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Introduction
Chronic bronchitis (CB) is one of the usual occurrences during chronic obstructive pulmonary disease (COPD). It presents divergent clinical complications such as a risk of acquiring of airflow obstruction in people who smoke, and increased lung function decline, an inclination to infections in the lower respiratory tract, and higher mortality rates (Kim & Criner, 2013).
Recommendations for chronic bronchitis
Clinical findings correlating with M. K.s CB are a chronic cough, distended neck veins, light-headedness, and increased urination at night. Since the patient has a very long history of smoking, the first recommendation would be to smoking cessation. According to research, quitting smoking can enhance cough in CB patients as it lowers goblet cell hyperplasia and promotes mucociliary function (Kim & Criner, 2013). Moreover, airway injury and mucus levels in exfoliated sputum tracheobronchial cells are reported to lessen in patients who quit smoking in comparison with those who kept on smoking (Kim & Criner, 2013). Other therapeutic interventions aimed at eliminating CB symptoms are short-acting ß-adrenergic receptor agonists (SABAs) and methylxanthines which enhance lung function and raise ciliary beat frequency (Kim & Criner, 2013). To reduce inflammation, glucocorticoids, and phosphodiesterase-4 (PDE-4) inhibitors, and macrolides are recommended. Antioxidants are prescribed to reduce mucus production and break down mucus polymers (Kim & Criner, 2013). Long-acting ß-adrenergic receptor agonists (LABAs) have proved to have an impact on mucociliary function, reduce hyperinflation, and raise peak expiratory flow. All of these factors are crucial components of an effective cough (Kim & Criner, 2013). Therefore, a physician may choose from the above-mentioned recommendations and types of treatment to eliminate the symptoms of M. K.s bronchitis.
Suspected heart failure and its pathogenesis
The following symptoms in M. K. raise the concern of heart failure: excessive peripheral edema, increased hematocrit level, and increased PaCO‚ level. These symptoms are indicators of congestive heart failure (CHF) (Verbrugge et al., 2013). The pathogenesis of this failure is rather complex and is associated with various peculiarities. The most common sign of CHF is low cardiac output. Other pathophysiology factors are a backward failure, renal dysfunction, pulmonary congestion, and dyspnea (Verbrugge et al., 2013). Also, M. K.s has got several symptoms which may increase the risk of CHF: she is overweight, which restricts heart pumping capability, and she has a chronic cough which disables the regularity of heart rhythm. M. K.s peripheral edema is an outcome of the activation of humoral and neurohumoral systems which increase water and sodium reabsorption (Verbrugge et al., 2013). New treatment approaches and therapeutic goals in CHF include relieving abdominal congestion and targeting maladaptive responses in the abdominal compartment (Verbrugge et al., 2013, p. 493).
Hypertension type and rationale for medications
According to the BP level, M. K. is experiencing stage 1 hypertension. She is currently receiving Lotensin and Latex. Lotensin is an angiotensin-converting enzyme used in hypertension treatment ( Lotensin, 2017). However, one of its side effects is coughing ( Lotensin, 2017). Since M. K. already has a severe cough, this medicine should be reconsidered. Lasix is used to normalize blood pressure, but it is also known to reduce the symptoms of edema in patients with congestive heart failure ( Lasix, 2017). Thus, this drug is rather beneficial for M. K. Hypertension is one of the most widely spread diseases in the USA. Nearly 29 percent of US adults have high blood pressure ( High blood pressure facts, 2016). Out of these, only about half of the people have their disease under control. The cost of health care and missed work days amounts to $46 billion each year annually ( High blood pressure facts, 2016).
Lipid panel analysis
According to the lipid panel, M. K. has a very high cholesterol level and hypertriglyceridemia. These symptoms increase the risk of heart disease and heart attack. For hypertriglyceridemia treatment, the following groups of medications are recommended: niacin, fabric acid derivatives, HMG-CoA reductase inhibitors (lovastatin, rosuvastatin, atorvastatin, and others), and omega-3 fatty acids (Sweeney, 2017). To lower cholesterol levels, such medicines as nicotinic acid, statins, fibrates, bile acid sequestrants, and ezetimibe are considered the most effective ( How is high blood cholesterol treated? 2016). Other findings from the case study correlating with both hypertension and Type II diabetes mellitus are high blood pressure and obesity.
HbA1c test and its rationale
The patients lab value for HbA1c means that M. K. has a high hemoglobin ( Hemoglobin A1c (HbA1c) test for diabetes, 2016). The rationale for this test is that people can do it without fasting. HbA1c checks the average glucose level within the past three months ( Hemoglobin A1c (HbA1c) test for diabetes, 2016). Thus, HbA1c helps to identify the abnormalities in body function such as high glucose level or diabetes.
Conclusion
The comprehensive case study made it possible to identify several important findings. The patient has several severe diseases, each of them presupposing various kinds of treatment. To successfully manage M. K.s health condition, it is necessary to take into consideration all symptoms and side effects of treatment methods. The first urgent recommendation is to smoke cessation. Further, it will be necessary to reconsider some medications and replace them with more effective ones. Also, it is crucial to pay close attention to the medicines side effects so that no complications for the patients condition are created.
References
Hemoglobin A1c (HbA1c) test for diabetes. (2016). Web.
High blood pressure facts. (2016). Web.
How is high blood cholesterol treated? (2016). Web.
Kim, V., & Criner, G. J. (2013). Chronic bronchitis and chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 187(3), 228-237.
Lasix. (2017). Web.
Lotensin. (2017). Web.
Sweeney, M. E. T. (2017). Hypertriglyceridemia. Medscape. Web.
Verbrugge, F. H., Dupont, M., Steels, P., Grieten, L., Malbrain, M., Tang, W., & Mullens, W. (2013). Abdominal contributions to cardiorenal dysfunction in congestive heart failure. Journal of the American College of Cardiology, 62(6), 485-495.
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