M. K. has recently been diagnosed with chronic bronchitis. A correlation exists between the findings and chronic bronchitis. Before elaborating on the correlation between the findings and chronic bronchitis, it is essential to understand what chronic bronchitis is. Chronic bronchitis is a type of chronic obstructive disease. It is a disease that is known for narrowing of the airways thus making it difficult to breathe. It is also associated with the inflammation of the bronchi. The most significant challenge with this disorder is that it attacks the bronchi that have no smooth muscle thus making it an irreversible condition. It is manifested through “swelling of the bronchial mucosa and scarring, increased fibrosis of the mucous membrane, hyperplasia of bronchial mucous glands and goblet cells, hypertrophy of bronchial glands and goblet cells, and increased bronchial wall thickness” (Kim, & Criner, 2013). All the factors mentioned above contribute to the obstruction of the airway in patients. The mucus production is accelerated by the presence of hyperplasia of the bronchial mucosa as well as goblet cells. When the mucous is combined with purulent exudate, mucous plug is formed. Another effect of hyperplasia is the increased thickening of the bronchial walls. All these factors play a significant role in restricting gas exchange in the airways making it difficult for the patient to breath. The aspect which makes this condition to be classified as a chronic disorder is the fact that cough produces sputum for the majority of the days. This condition carries on for at least three consecutive months and not less than a duration of two consecutive years.
To identify the correlation between the findings and chronic bronchitis, it is important to consider the major causal factors of this disease. Smoking is one of the primary etiologic agents. It has been identified that the patient has a history of smoking. The main risk factors of chronic bronchitis are smoking as well as being overweight. The patient has been found to be 225 lbs. at the age of 45. This can be considered as an overweight situation. The effect of smoking is that it increases the number as well as the size of bronchial mucous glands (Kim, & Criner, 2013). Consequently, the increased size and number of bronchial mucous glands lead to the excessive production of mucous within the bronchial tree. This explains the consistent coughing the patient experiences. Furthermore, smoking causes paralysis of the cilia in the respiratory system. It means that hair-like cells are no longer functional thus their function of removing mucus in the airways is rendered inactive increasing the inflammation in the bronchi. The bronchi become more narrowed, occluded and inflamed leading to trouble in breathing (Kim, & Criner, 2013). As mentioned above, M.K. has had a history of smoking. She is also overweight and has a history of poor diet. She has smoked for over 20 years. With minimal doubt, it can be concluded that the 20 years of smoking have played a vital role in the latest discovery of chronic bronchitis in M.K. The clinical findings have several factors that correlate with chronic bronchitis. Her persistent cough is the main correlating factor in the results. A cough is severe during morning hours and associated with sputum. She also has excessive edema. The sputum from a severe cough and excessive edema are the key clinical manifestation of the chronic disorder.
The chronic bronchitis is a disease that should be treated immediately. This chronic disorder is known to cause apnea or difficulty in breathing, which can result in pulmonary hypertension. At the point where the patient suffers from pulmonary hypertension, the bronchial walls experience inflammation while the pulmonary arteries experience vasoconstriction. This condition can further increase the resistance of the pulmonary artery leading to cor pulmonale (Simonneau et al., 2009). Consequently, this situation results in heart failure on the right side because complications related to hypertension occur in the right ventricle of the heart. One of the clinical findings to determine chronic bronchitis is the arterial blood gas assessment data. When testing for chronic bronchitis, the arterial blood gas evaluation may show elevated PaCO2 and decreased PaO2. These measurements are the partial pressure of carbon dioxide and oxygen in the arterial blood. Decreased levels of PaO2 would be below sixty-five mm Hg, and elevated PaCO2 would be above forty mm Hg. In the case of M.K., the patient’s PaO2 level was forty-eight mm Hg, and the PaCO2 level was fifty-two mm Hg. These clinical laboratory findings are a vital indication that this patient has chronic bronchitis.
