Pathophysiology Assignment Essay

 Pathophysiology Assignment Essay

 

Pathophysiology & Clinical Findings of the Disease

1. Are the spirometry results consistent with obstructive or restrictive pulmonary disease? What is the most likely pulmonary diagnosis for this patient?

The spirometry results indicate obstructive pulmonary disease. The lungs can take up much capacity, as seen in the vital and total inspiratory capacity and other lung volumes. Obstructive pulmonary disease entails restriction of normal airflow due to alveoli and other respiratory organs’ collapse and blockade by fluid or narrowing due to inflammation. The changes are thus visible in the expiratory volumes, with a more than 30% decrease in forced expiratory volume (Sarkar et al., 2019). The most common conditions include asthma and bronchitis. In restrictive pulmonary disease, the lung is prevented from expanding intrinsic or extrinsic factors, and spirometry results show a marked decrease in inspiratory and expiratory volumes. Lung infections or diseases (pneumonitis, pulmonary fibrosis, and interstitial lung disease) that cause the replacement of normal lung tissue with fibrous tissues restricting movement also cause restrictive disorders. Extrinsic factors include pleural effusion, respiratory muscle failure, and chest wall abnormalities, and they limit lung expansion, decrease lung volumes, and lead to progressive lung failure. The most likely condition is asthma to the patient history, review of systems, physical exam, and diagnostic tests.

2. Explain the pathophysiology associated with the chosen pulmonary disease.

Asthma is a severe pulmonary disease that can be acute or chronic, depending on its severity—the condition results from pulmonary airway inflammation that presents with reversible lower airway obstruction. The patient presents with hyperresponsiveness and immune mediation to specific environmental triggers. Sinyor and Perez (2021) note that the airway is triggered by allergens such as cold air, chemicals, and cigarette smoke which cause an early-phase immunoglobulin E (IgE)-mediated bronchial airflow reduction followed by a late-phase IgE media airflow reduction for 4-8 hours. Chronic asthmatic episodes lead to various changes, such as lung hyperinflation seen on an X-ray, smooth muscle hypertrophy, mucosal edema, and mucus gland hypersecretion. The narrowing of the airway may lead to forced inspiration hence the wheezing sound in some asthmatic patients. Chronic obstruction impairs gaseous exchange leading to orthopnea. Exercises increase the oxygen demand, and with poor airflow, breathlessness worsens. In asthma, eosinophils, neutrophils, lymphocytes, and plasma cells increase. Leukocytes in the blood trigger these immune mediators to release inflammatory mediators such as histamine. The activated T-lymphocytes also trigger interleukin IL-3, IL-4, and IL-5; interleukin 3 and 4 trigger the conversion of IgM to IgE responsible for the asthma presentations (Sinyor & Perez, 2021). IL increases eosinophils production and release. All these etiologies lead to asthma. Regardless of the etiology, asthma causes progressive damage to the lungs and airway, leading to changes in the lung and airway structures.

3. Identify at least three subjective findings from the case which support the chosen diagnosis.

The patient was diagnosed with bronchitis three weeks ago. Asthma follows a chronic airway inflammation and is often associated with chronic bronchitis. The patient reports that exercise exacerbates breathlessness and severely limits cardiac rehabilitation exercises. The patient is experiencing shortness of breath. The patient also experiences a dry cough in the AM. Asthma can cause bronchitis due to repeated damage to the epithelium and increased sensitivity to inflammation. However, chronic bronchitis can also lead to asthma. Airway obstruction causes hypoxia in the cells, and exercises increase oxygen demand. Cardio exercises coupled with narrowed airways worsen breathlessness. They may cause stridor, a high-pitched sound produced as individuals try to force air through the narrowed airways, a classical presentation in asthma (Hull et al., 2020). Constriction of the airway can irritate hence chronic dry cough. However, patients may produce phlegm due to the accumulation of secretions in the airway hence a productive cough

4. Identify at least three objective findings from the case which support the chosen diagnosis

The X-ray reveals a hyperinflated lung, common in asthma and other COPD. Ullmann et al. (2019) note that most imaging studies are normal in asthma, but chronic illness causes structural changes in the airways and alveoli, and hyperinflation can be visible. Auscultation of the lungs reveals bilateral wheezes noted with forced exhalation and a prolonged expiratory phase (increased respiratory effort coupled with fatigue from the subjective data indicate COPD such as asthma). The spirometry results indicate obstructive pulmonary disease with reductions in expiratory volumes (Sarkar et al., 2019). The respiratory rate is 22, above the normal respiratory rate to compensate for the obstructed airway movement

Management of the Disease

1. Classify the patient’s disease severity. Is this considered stable or unstable?

The patient has moderately persistent asthma (stage 3), where patients feel like they are in a continuous flare-up. The symptoms of breathlessness are persistent and only worsen with time. The condition can be considered stable asthma due to the lack of recent changes in asthmatic symptoms. Unstable or brittle asthma reverberates from severe to mild episodes and places the patient at risk for severe life-threatening episodes, thus requiring aggressive management.

2. Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.

There are various medications approved for asthma. The medication’s major focus is to dilate the airway and reduce inflammation. Medications can target the airway diameter change or inflammation to implement change. Different medications have different onsets of action hence their use in long-or short-term management. Inhaled short-acting beta2 agonists such as salbutamol and corticosteroids such as fluticasone are some first-line medications for asthma management according to GINA guidelines (Rajan et al., 2020). Other medications include leukotriene, which modifies that target inflammation mediators

3. Describe the mechanism of action for each of the medication classes identified above.

Salbutamol is an FDA-approved beta 2A receptor agonist used in asthma patients. It is often given to asthmatic patients during asthmatic attacks as a nasal spray. It activates beta-2 receptors relaxing the bronchial smooth muscles through depolarization through the uptake of potassium ions into the cells (Krings et al., 2019). Bronchial muscle relaxation causes dilatation hence relieve of obstruction caused by bronchoconstriction. The medication also stabilizes mast cells, which are vital in inflammatory mediation, and reduces the inflammation that follows asthma.

Fluticasone is an FDA-approved medication for asthma and other chronic obstructive pulmonary disease in individuals aged four years and above. It is a corticosteroid that inhibits inflammatory mediators such as mast cells, neutrophils, lymphocytes, and macrophages responsible for asthma presentations (Krings et al., 2019). The medication also inhibits the secretion of histamines, cytokines, and leukotrienes, hence managing allergic symptoms in asthma. The drug has a late onset of action and takes three days to reach therapeutic plasma levels; hence, it is used for long-term asthma management.

4. Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.

Asthma patient education is a priority in non-pharmacologic management. Nanda et al. (2020) note that allergen avoidance is an important management intervention for asthma, and patient education is thus paramount. Individuals who develop attacks after exposure to colds should keep warm and avoid other allergens to prevent asthmatic attacks. For example, athletes with asthma often practice intermittent work, exercises, and competitions to prevent asthma exacerbations (Williams et al., 2020). Individuals also take supplements such as vitamin c, omega three fatty acids, and probiotics (especially in pediatrics) which help increase immunity and prevent asthma exacerbations. Breathing exercises can prove useful in patients with limited cardiac rehabilitation training. GINA recommends that asthma patients practice breathing exercises that include diaphragmatic, nasal, and pursed lip breathing exercises as effective non-pharmacological management interventions (Reddel et al., 2022). They include lung volumes and help improve lung health, airway opening, and oxygen supply to the tissues

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References

Hull, J. H., Godbout, K., & Boulet, L. P. (2020). Exercise-associated dyspnea and stridor: thinking beyond asthma. The Journal of Allergy and Clinical Immunology: In Practice, 8(7), 2202-2208. https://doi.org/10.1016/j.jaip.2020.01.057

Nanda, A., Baptist, A. P., Divekar, R., Parikh, N., Seggev, J. S., Yusin, J. S., & Nyenhuis, S. M. (2020). Asthma in the older adult. Journal of Asthma, 57(3), 241-252. https://doi.org/10.1080/02770903.2019.1565828

Reddel, H. K., Bacharier, L. B., Bateman, E. D., Brightling, C. E., Brusselle, G. G., Buhl, R., & Boulet, L. P. (2022). Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. American Journal of Respiratory and Critical Care Medicine, 205(1), 17-35. https://doi.org/10.1016/j.arbres.2021.10.003

Sarkar, M., Bhardwaz, R., Madabhavi, I., & Modi, M. (2019). Physical signs in patients with chronic obstructive pulmonary disease. Lung India: Official Organ of Indian Chest Society, 36(1), 38. https://doi.org/10.4103/lungindia.lungindia_145_18

Sinyor, B., & Perez, L. C. (2021). Pathophysiology Of Asthma. In StatPearls [Internet]. StatPearls Publishing.

Ullmann, N., Mirra, V., Di Marco, A., Pavone, M., Porcaro, F., Negro, V., Onofri, A., & Cutrera, R. (2018). Asthma: differential diagnosis and comorbidities. Frontiers in Pediatrics, 6, 276. https://doi.org/10.3389/fped.2018.00276

Williams, N. C., Johnson, M. A., Adamic, E. M., & Mickleborough, T. D. (2020). Non-pharmacological management of asthma-related issues in athletes. Complete Guide to Respiratory Care in Athletes (pp. 86-98). Routledge. https://doi.org/10.4324/9780429492341-7

