Week 3 Shortness of breath discusion Essay

Week 3 Shortness of breath discusion Essay

Week 3 Shortness of breath discusion Essay

Shortness of Breath
Are the spirometry results consistent with obstructive or restrictive pulmonary disease? What is the most likely pulmonary diagnosis for this patient?
The spirometry results correspond with chronic obstructive pulmonary disease (COPD). The client’s spirometry data support a diagnosis of COPD. Pre-bronchodilator FEV1/FVC is below 70%, and FEV1 is below standard at 64%. After using a bronchodilator, the client’s FEV1/FVC predicted ratio decreased from 69% to 64%. The individual has air entrapment, which is consistent with COPD, according to the TLC prediction value of 125%. 80% to 120% TLC is acceptable (McCance & Huether, 2019). It is also worth noting that patients’ forced vital capacity (FVC) before and after bronchodilator administration does not change considerably. Clinically, a COPD diagnosis is supported by the patient’s smoking history, the presence of chronic symptoms for more than three months, and a background of acute bronchitis.

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Explain the pathophysiology associated with the chosen pulmonary disease.
Chronic bronchitis and emphysema make up COPD. Its symptoms include bronchial hyperinflation, mucus secretion, dyspnea, coughing, and wheezing. Chronic irritation of the respiratory tract is a hallmark of COPD. Inhalants like cigarette smoke might aggravate the condition (McCance & Huether, 2019). A cascade of inflammatory cells, including neutrophils, macrophages, and lymphocytes, are sent to the airways in response to any airway discomfort (McCance & Huether, 2019). Histamine, prostaglandins, leukotrienes, and interleukins are only some of the inflammatory mediators released by activated cells as part of the body’s defense mechanisms (McCance & Huether, 2019). There is oversecretion of mucus and contraction of the smooth muscles in the bronchi.
COPD develops due to prolonged exposure to airway irritants, resulting in airway remodeling. Mucus hypersecretion from goblet cells in the bronchioles’ inner layer, a shift to less efficient epithelial cells, and persistent inflammation are all hallmarks of chronic bronchitis. Elasticity is lost, and the alveolar septa are destroyed in emphysema (McCance & Huether, 2019). Airway fibrosis, thickening, and constriction develop gradually (McCance & Huether, 2019). Both types of COPD are characterized by structural abnormalities that result in air entrapment and hyperinflation of the alveolar (McCance & Huether, 2019). Dyspnea and slowed breathing are the results of trapped air in the airway. Patients also suffer from hypoxia because of airway obstruction.
Identify at least three subjective findings from the case which support the chosen diagnosis.
a. Dyspnea on exertion
b. A history of smoking
c. A dry, nonproductive cough in the AM
Identify at least three objective findings from the case which support the chosen diagnosis.
a. Bilateral wheezes on forced exhalation with extended expiratory phase
b. Spirometry results congruent with COPD
c. Chest x-ray imaging shows a flattened diaphragm with hyperinflated lungs
Management of the Disease
Classify the patient’s disease severity. Is this considered stable or unstable?
The patient has mild (default) COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Criteria is utilized to categorize the severity of COPD. Patients with mild (default) COPD, as defined by the GOLD 2023 standards, have symptoms of dyspnea on exertion, a respiratory rate of fewer than 24 breaths per minute, and a resting oxygen saturation of more than 92%. This is a stable COPD.
Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
Inhaled long-acting bronchodilators, such as long-acting beta2 agonists (LABA), and inhaled corticosteroids are the two “Evidence A” drug classes suggested by GOLD. GOLD recommends oladaterol and vilanterol as two LABAs to treat COPD (GOLD, 2023). The inhaled corticosteroids budesonide and fluticasone propionate are two examples recommended (GOLD, 2023). GOLD reports that combining inhaled corticosteroids and bronchodilators is superior to monotherapy in avoiding and treating COPD exacerbations (GOLD, 2023).
Describe the mechanism of action for each of the medication classes identified above.
LABA drugs include olandaterol and vilanterol. The medications are effective because they simulate naturally occurring catecholamines in the human body, including adrenaline, norepinephrine, and dopamine (Hsu & Bajaj, 2021). All these medications target adrenergic receptors by binding them (Hsu & Bajaj, 2021). When they attach to the receptor, they trigger a series of reactions. The intracellular concentration of cAMP is raised via a transmembrane signal that includes heterotrimeric G protein and the effector adenylyl cyclase (Hsu & Bajaj, 2021). Protein kinase A (PKA) is activated in response to increased cAMP (Hsu & Bajaj, 2021). In smooth muscle, PKA phosphorylates Gq-coupled receptors to lower intracellular Ca2+ levels or decrease the receptors’ sensitivity to Ca2+ (Hsu & Bajaj, 2021). As a result, the effects of myosin on contracting airway smooth muscles are dampened by the low Ca2+ level.
Budesonide and fluticasone propionate are two examples of inhaled corticosteroids. They function by attaching to glucocorticoid receptors in the cytoplasm of bronchial cells (Ye et al., 2019). Then, the steroid receptor complex moves to the nucleus, where it attaches to glucocorticoid-response components in the steroid-sensitive genes promoter regions (Ye et al., 2019). As steroid-sensitive genes could code for anti-inflammatory molecules, this would reduce the expression of pro-inflammatory genes that have been activated (Ye et al., 2019). An uptick in anti-inflammatory gene transcription is also observed. Anti-inflammatory and anti-hyperresponsivity effects are seen.
Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.
Pulmonary rehabilitation is helpful in individuals with COPD. Pulmonary rehabilitation alleviates symptoms like fatigue, weakness, and difficulty breathing (GOLD, 2023). Oxygen therapy is another “Evidence A” non-pharmaceutical treatment option. Long-term oxygen therapy benefits individuals with chronic severe resting arterial hypoxemia (GOLD, 2023).

