Week 3 Case Study Template

Week 3 Case Study 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? The spirometry results are consistent with obstructive lung disease since the patient has forced expiratory volume in one second (FEV1) is reduced, as seen in obstructive pulmonary disease, and the normal range is >80% (Global Initiative for Chronic Obstructive Lung Disease, 2021). In addition, the patient's FEV1/FVC ratio is less than 70%, with a 69% pre-bronchodilator prediction and a 64% post-bronchodilator forecast. The TLC is 125, and the TLC range for the obstructive pulmonary disease is >120%, which is deemed normal. Chronic Obstructive Pulmonary Disease (COPD) is the most likely pulmonary diagnosis for this patient. The patient has been experiencing difficulties for nearly three months and attempts to alleviate some of his problems have been unsuccessful. In addition, the patient had a 35-pack-year smoking history. Dyspnea with exertion is a classic symptom of COPD, and his chest x-ray shows hyperinflated lungs with a flattened diaphragm. 2. Explain the pathophysiology associated with the chosen pulmonary disease. Shortness of breath is a sign of chronic obstructive pulmonary disease (COPD) when patients have trouble expelling all of the air from their lungs. COPD is an inflammatory condition that involves airway thickness, increased mucus production, and probable lung structural alterations (McCance et al., 2019). COPD affects the lungs by causing fibrosis of the tiny airways and a loss of elasticity due to the deconstruction of the lung parenchyma, including the air sacs. When the lungs' structure is deconstructed, it leads to airflow resistance, air trapping, hyperinflation, dyspnea, coughing, and additional mucus Week 3 Case Study Template production (McCance et al., 2019). COPD increases neutrophils, activated macrophages, and CD8 T lymphocytes when the lungs become inflamed (McCance et al., 2019). COPD is a group of small airway illnesses that includes obstructive bronchiolitis and emphysema. Patients' symptoms vary depending on their medical history, risk factors, and pollution exposure. Chronic inflammation leads to anatomical abnormalities in the airways, limiting airflow and producing mucociliary dysfunction. 3. Identify at least three subjective findings from the case which support the chosen diagnosis. The patient had a 35-pack-year smoking history, which is a subjective finding supporting COPD diagnosis. The patient complains of dyspnea with exertion, nonproductive dry cough, fatigue, and chest tightness/mid-sternal chest pain. With these subjective findings and a request for a second opinion from the cardiologist, the lungs would be the next system to be examined for pulmonary illness. 4. Identify at least three objective findings from the case which support the chosen diagnosis Bilateral wheeze with forceful exhalation and a protracted expiratory phase, hyperinflated lugs with a flattened diaphragm on the chest x-ray, and aberrant spirometry results of a normal FVC, decreased FEV1, a decreased FEV1/FVC, and an increased TLC implies an obstructive lung disease 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? Week 3 Case Study Template The patient's illness categorization can be rated as Gold 2- moderate. The patients' anticipated FEV1 is 64% pre-bronchodilator and 66% post-bronchodilator, respectively, which is <80% and >50% (Global Initiative for Chronic Obstructive Lung Disease, 2021). Based on his respiratory rate of 20-30 breaths per minute, no use of accessory muscles, and no changes in mental status, the patient is not in respiratory failure and is stable. This patient can be treated with bronchodilators, corticosteroids, and/or antibiotics in the outpatient context. 2. Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each. In COPD, pharmacologic therapy is used to relieve symptoms, prevent, or minimize the frequency of exacerbations, enhance exercise tolerance, and improve overall health. While various pharmacologic groups can be used, the choice will be based on medication availability, clinical response, and side effect balance. One medication class recommended would be a bronchodilator and anti-inflammatory agents (inhaled corticosteroids (ICS)). Bronchodilators are used to help patients with COPD increase their FEV1 and improve their spirometry results. Bronchodilators reduce the smooth muscle tone of the airway and increase expiratory flow by expanding the airways (Global Initiative for Chronic Obstructive Lung Disease, 2021). Examples of short-acting betaagonist (SABA) are albuterol and levalbuterol. One example of a long-acting beta two agonist bronchodilator is Salmeterol. When treating COPD patients, anti-inflammatory drugs (ICS) in combination with long-acting bronchodilator therapy are successful. Combining the two aids in increasing lung function, boosting health rankings, and Week 3 Case Study Template reducing exacerbation events (Global Initiative for Chronic Obstructive Lung Disease, 2021). Fluticasone propionate is an example of an anti-inflammatory (ICS). In addition, the healthcare professional can use anti-inflammatory medications, inhaled corticosteroids, methylxanthines, and mucolytic agents. 3. Describe the mechanism of action for each of the medication classes identified above. In contrast to long-acting beta-agonists, short-acting beta-agonists (SABAs) have the shortest half-life and fast symptomatic relief. The smooth muscle of the airway, uterus, colon and systemic vasculature are the most affected by SABAs. The activation of B adrenergic receptors, which relax the smooth muscle in the lungs and dilate the opening of the airways, is part of the mechanism of action. Beta-2 agonists have also been claimed to have anti-inflammatory actions in the smooth muscle via lowering intercellular adhesion molecules, reducing granulocyte-macrophage colony-stimulating factors, stabilizing mast cells, and preventing inflammatory pathways (Hsu et al., 2020). Salmeterol is a beta-2 agonist that helps bronchiolar smooth muscle relaxation, bronchodilation, and bronchiole airflow (Adams et al., 2021). Salmeterol suppresses mast cell mediators such as histamine, leukotrienes, and prostaglandins in human lungs, reducing inflammation. Salmeterol's principal effect is bronchodilation; its antiinflammatory properties are present to a lesser extent (Adams et al., 2021). A single inhaled dose of salmeterol lasts around 12 hours, compared to 4 to 6 hours for salbutamol, due to its unique molecular structure. Salmeterol, administered twice daily, is clinically superior to albuterol, given either regularly or sporadically as needed, in treating mild-to-moderate asthma, COPD. On the other hand, Fluticasone is a corticosteroid that has anti-inflammatory and vasoconstrictive properties. It can be taken Week 3 Case Study Template orally, nasally, or topically. The patient's diagnosis determines the administration route. Inhaled steroids enhance lung function and COPD symptoms modestly, but they do not affect the pace of lung function loss. Fluticasone reduces the number of inflammatory cells such as eosinophils, monocytes, mast cells, macrophages, and dendritic cells in the body. It also enhances beta-2 receptors on the airway's smooth muscle and reduces mucus formation (Bullone et al., 2017). 4. Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient. Smoking cessation is a non-pharmacological approach (Global Initiative for Chronic Obstructive Lung Disease, Inc., 2021). Because smoking is one of the primary causes of COPD, teaching the patient how to quit can help to reduce the chance of developing severe COPD. Making suggestions for smoking cessation will be beneficial to the patient. It is critical to assist patients with tools and other smoking cessation approaches to help them avoid COPD exacerbations. Pulmonary rehabilitation is another nonpharmacological therapeutic option that improves exercise tolerance, reduces dyspnea, and improves the overall quality of life (Global Initiative for Chronic Obstructive Lung Disease, Inc., 2021). Physical activity can also help reduce COPD symptoms. Therefore, teaching and encouraging patients to engage in some physical activity can reduce hospitalizations and exacerbations and enhance the quality of life.