the same time creating the platform for a gradual improvement in the quality of M. K.’s life.

References

Centers for Disease Control and Prevention. (n.d.). Heart failure. Web.

Centers for Disease Control and Prevention. (2017). Know the facts about high cholesterol. Web.

Centers for Disease Control and Prevention. (2018). Learn about high blood pressure. Web.

De la Rosa, D., Martínez-Garcia, M. A., Olveira, C., Giron, R., Maiz, L., & Prados, C. (2016). Annual direct medical costs of bronchiectasis treatment: Impact of severity, exacerbations, chronic bronchial colonization and chronic obstructive pulmonary disease coexistence. Chronic Respiratory Disease, 13(4), 361-371. Web.

Fu, S. N., Wong, C. K. H., Chin, W. Y., & Luk, W. (2015). Association of more negative attitude towards commencing insulin with lower glycosylated hemoglobin (HbA1c) level: A survey on insulin-naive type 2 diabetes mellitus Chinese patients. Journal of Diabetes & Metabolic Disorders, 15(1), 3-11. Web.

Gierman, L. M., Kühnast, S., Koudijs, A., Pieterman, E. J., Kloppenburg, M., van Osch, G. J. V. M.,… Zuurmond, A. M. (2014). Osteoarthritis development is induced by increased dietary cholesterol and can be inhibited by atorvastatin in APOE* 3Leiden. CETP mice – A translational model for atherosclerosis. Annals of the Rheumatic Diseases, 73(5), 921-927. Web.

Hemoglobin A1C (HbA1c) test. (2018). Web.

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Lloyd-Jones, D. M., Morris, P. B., Ballantyne, C. M., Birtcher, K. K., Daly, D. D., DePalma, S. M.,… Smith, S. C. (2016). 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. Journal of the American College of Cardiology, 68(1), 92-125. Web.

Nagurka, R., Bechmann, S., Gluckman, W., Scott, S. R., Compton, S., & Lamba, S. (2014). Utility of initial prehospital end-tidal carbon dioxide measurements to predict poor outcomes in adult asthmatic patients. Prehospital Emergency Care, 18(2), 180-184. Web.

Paul, C. L., Piterman, L., Shaw, J. E., Kirby, C., Barker, D., Robinson, J.,… Sanson‐Fisher, R. W. (2016). Patterns of type 2 diabetes monitoring in rural towns: How does frequency of HbA1c and lipid testing compare with existing guidelines? Australian Journal of Rural Health, 24(6), 371-377. Web.

Proctor, D. B., Niedzwiecki, B., Pepper, J., Madero, J., Garrels, M., & Mills, H. (2016). Kinn’s “The medical assistant”: An applied learning approach (13th ed.). New York, NY: Elsevier Health Sciences.

Rallidis, L. S., Triantafyllis, A. S., Tsirebolos, G., Katsaras, D., Rallidi, M., Moutsatsou, P., & Lekakis, J. (2016). Prevalence of heterozygous familial hypercholesterolaemia and its impact on long-term prognosis in patients with very early ST-segment elevation myocardial infarction in the era of statins. Atherosclerosis, 249, 17-21. Web.

Rosenkranz, S., Gibbs, J. S. R., Wachter, R., De Marco, T., Vonk-Noordegraaf, A., & Vachiery, J. L. (2015). Left ventricular heart failure and pulmonary hypertension. European Heart Journal, 37(12), 942-954. Web.

Talaei, M., Hosseini, N., Koh, A. S., Yuan, J. M., & Koh, W. P. (2018). Association of “elevated blood pressure” and “stage 1 hypertension” with cardiovascular mortality among an Asian population. Journal of the American Heart Association, 7(8), 1-10. Web.

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