References
Bollmeier, G., & Hartmann, P. (2020). Management of chronic obstructive pulmonary disease: A review focusing on exacerbations. American Journal of Health-System Pharmacy, 77(4), 259–268. https://doi.org/10.1093/ajhp/zxz306
Global Initiative for Chronic Obstructive Lung Disease. (2023). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Accessed 20th March 2023 from https://goldcopd.org/wp-content/uploads/2023/03/GOLD-2023-ver-1.3-17Feb2023_WMV.pdf
Global Initiative for Chronic Obstructive Lung Disease. (2022). GOLD spirometry guide. Accessed 20th March 2023 from https://goldcopd.org/wp-content/uploads/2016/04/GOLD_Spirometry_2010.pdf
Hsu, E., & Bajaj., T. (2021). Beta 2 agonist. StatPearls publishing. https://www.ncbi.nlm.nih.gov/books/NBK542249/
McCance, L. & Huether, E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier Health Sciences.
Ye, Q., He, O., & D’Urzo, A. (2019). A review on the safety and efficacy of inhaled corticosteroids in the management of asthma. Pulmonary Therapy, 3(1), 1–18. https://doi.org/10.1007/s41030-017-0043-5

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Read the case study listed below.

Refer to the rubric for grading requirements.

Utilizing the Week 3 Case Study TemplateLinks to an external site., provide your responses to the case study questions listed below.

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.

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.

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

Title Predicted Pre-bronchodilator % Predicted Post-bronchodilator % Predicted Change

FVC (L)

5.64

5.23

93

5.77

102

9%

FEV1 (L)

4.57

2.92

64

3.01

66

2%

FEV1/FVC (%)

81

56

69

52

64

-5%

TLC

5.5

6.9
125

125

0%

Case Study Questions

Pathophysiology & Clinical Findings of the Disease

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

Explain the pathophysiology associated with the chosen pulmonary disease.

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

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

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

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

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

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ASSIGNMENT CONTENT
Category Points % Description
Pathophysiology & Clinical Findings of the Disease 45 45%

The student:

Identifies the correct hypersensitivity reaction.

Explains the pathophysiology associated with the chosen hypersensitivity reaction.

Supports the pathophysiology statement with at least one appropriate, scholarly reference (textbook is acceptable for pathophysiology statements only).

Identifies at least three subjective findings from the case.

Identifies at least three objective findings from the case.

(5 Required Elements)

Management of the Disease 45 45%

The student:

Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations.

Identifies two strongly recommended medication classes for the treatment of the condition and provides an example (drug name) for each.

Describes the mechanism of action for each of the medications identified.

Identifies two treatment options that are NOT recommended (I.e.,recommended against).

90 90% Total CONTENT Points = 90 pts

ASSIGNMENT FORMAT
Category Points % Description
Organization, spelling, grammar & APA format 10 10%

The student:

Uses the week 1 case study template for case study responses.Provides correct in-text citations for responses which match the reference page.

Has minimal spelling, grammar & APA format errors.10 10% Total FORMAT Points = 10 pts
100 100% ASSIGNMENT TOTAL = 100 points

Rubric

Week 3 Respiratory Case Study

Week 3 Respiratory Case Study

Criteria Ratings Pts
This criterion is linked to a Learning OutcomePathophysiology & Clinical Findings of the Disease

The student:

– Identifies the correct spirometry pattern and likely diagnosis.

– Explains the pathophysiology associated with the chosen disorder.

– Supports the pathophysiology statement with at least one appropriate, scholarly reference (textbook is acceptable for pathophysiology statements only).

– Identifies at least three subjective findings from the case.

– Identifies at least three objective findings from the case.

(5 Required Elements)

45 pts

All 5 required elements are present.41 pts

1 required element is missing.23 pts

3-4 required elements are missing.

0 pts

All 5 required elements are missing.
45 pts
This criterion is linked to a Learning OutcomeManagement of the Disease

The student:

– Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations.

– Correctly classifies the disease severity and states whether or not the disease is stable or unstable.

– Identifies two (2) “Evidence A” recommended medication classes for the treatment of the condition and provides an example (drug name) for each.

– Identifies two (2) “Evidence A” recommended non-pharmacological treatment options for the condition.

(4 Required Elements)

45 pts
All 4 elements are present

41 pts
1 required element is missing

37 pts
2 required elements are missing

23 pts
3 required elements are missing

0 pts

All 4 required elements are missing

45 pts

This criterion is linked to a Learning OutcomeOrganization, spelling, grammar & APA format

The student:

Uses the week 3 case study template for case study responses.

Provides correct in-text citations for responses which match the reference page.

Has minimal spelling, grammar & APA format errors.

10 pts
Case study template is used for responses AND In-text citations are correct which match the reference page AND There are 0-2 errors in spelling, grammar or APA format.

9 pts
Case study template is used for responses AND In-text citations are correct which match the reference page AND There are 3-5 errors in spelling, grammar or APA format.

8 pts
Case study template is used for responses AND In-text citations are correct which match the reference page AND There are 6-8 errors in spelling, grammar or APA format.

5 pts
Case study template is not used for responses OR In-text citations are incorrect or do not match the reference page AND There are 0-5 errors in spelling, grammar or APA format.

0 pts
Case study template is not used for responses AND/OR In-text citations are incorrect or do not match the reference page AND There are 6 or more errors in spelling, grammar or APA format.

10 pts

This criterion is linked to a Learning OutcomeLate penalty deductions
Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment. Quizzes and discussions are not considered assignments and are not part of the late assignment policy.0 pts

Manual Deductions0 pts

Manual Deductions 0 pts

Total Points: 100

Please follow the instruction thoroughly