Pathophysiology of COPD and its Relationship with Clinical Condition: A Case Study

This case study explores the pathophysiology of Chronic Obstructive Pulmonary Disease (COPD) and its relationship with the clinical condition of a patient. It discusses the symptoms, assessment findings, and the underlying physiological mechanism of COPD. The study also examines the comorbidity of COPD with other health conditions such as asthma, diabetes, and ischemic heart disease. The findings highlight the importance of understanding the pathophysiology of COPD for effective management and early interventions.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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This case study is based on Mr. Brown who was presented to the emergency unit of
the hospital with respiratory failure arising out of Chronic Obstructive Pulmonary Disease
(COPD). The essay will begin by giving a brief overview of the pathological condition of Mr.
Brown including his past medical history along with a brief description of his symptoms and
the subsequent representation of the assessment findings. The underlying physiological
mechanism of the cardiopulmonary system will be illustrated along with a brief definition of
COPD. This will be followed by a detailed discussion of the pathophysiology of the COPD
including the principal issues and pathophysiology specific to Mr. Brown’s physiological
state of health. In the following discussion, the essay will try to inter-relate the underlying
pathophysiology of the symptoms, assessment findings and the current clinical condition of
Mr. Brown and will relate with the pathophysiology of COPD. In the conclusion there will be
a compilation of all the significant points raised in the essay and no new information will be
stated.
In this case study, a 65 years old man will be referred as Mr. Brown, it is his pseudo
name. Pseudo name is used in order to keep his identity confidential as her the nursing ethics
and hospital guidelines (Anderson et al. 2015). He was admitted to the emergency unit to the
hospital two days after suffering from ischemic heart disease (IHD). After initial assessment
in the emergency unit, he was shifted to the intensive care unit (ICU). He also has a history of
type 2 diabetes mellitus (T2DM), obesity, bronchial asthma, high blood pressure
(hypertension), high level of blood cholesterol (hypercholesterolemia), chronic renal failure
and severe obstructive sleep apnoea. She was presented to the emergency unit of the hospital
with breathless, persistent cough in the chest as evident from his cough sound along with
wheezing in breath. He was using his accessory muscles to breath. He also had informed the
sensation of pain upon inspiration with swollen ankles highlighting fluid build up. The poster
anterior and lateral chest x-ray revealed that presence of thick phlegm in both the side of the

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lungs with pulmonary oedema and bilateral pleural effusions. The chest X-ray results also
revealed Emphysema, an abnormal enlargement of the airspaces present distal to the
respiratory bronchioles and mainly results from the destruction of the septal walls of the
pulmonary cavity (Milne and King 2014). All full set of observation were studied and
recorded followed by an echocardiogram (ECG) test. He was placed on a continuous cardiac
and SPo2 monitoring and his arterial blood gas was obtained. His SpO2 was found low,
recording in between 88 to 90% along with acidic value in the arterial blood gas. Pathological
report was also collected in the parameters like complete blood count, electrolyte balance of
the body and complete renal function test. Since he was suffering from renal problems he was
fitted with indwelling urinary catheter and was placed in loop diuretic. In the loop diuretic,
furosemide (frusemide). Furosemide binds reversibly with the carrier protein Na+/2Cl-/K+
and thus promotes reducing or abolishing NaCl re-absorption in the ascending limb of the
loop of Henle. This in turn decreases the interstitial hypertonicity and thereby reducing water
reabsorption (Duffy et al. 2015). He was also given external supply of oxygen in order to
reducing his high respiratory rate and poor level of oxygen saturation. The external oxygen
supply was given through nasal canula (Frat et al. 2015). Mr. Brown as given intravenous
injection of analgesic in the form of morphine in order to decrease his respiratory effort and
high cardiac output and at the same time reduce the sensation pain during inspiration.
Sivaraman and Yellon (2014) reported that Morphine or opoids have limited direct negative
effects on the overall cardiac contractility. However, opoid administration is associated with
reduced cardiac function when it is administered with additional medication like
benzodiazepines. Opoids caused bradycardia along with bronchila vasodilation and thereby
helping to reduce blood pressure, chest pain, cardiac output and severity of bronchial asthma.
It was observed that Mr. Brown was suffering from fatigue and nausea as he was becoming
drowsy. This might be due to his poor level of oxygen saturation within the b ody along with