Since chronic bronchitis is irreversible and causes difficulty breathing, it is important to treat this patient right away. The importance of proper recommendations and treatment that would be appropriate for M.K.’s chronic bronchitis is to return the patient to normal respiratory function. The first thing that needs to happen is smoking because this is an important etiologic agent that caused this disorder and could significantly increase the progression of the disease (Lawes, Vander Hoorn & Rodgers, 2016). I would also recommend that the patient reduce their exposure to other physical and chemical bronchial irritants to decrease the likelihood of progression. Additional recommendations for her chronic bronchitis would be for the patient to have proper rest, diet, exercise, and hydration because not properly caring for one’s body contributes to apnea and progression of this disease.
One of the later signs of chronic bronchitis is cyanosis, which causes a blue appearance, also called a “blue bloater,” so it is something to look out for. Since the patient is showing a PaO2 level lower than fifty-five mm Hg, it is recommended to get the patient on a low-dose oxygen therapy, because the “lungs may not be getting enough oxygen to the blood” (Lawes, Vander Hoorn & Rodgers, 2016). Different medications can be used to treat chronic bronchitis, but it is important to note that it cannot be cured. One of the important drugs that can be given would be “inhaled short-acting beta-2 agonists and inhaled anticholinergic bronchodilators” (Kim, & Criner, 2013). These are sympathetic drugs which are dilator drugs to help reverse the constriction of the airways. Cough suppressants, otherwise known as antitussive drugs, may also be used but only recommended at night when the patient is having problems sleeping due to a cough. Coughing is encouraged because it helps get rid of sputum obstructing the airway. The antitussive drug used to help with sleeping is called Dextromethorphan. Antimicrobial agents are used if the patient is shown to have a bacterial infection. In the case of M.K., it is not known whether or not she has a bacterial infection, so further diagnostic testing must be done.
It was mentioned above that chronic bronchitis can lead to pulmonary hypertension. Thus, cor pulmonale is the kind of heart failure I will suspect M.K. is suffering from. It has not been mentioned when her chronic bronchitis started although the history of her smoking has been provided. Cor pulmonale is a condition that causes the right side of the heart to fail. It is caused by elevated blood pressure in the arteries of the lungs as well as the right ventricle of the heart. Pulmonary hypertension caused by chronic bronchitis is what mostly causes cor pulmonale. A patient suffering from chronic bronchitis will have difficulty in breathing (Simonneau et al., 2009). Consequently, the trouble in breathing forms the main cause of hypertension. In situations where a patient has both chronic bronchitis and pulmonary hypertension, there are two things that happen. Continued chronic bronchitis means the patient will have more inflammation in the bronchi walls. This causes further problems in breathing. On the other hand, with increased pulmonary hypertension, more pulmonary blood vessels become resistance. It is important to note that pulmonary hypertension is associated with the changed in the small blood vessels in the lungs (Lawes, Vander Hoorn & Rodgers, 2016). The above conditions can easily lead to increased blood pressure in the right-hand side of the heart. The more the pressure increases, the higher the strain on the right side of the heart. The strain can easily cause cor pulmonale. If chronic bronchitis in M.K. is not treated early, it can result in pulmonary hypertension that is associated with cor pulmonale, a type of heart failure on the right side of the heart. There are two symptoms in M.K. that show some signs of pulmonary hypertension. It has been found that M.K. has distended neck veins. The distended neck veins is an indication that there might be a problem concerning the heart and lungs. The more severe the heart or lung disease, the more distended the veins will be. M.K. already has pulmonary hypertension as indicated by the distended neck vein and low artery blood gas. From the Artery Blood Gas Assessment results, M.K has 52 mm Hg of PaCO₂ and 48 mm Hg of PaO₂. Since cor pulmonale is known to be caused by pulmonary hypertension, it shows that M.K. is at the risk of suffering cor pulmonale. Apart from the gas assessment and neck veins, the blood pressure of M.K. is vital in determining the stage of hypertension she is currently at. The blood pressure is said to be normal if it is below 120/80 mm Hg. However, considering the blood pressure of M.K. is 158/98 mm Hg then it is rightful to conclude that M.K.’ blood pressure is abnormal and she is suffering from hypertension. The blood pressure reading of M.K. coincides with the blood pressure ranges for stage 1 hypertension. For individuals with stage 1 hypertension, the systolic pressure ranges between 140 to 159 mm Hg while the diastolic pressure ranges between 90 to 99 mm Hg. The three stages of hypertension are treated differently (Lawes, Vander Hoorn & Rodgers, 2016). For instance, in stage I, the patient is expected to take one drug until the pressure reduces to the required value. For stage II, the patient takes two types of drugs. An additional drug is only recommended in cases where the blood pressure does not come to the accepted level. For the case of M.K. who has stage I hypertension, it is expected that she will be taking thiazide diuretics. If the treatment with this type of antihypertensives is not successful, ACE inhibitors, AR blockers, beta-blockers, or calcium channel blockers can be considered.
