NURS 6501 Week 2 Case Study Assignment
Assignment (3 page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following
The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient.
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Pathophysiology and the Role of Race/ Ethnicity in a 45 Year-Old Woman Presenting with Dyspnea, Productive Cough, Fever, Hyperresonance, and a History of Chronic Obstructive Pulmonary Disease (COPD)
The GOLD guidelines state that a diagnosis of COPD is true when there is shortness of breath, a chronic productive cough, and a history of notable risk factors such as cigarette smoking. Typically, the patient is usually in their mid-life. The 45 year-old female patient in the case study fits this bill. In all likelihood, the woman must be suffering from an exacerbation of her COPD due to one or several of many exacerbating factors. The majority of these exacerbating factors are environmental in nature, such as industrial smoke. With COPD, however, the definitive diagnosis is made by means of spirometry. The forced expiratory ratio (FER) post-bronchodilator has to be below 0.7 on spirometry (GOLD, 2017). This paper is about determining the pathophysiologic processes and any ethnic or racial contributing factors in the symptomatology of the 45 year-old female patient.NURS 6501 Week 2 Case Study Assignment
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The Cardiovascular and Cardiopulmonary Pathophysiologic Processes Causing the Presenting Symptoms
The main pathophysiologic processes that define COPD are a loss of alveolar elasticity and an inflammation of the airways with resultant overproduction of mucus. The former is emphysema and the latter is bronchitis (Kennedy-Malone et al., 2019; Hammer & McPhee, 2018; Huether & McCance, 2017). The symptoms of COPD such as the 45 year-old is presenting with usually show a mixture of bronchitis, emphysema, and small airway disease. Typically, there is a productive cough with purulent sputum, rhonchi and wheezing due to the increased secretions of mucus, a marked reduction in the respiratory volumes such as the FER, and a derangement of the ventilation-perfusion ratio (Hammer & McPhee, 2018; Cannizzaro, 2017). All these symptoms result from the pathophysiologic processes inside the patient.
The cardiopulmonary pathophysiologic processes that cause most of these symptoms result from the hypertrophy or enlargement of the bronchial mucus glands. The result of this is that the glands start producing excessive amounts of tenacious mucus that is not easy to expectorate. The cough cannot clear the mucus fast enough and the same accumulates in the airways causing blockage. There is an accompanying inflammatory process mediated by lymphocytes and leucocytes that happen to infiltrate the mucosal lining of the airway. A combination of the inflammatory process and the hypertrophied mucus glands causes the airways to narrow significantly. This narrowing coupled with the tenacity of the mucus compromises the normal mucociliary clearance. A vicious cycle ensues and the airways blockage worsens requiring suctioning and urgent anticholinergic and beta2-adrenergic intervention. Hyperinflation also occurs as a result of the narrowed airways. Lung parenchyma is destroyed, expiratory time is increased, and alveolar elastic recoil is lost. Compliance increases. This increase in compliance is what makes the lungs appear larger in terms of the AP aspect on chest X-ray. The diaphragm is flattened because expiratory time is increased and elastic recoil is lost. The narrowed airways cause the shortness of breath and the excess mucus and lowered mucociliary clearance cause the productive cough, wheezing, rales, and rhonchi (American Thoracic Society, 2019; Singh et al., 2018). With these pathophysiologic processes representative of bronchitis and emphysema, it is not unusual for comorbid infections to be present and cause the fever that the patient has.
Possible Racial/ Ethnic Factors that May Affect Physiological Functioning and How Processes Interact to Affect the Patient
In a study by Lee et al. (2018), they found that non-Hispanic Blacks suffered the most severe forms of COPD at 9.2% compared to Hispanics who were the least affected in terms of severity at only 3.6%. This important racial disparity means that if the 45 year-old female patient is African American or Black, they will be expected to have a worsening of symptoms. Being Black apparently has the effect of making the pathophysiological processes more pronounced and unmitigated resulting in worse symptomatology. The importance of this is that therapy must be planned in a timely manner and the goal should be to restore cardiopulmonary function or physiology as soon as possible. The fact of being Black or African American also should inform the health education and health promotion decisions in the management of this patient. This is because Lee et al (2018) also found out that non-Hispanic Blacks were most likely to be active current smokers at 42.4%. Smoking is one of the most important risk factors for COPD (American Thoracic Society, 2019; Hammer & McPhee, 2018; GOLD, 2017). Part of the lifestyle and behavioral change educational intervention must therefore focus on this important risk factor if it is present in this 45 year-old female.