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decreased lung compliance and increased respiratory effort as highlighted in the results of the
chest X-ray (Morrow et al. 2016). In order to ensure effective transport of oxygen
throughout the body, he has positioned in semi-fowler’s position, with his head making an
angle of 45 to 60 degrees from the waist line while he was on non-invasive ventilation in the
form of Bipap in order to assist him in breathing and to cure his chest infection arising from
COPD (Morrow et al. 2016).
On the second day of Mr. Brown’s admission in the ICU, he was asked to undertake
Percutaneous Coronary Intervention in order to check the condition of his coronary arteries
and the extent of cholesterol build up within the arteries. Freitas Lima et al. (2015) reported
that older adults who are above 65 years of age and are suffering from unmanaged T2DM
along with hypercholesterolemia are found to suffer from arthrosclerosis. In order to diagnose
the severity of arthrosclerosis, Percutaneous Coronary Intervention (PCI) is recommended. It
is formerly known as angioplasty and is a non-surgical procedure that employs catheter for
placing a small structure called a stent for opening up the blood vessels in the heart that is
narrowed down due to deposition of plaque, a condition popularly known as atherosclerosis.
Since Mr. Brown has unmanaged T2DM along with hypercholesterolemia and has
encountered IHD two days before hospital admission, PCI was recommended by the doctors
in the ICU. While conducting the test, Mr. Brown report pain in chest along with breathless.
His pulse oxymetry reported increases heart rate and respiratory rate. Mr. Brown immediately
went to respiratory arrest followed by stroke. Being a junior nurse who has initiated her work
in the ICU unit, I was completely clueless in handling such fatal situation. My care plan and
identification of the clinical priority of the patients was conducted solely conducted under the
clinical guidance of senior nurses in the ICU. Thus, I think this is an excellent chance to
reflect and do some research in COPD and IHD associated with COPD so that I can use my
own knowledge going further while handling similar situation in coming future.

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From the presentation of Mr. Brown, it can be said that there are numerous
pathological process associated with his psychological condition. The primary health
condition of Mr. Brown is arising out of COPD. According to National Health Service (NHS)
(2019), Chronic Obstructive Pulmonary Disease (COPD) is a name given to a group of
different kind of lung conditions that lead to the generation of breathing problems like
chronic bronchitis (long-term inflammation in the pulmonary airways) and emphysema
(damage in the air sacs of the pulmonary cavities). Condition of COPD mainly affects the
middle-aged older adults or older adults who have a history of tobacco smoking. Mr. Brown
was an older adult with and was smoking for the last 30 years. In COP, the breathing
problems gradually become worse during the course of time and thus creating a barrier in the
execution of the activities of daily living (ADL). However, proper management of the
lifestyle condition (smoking, drinking and body weight) along with medication management
helps to reduce the severity of the disease. Apart from poor lifestyle condition, the severity of
COPD in Mr Brown has increased as a result of bronchial asthma. Papaiwannou et al. (2014)
reported that there is an inherent relationship between asthma and COPD. Asthma is a
chronic inflammatory condition that affects that pulmonary airways. It caused recurrent
episodes of wheezing, hyperresponsiveness, tightness of chest at night and labored breathing.
Mr. Brown was also showing labored breathing as highlighted from his used of accessory
muscles in the process of breathing. The inflammation in the airways leads to chronic
bronchitis and emphysema leading to the development of COPD during the later stages of
life. In asthma there us n heightened inflammatory response like infiltration of neutrophills,
cytokines, lymphocytes and monocytes in the pulmonary cavities and this heightened
inflammatory response increase the vulnerability of developing COPD by increasing the
secretion of chemotactic factor (Papaiwannou et al. 2014). Mr. Brown also has unmanaged
diabetes mellitus for a prolong period of time and this might the reason behind this increased