Purpose
The purpose of this assignment is to apply hypersensitivity pathophysiological concepts to explain assessment findings of a patient with respiratory disease. . Students will examine all aspects of the patient\’s assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
1. Examine the case scenario and analyze the spirometry results to determine the most likely respiratory diagnosis. (CO1)
2. Explain the pathophysiology of the respiratory disease. (CO1)
3. Differentiate between subjective and objective findings which support the chosen diagnosis. (CO4)
4. Apply evidence-based practice guidelines to classify the severity of the respiratory disorder and employ an appropriate treatment plan. (CO1, CO5)
Requirements:
Content Criteria:
1. Read the case study listed below.
2. Refer to the rubric for grading requirements.
3. Utilizing the Week 3 Case Study Template Links to an external site., provide your responses to the case study questions listed below.
4. You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.
5. You must use the current Clinical Practice Guideline (CPG) for the management and prevention of COPD (GOLD Criteria) to answer the classification of severity and treatment recommendation questions. The most current guideline may be found at the following web address: https://goldcopd.org/ Links to an external site.. At the website, locate the current year’s CPG and download a personal copy for use. You may also use a medication administration reference such as Epocrates to provide medication names.
6. Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.
Case Study Scenario
Chief Complaint
A.C., is a 61-year old male with complaints of shortness of breath.
History of Present Illness
A.C. was seen in the emergency room 1 week ago for an acute onset of mid-sternal chest pain. The event was preceded with complaints of fatigue and increasing dyspnea for 3 months, for which he did not seek care. He was evaluated by cardiology and underwent a successful and uneventful angioplasty prior to discharge. Despite the intervention, the shortness of breath has not improved. Since starting cardiac rehabilitation, he feels that his breathlessness is worse. The cardiologist has requested that you, his primary care provider, evaluate him for further work-up. Prior to today, his last visit with your practice was 3 years ago when he was seen for acute bronchitis and smoking cessation counseling.
Past Medical History 
• Hypertension 
• Hyperlipidemia 
• Atherosclerotic coronary artery disease
• Smoker
Family History
• Father deceased of acute coronary syndrome at age 65
• Mother deceased of breast cancer at age 58. 
• One sister, alive, who is a 5 year breast cancer survivor.
• One son and one daughter with no significant medical history. 
Social History
• 35 pack-year smoking history; he has cut down to one cigarette at bedtime following his cardiac intervention. 
• Denies alcohol or recreational drug use 
• Real estate agent  
Allergies
• No Known Drug Allergies 
Medications
• Rosuvastatin 20 mg once daily by mouth 
• Carvedilol 25 mg twice daily by mouth
• Hydrochlorothiazide 12.5 mg once daily by mouth
• Aspirin 81mg daily by mouth
Review of Systems
• Constitutional: Denies fever, chills or weight loss. + Fatigue.
• HEENT: Denies nasal congestion, rhinorrhea or sore throat.  
• Chest: + dyspnea with exertion. Denies productive cough or wheezing. + Dry, nonproductive cough in the AM.
• Heart: Denies chest pain, chest pressure or palpitations.
• Lymph: Denies lymph node swelling.
General Physical Exam  
• Constitutional: Alert and oriented male in no apparent distress.  
• Vital Signs: BP-120/84, T-97.9 F, P-62, RR-22, SaO2: 93% 
• Wt. 180 lbs., Ht. 5\’9\”
HEENT 
• Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva. 
• Ears: Tympanic membranes intact. 
• Nose: Bilateral nasal turbinates without redness or swelling. Nares patent. 
• Mouth: Oropharynx clear. No mouth lesions. Dentures well-fitting. Oral mucous membranes dry. 
Neck/Lymph Nodes 
• Neck supple without JVD. 
• No lymphadenopathy, masses or carotid bruits. 
Lungs 
• Bilateral breath sounds clear throughout lung fields. + Bilaterally wheezes noted with forced exhalation along with a prolonged expiratory phase. No intercostal retractions.
Heart 
• S1 and S2 regular rate and rhythm, no rubs or murmurs. 
Integumentary System 
• Skin cool, pale and dry. Nail beds pink without clubbing.  
Chest X-Ray 
• Lungs are hyper-inflated bilaterally with a flattened diaphragm. No effusions or infiltrates.
Spirometry

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Week 3 Template
Pathophysiology & Clinical Findings of the Disease
1. Are the spirometry results consistent with obstructive or restrictive pulmonary disease? What is the most likely pulmonary diagnosis for this patient?

 

2. Explain the pathophysiology associated with the chosen pulmonary disease.

 

 

3. Identify at least three subjective findings from the case which support the chosen diagnosis.

 

 

 

4. Identify at least three objective findings from the case which support the chosen diagnosis

 
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
1. Classify the patient’s disease severity. Is this considered stable or unstable?

 

 

 

2. Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.

 

 

 

3. Describe the mechanism of action for each of the medication classes identified above.

 

 

 

4. Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.

 

 

 

 
References

[Must be on a separate page and in APA format