According to the statistics provided by Centers for Diseases Control and Prevention (CDC), about 75 million of the adult Americans have high blood pressure. The 75 million contribute to 29 percent of the entire population. Of the 75 million people only 54 percent have their blood pressure in control (Lawes, Vander Hoorn & Rodgers, 2016). The lipid panel results can be used to identify some other risks in M.K.’s medical condition. The lipid panel shows the types of cholesterol, total cholesterol, HDL, and LDL. For an adult, the normal total cholesterol of a value less than 200 mg/dl is considered normal; the borderline is between 200-239 mg/dl, and a value of above 240 mg/dl is risky. For LDL, the optimal value is less than 100 mg/ dl while 160-189 mg/ dl is considered high. Any value above 190 mg/ dl is considered very high. For M.K. the total cholesterol is 242 mg/ dl while LDL is 173 mg/dl. For both measurements, the values are high. Of the three types of cholesterol, Low-density Lipoproteins (LDL) is the most dangerous. LDL is commonly referred to as “bad cholesterol” because of its tendency to build in the arteries causing health problems such as stroke and heart attack (Simonneau et al., 2009). This is an indication that M.K. is at risk for suffering from a stroke. The most suitable medication for this condition is statin (Lawes, Vander Hoorn & Rodgers, 2016). Patients with high levels of cholesterol are given statin. Statin helps prevent the liver from producing high levels of cholesterol. High cholesterol is also associated with both hypertension and Type II diabetes mellitus. Glycosylated hemoglobin (HbA1c) is another indicator that can be used to measure body functionality of M.K. A healthy adult is expected to have a Glycosylated hemoglobin (HbA1C) value between 4.8-5.9 percent. As per the results provided for M.K., HbA1C value is 7.3 percent. This is an indication that M.K. has very high glycosylated hemoglobin in the blood. A higher value of HbA1C shows that the body is not functioning well to control body glucose.
Conclusion
To sum up, M.K. who has a history of poor diet and history of Type II diabetes mellitus along with primary hypertension and has recently been diagnosed with chronic bronchitis is at the risk of several other complications. The main risk factors of chronic bronchitis are smoking as well as being overweight. The patient has been found to be 225 lbs. at the age of 45. She also has a history of smoking. If chronic bronchitis is not treated early, it might lead to pulmonary hypertension. This condition can further increase the resistance of the pulmonary artery leading to cor pulmonale. From the blood pressure results, it has been identified that the reading of M.K. coincides with the blood pressure ranges for stage 1 hypertension. For individuals with stage 1 hypertension, the systolic pressure ranges between 140 to 159 mm Hg while the diastolic pressure ranges between 90 to 99 mm Hg. This level is treated using one antihypertensive drug. The high level of cholesterol in lipid panel shows that M.K is at the risk of developing a stroke. She should be treated using satin.
References
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.
Lawes, C. M., Vander Hoorn, S., & Rodgers, A. (2016). Global burden of blood-pressure-related disease, 2001. The Lancet, 371(9623), 1513-1518.
Simonneau, G., Robbins, I. M., Beghetti, M., Channick, R. N., Delcroix, M., Denton, C. P., … & Krowka, M. J. (2009). Updated clinical classification of pulmonary hypertension. Journal of the American College of Cardiology, 54(1), S43-S54.