SIGNATURE ASSIGNMENT
Comprehensive Case Study on COPD, Heart Failure, Hypertension and Diabetes Mellitus M.K. is a 45 year old female; measuring 5’5” and weighs 225 lbs. M.K. has a history of smoking about 22 years along with a poor diet. She has a history of Type II diabetes mellitus along with primary hypertension. M.K. has recently been diagnosed with chronic bronchitis. Her current symptoms include chronic cough, more severe in the mornings with sputum, light-headedness, distended neck veins, excessive peripheral edema, and increase urination at night. Her current medications include Lotensin and Lasix for the hypertension along with Glucophage for the Type II diabetes mellitus.
The following are lab findings that are pertinent to this case:
Vitals:
BP- 158/98 mm Hg CBC
CBC:
Hematocrit- 57%
Glycosylated hemoglobin- (HbA1c) 7.3 %
Arterial Blood Gas Assessment:
– PaCO₂ 52 mm Hg
– PaO₂ 48 mm Hg
Lipid Panel:
Cholesterol- 242 mg/dL
HDL- 32 mg/dL
LDL- 173 mg/dL
Triglycerides- 184 mg/dL
1. What clinical findings correlate with M.K.’s chronic bronchitis? What type of treatment and recommendations would be appropriate for M.K.’s chronic bronchitis?
2. Which type of heart failure would you suspect with M.K.? Explain the pathogenesis of how this type of heart failure develops.
3. According to the B.P. value, what stage of hypertension is M. K. experiencing? Explain the rationale for her current medications for her hypertension. Also, discuss the impact of this disease in the U.S. population.
4. According to the lipid panel, what other condition is M.K. at risk for? According to this case study, what other medications should be given and why? What additional findings correlate for both hypertension and Type II diabetes mellitus?
5. Interpret the lab value for HbA1c and explain the rationale for this value in relation to normal/abnormal body function.
Expert Solution Preview
Introduction:
This case study presents the health condition of M.K, a 45-year-old female with a history of smoking, poor diet, Type II diabetes mellitus, primary hypertension, and recently diagnosed with chronic bronchitis. The lab findings are also provided to aid in the evaluation of her condition. As a medical professor, my responsibility is to provide detailed answers to each question and recommend appropriate treatment and recommendations to manage her conditions.
1. The clinical findings that correlate with M.K.’s chronic bronchitis include chronic cough, sputum production (more severe in the morning), light-headedness, distended neck veins, excessive peripheral edema, and increase urination at night. The appropriate treatment and recommendations for M.K.’s chronic bronchitis should include bronchodilators, inhaled corticosteroids, and oxygen therapy. Lifestyle modifications such as smoking cessation, weight loss, and a healthy diet should also be recommended.
2. M.K.’s symptoms suggest left-sided heart failure. The pathogenesis of left-sided heart failure involves poor left ventricular function leading to impaired cardiac output, increased pulmonary venous pressure, and pulmonary congestion. The impaired cardiac output results from damage to the heart muscle, such as from hypertension or coronary artery disease.
3. Based on her BP value, M.K. is experiencing stage 1 hypertension. The current medications for M.K.’s hypertension, Lotensin, and Lasix, are appropriate as they target hypertension and help manage fluid retention. The impact of hypertension in the US population relates to the high incidence of cardiovascular complications such as heart disease and stroke.
4. M.K. is at risk of developing atherosclerosis, which can lead to coronary artery disease. Statins should be prescribed to help manage and lower cholesterol levels. Additional findings that correlate with both hypertension and Type II diabetes mellitus include glycosylated hemoglobin (HbA1c) levels and lipid panel results.
5. The lab value for HbA1c indicates good long-term control of blood glucose levels. The HbA1c value of 7.3% is slightly elevated and suggests poor control of blood glucose levels over the past two to three months. This result is essential in providing insight into the effectiveness of current treatment for her Type II diabetes mellitus.
Conclusion:
Managing M.K.’s conditions requires a thorough evaluation of her symptoms, medical history, and lab findings. Appropriate treatment and lifestyle modifications are crucial in managing her conditions effectively and mitigating any complications. As a medical professor, educating college students on the appropriate evaluation and management of patients with a multifactorial medical history is crucial in providing optimal care.