The interaction of the processes is that genetics accorded by racial identity (Blacks) makes them more susceptible to severe exacerbations of their COPD. Symptoms become more severe and therefore require more urgent treatment. Being Black also makes one more likely to smoke and therefore more likely to make the exacerbation worse.
COPD symptoms are caused by specific cardiopulmonary pathophysiologic processes that are well known. They are caused by hypertrophy of airway mucus glands and inflammation of the lung parenchyma. The result is a narrowing of the airways, increased production of mucus, reduced lung volumes such as the forced expiratory ratio (FER), and compromised mucociliary clearance. The 45 year-old patient fitted this profile and was most likely African American as the racial/ ethnic factor in COPD is somewhat congruent with her severe exacerbatory presentation. NURS 6501 Week 2 Case Study Assignment
American Thoracic Society (2019). Chronic obstructive pulmonary disease (COPD). American Journal of Respiratory and Critical Care Medicine, 199(1). http://dx.doi.org/10.1164/rccm.1991P1
Cannizzaro, T. (August 25, 2017). Staging for COPD. https://copd.net/clinical/new-to-staging/
Global Initiative for Chronic Obstructive Lung Disease [GOLD] (2017). Pocket guide to COPD diagnosis, management, and prevention: A guide for health care professionals. https://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf
Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.
Huether, S.E. & McCance, K.L. (2017). Understanding pathophysiology, 6th ed. Elsevier, Inc.
Kennedy-Malone, L., Plank, L.M., & Duffy, E.G. (2019). Advanced practice nursing in the care of older adults, 2nd ed. Davis Company.
Lee, H., Shin, S.H., Gu, S., Zhao, D., Kang, D., Joi, Y.R., Suh, G.Y., Pastor-Barriuso, R., Guallar, E., Cho, J., & Park, H.Y. (2018). Racial differences in comorbidity profile among patients with chronic obstructive pulmonary disease. BMC Medicine, 16(178), 1-8. https://doi.org/10.1186/s12916-018-1159-7
Singh, D., Barnes, P.J., Stockley, R., Valera, M.V.L., Vogelmeier, C. & Agusti, A. (2018). Pharmacological treatment of COPD: The devil is always in the detail. European Respiratory Journal, 51(4), https://doi.org/10.1183/13993003.00263-2018
Racial and Ethnic Variables
“Patient populations are now becoming more diverse in race and ethnicity. Please heavily reflect and cover the racial and ethnic variables that can be addressed within your writing this paper. There are certainly different types of assessment methods that can be used to assess race and ethnic variables when in the clinical setting. One understands that race can be multidimensional and complex. Race itself, can be associated with groups of individuals in genetically different populations. When discussing race, one can review variations in health care and illnesses, to include outcomes specific to the population. Specifically, one can review environmental, social, and behavioral factors that are associated with disease outcomes. Ethnicity, on the other hand, could be related to the origin and culture of the traditions that are shared within a group. This can include commonalities such as shared origin, psychological characteristics, attitudes, language, religion, and cultural traditions. To this end, ethnicity can be influenced by beliefs based on the diversity of the group.”
Assignment (3pages case study analysis)
Case Study Analysis: 45-year-old woman presents with chief complaint of 3-day duration of shortness of breath, cough with thick green sputum production, and fevers. Patient has history of COPD with chronic cough but states the cough has gotten much worse and is interfering with her sleep. Sputum is thicker and harder for her to expectorate. CXR reveals flattened diaphragm and increased AP diameter. Auscultation demonstrates hyper resonance and coarse rales and rhonchi throughout all lung fields
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Related to the scenario provided, explain the following:
Develop a 3page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:NURS 6501 Week 2 Case Study Assignment
1. Explain both the cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms.
NURS 6501 Week 2 Case Study Assignment