Paper Example on M.K.'s Chronic Bronchitis: A Case of Smoking-Induced Inflammation.

After studying the case of the patient, it was found that she had chronic bronchitis which came about because of her smoking habit. The conclusion is sensible because M.K has had a smoking habit for twenty-two years. Cigarette smoking is the most common cause of this disease because cigarettes can release different cytokines. Cytokines are signal proteins that lead the airway in thickening and make the airways to have inflammations. The smoke from the Cigarettes also makes cells produce more mucus (Zannad, 2015).

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Elevated hematocrit, elevated glycosylated hemoglobin, abnormal blood gas levels, excessive peripheral edema, chronic cough with sputum are all clinical findings which can be associated with chronic bronchitis. The patient has strange arterial blood, and because of this, Carbon dioxide's pressure is elevated to 52mm Hg while its normal range should be from 35 to 45mmHg. As a result of this, the lungs do not have enough gaseous exchange, which causes the blood to have carbon dioxide accumulation. The normal range of the partial oxygen pressure of oxygen should be from 80 to 100 mmHg, but the patients are 48 mm Hg which is low than the normal range (Gotts & Matthay, 2016). This is caused by the reduced sufficiency of the functioning of the lungs, which is caused by chronic bronchitis inflammation.

For her chronic bronchitis, the treatment can begin with a bronchodilator together with glucocorticoids and glucocorticoids followed by quitting from smoking. This can be achieved through therapy and counseling to quit smoking. The patient should also avoid being in environments which are dusty and those with air pollution. The cough caused by smoking can be treated using oxygen therapy and with mild cough syrups to clear her air passages. The administration of antibiotics is also crucial to help in addressing any secondary infections she could develop (Zipes, 2018).What type of heart failure would you suspect with M.K.?

For the case of M.K, I would suspect her to have heart failure on the right side. Chronic Bronchitis because of smoking directly affects the right ventricle of the heart, and this causes pulmonary hypertension (Zipes, 2018). The fluid buildup in her body is the reason for the failure of the right side of M.K's heart; blood backs up in her body veins and makes her ankles and legs to swell and also to swell in parts of the abdomen like the liver and the GI tract (Seferovic, 2018). Sputum also congested her bronchi, and this made it challenging for her to breathe and caused hypertension. Overworking of the heart eventually led to the cardiac muscles hypertrophy, which led to heart failure (Zipes, 2018).

What stage of Hypertension is M.K. experiencing?

Hypertension comes about when the blood flows through the body blood vessels with a greater magnitude than the normal one which is indicated when a patient has a systole pressure of 120 mm Hg and a diastole pressure of 80 mm Hg (Gotts & Matthay, 2016). Hypertension usually has two stages; the first stage is diagnosed when an individual has a systole pressure of 140 and 159 mm Hg and a diastole pressure of 90 and 99 mm Hg. For the second stage of hypertension, the patient has a systole pressure of 160 mm Hg or higher and a diastole pressure of 100 mm Hg or higher (Seferovic, 2018). From the details of M.K, her blood pressure was found to be 158/98 mm Hg. Thus it can be established that she has stage one hypertension.

Currently, her medications include Lasix and Lotensin for her hypertension problem. Lotensin is an ACE inhibitor; this means that the medicine prevents the person's kidneys from retaining water and sodium by making angiotensin-converting inactive. Angiotensin-converting is the enzyme responsible for activating inactive angiotensin and making it active angiotensin II (Zipes, 2018). Angiotensin II raises the pressure of the blood since it enables the retention of water and sodium, and this makes the arteries to constrict. Lasix is the other medication which M.K uses, and it is a loop diuretic. Generally, diuretics aid the kidneys to eliminate any water and sodium from the human body. This activity makes the volume of blood to decrease, which means the heart pumps less blood per heartbeat and thus lowering the blood pressure. Lasix works on specific parts of the tubules of the kidney known as the loop of Henle and blocks chloride and sodium from being reabsorbed from these tubules into the bloodstream (Zannad, 2015).

What other condition is M.K. at risk for?

As per the lipid panel of the patient which indicated Triglycerides 184 mg/dL, LDL 173 mg/dL, HDL 32 mg/dL, and Cholesterol 242 mg/dL. Because of the results, it is evident that the patient has high cholesterol levels. A normal lipid panel should indicate less than 200 mg/dL while a normal level of LDL should indicate lower than100 mg/dL (Zannad, 2015). Because of this, M.K is at risk of having atherosclerosis- a process in which arteries are blocked by cholesterol. Cholesterol build up makes the arteries to narrow, and this increases the risk of M.K developing heart attack. Narrow arteries can cause the growth of blood clots, and this leads to heart attacks (Gotts & Matthay, 2016). The patient needs to be given Statin medicines to regulate the levels of cholesterol in her body and reduce the risk of cholesterol building up in her arteries. Findings relating to her type II Mellitus diabetes and hypertension also include her being overweight and eating a poor diet, which increases her risk of developing cardiovascular disease.

HbA1c lab value

The patients HbA1c lab value is 7.3%, while the normal range should be 4 to 5.6% (Zipes, 2018). If the level of HbA1c is more than 6.5%, then the patient should be diagnosed with diabetes; for M.K, her HbA1c lab value is 7.3%. HbA1c lab value reflects the level of glucose in the blood for over six to eight weeks; however, it does not show the daily changes in glucose levels in the blood. High levels of HbA1c show poor care and control of diabetes and levels below 6% indicate a well-managed diabetes mellitus. Any changes from the normal levels of HbA1c indicate abnormal levels of glucose in a patient's body. The abnormal levels of HbA1c can cause heart failure because the blood levels experience an increased carrying capacity of glucose (Gotts & Matthay, 2016). This data is an indicator that the patient's diabetes is not well managed because her current dosage of Glucophage is also unknown. The patient could need a different medication or a larger dose because of the drug interactions of Lasix and Glucophage (Gotts & Matthay, 2016). Exercise and a healthy diet are highly recommended for this patient.

Conclusion

To conclude, after careful evaluation of the signs and symptoms and her history, it can be concluded that M.K's chronic bronchitis was caused by her long history of cigarette smoking. Her smoking caused a direct impact to the right ventricle of her heart, and this made her have pulmonary hypertension. From the collected data, it was concluded that she had a heart failure to the right side of her heart. She also experiences stage 1 hypertension. She is also at the risk of developing other conditions like atherosclerosis because of the high levels of cholesterol in her body. She should be administered with Statin to help in regulating the high levels and also to reduce the risks associated with high levels of cholesterol in the body. From her high levels of HbA1c, it was decided that a new medication has to be administered to her or her dosage of Glucophage should be increased because the levels of HbA1c show that her type II diabetes is not well managed.

References

Seferovic, P. M., Petrie, M. C., Filippatos, G. S., Anker, S. D., Rosano, G., Bauersachs, J., ... & Farmakis, D. (2018). Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. European journal of heart failure, 20(5), 853-872.

Zannad, F., Cannon, C. P., Cushman, W. C., Bakris, G. L., Menon, V., Perez, A. T., ... & Lam, H. (2015). Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicentre, randomized, double-blind trial. The Lancet, 385(9982), 2067-2076.

Zipes, D. P., Libby, P., Bonow, R. O., Mann, D. L., & Tomaselli, G. F. (2018). Braunwald's Heart Disease E-Book: A Textbook of Cardiovascular Medicine. Elsevier Health Sciences.

Gotts, J. E., & Matthay, M. A. (2016). Sepsis: pathophysiology and clinical management. Bmj, 353, i1585.