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severity of COPD. Ho et al. (2017) reported that pre-existing case of T2DM among the older
adults lead to worst outcome of COPD. The formation of IHD for Mr. Brown is also
associated with COPD. Campo et al. (2015) stated that IHD and COPD is mutually
influenced. The pathological conditions like hypoxia, systematic inflammation, dysfunction
of the endothelial cells, heightened action of the platelet reactivity arising out of
inflammation increase the development of COPD-IHD comorbidity. Moreover, the presence
of high level of blood cholesterol and arthrosclerosis leads to the generation of arterial
stiffness and modification in the right ventricle and thus increasing the vulnerability of
developing IHD and other associated cardiovascular adverse events (Campo et al. 2015).
Puhan et al. (2016) reported that in COPD there occurs damage in the alveoli or the
air sacs (emphysema). This damage leads to the disruption of the walls inside the alveoli and
thus increasing the size of the sacs. The large alveoli sacs absorb more oxygen leading to
depletion of dissolved oxygen in the blood haemoglobin. Decreasing the oxygen saturation in
the blood leads to the development of poor SpO2 (McCarthy et al. 2015). Moreover, damage
of alveoli in COPD causes enlargement of the lungs and thereby reducing its elasticity of
subsequent contraction and relaxation. The pulmonary airways become flabby and the air the
trapped inside the pulmonary cavity leading to tightness in chest, laboured breathing and
shortness in breath. Shortness of breath in COPD occurs due to chronic bronchitis. In chronic
bronchitis, the bronchial tubes become devoid of cilia. The role of the cilia (tiny hair like
projections in bronchial tubes) is to move the mucous from the tube by coughing out. But in
the absence of cilia, the cough or the phlegm is stored in the pulmonary cavities leading
laboured breathing and shortness in breath. Smoking also leads to deposition of tar in
between cilia, reducing its dextrousness and hampering its normal function (Puhan et al.
2016). The main purpose of breathing is effective exchange of gas. However, during COPD
normal breathing is hampered leading to the generation of acidic nature of arterial blood gas

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(high partial pressure of CO2 and low SpO2). As discussed earlier gas exchange occurs in the
alveoli of the lungs and the fluid in the lungs is regulated by hydrostatic and
osmotic/capillary pressure balance. Increase in the volume and pressure of the ventricles
during COPD, leads to backward flow of pulmonary venous system. This increases osmotic
pressure causing transudation of fluid into the interstitial spaces. Fluid is then accumulated in
the alveoli and causing few alveoli to collapse and other to compressed, hampering the flow
of oxygen and blood (Lange et al. 2015). The fluid build up in case of Mr Brown is also
reported in ankles and might be coursing due to peripheral neuropathy and renal failure,
exacerbation of unmanaged diabetes. If the hypoxic condition along with increased venous
pressure in the alveoli of the lungs is kept untreated, the microvascular pressure increasing
leading to rapid transudation of low protein fluid inside the lungs. The process leads to the
development of progressive deterioration of effective exchange of alveolar gas and
subsequent development of respiratory failure followed by heart failure as in case of Mr.
Brown (McCarthy et al. 2015).
Thus from the above discussion, it can be concluded that proper understanding of the
pathophysiology and the ways in which it relate with the clinical condition of the patient
helps to ascertain what is happening inside the might, why it is happening and what might
happen in the near future. This knowledge of the pathophysiology helps in proper
management of the disease condition by proper identification of the disease priority and
implementation of the early interventions. In case of Mr. Brown his COPD was an outcome
of prolong asthma, unmanaged diabetes and unhealthy lifestyle habits like smoking and
obesity.

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