Healthcare Case Study 2022

Running head: HEALTHCARE
Healthcare
Name of the Student
Name of University
Author’s note

1HEALTHCARE
Case Study
Answer 1
According to the study conducted by Rosenberg, Brunt and Rossman (2017), heart attack
or cardiac complication is one of the leading causes of mortality, morbidity and increased rate of
hospitalization among the older adults who are above 65 years of age. The vulnerability of
witnessing heart-attack of both men and women who are 80 years old is 20%. The age of Mrs
Brown is 78 years and she also has a past history heart attack, diagnosed 2 years ago. Her age
and her past medical history has accounted for her current clinical manifestations. Upon
admission to the emergency department, Mrs Brown showed severe dyspnoea. According to
Zhou, Zhang, Song, Li and Wang (2018) dyspnoea is a debilitating symptom that is defined as
shortness of breath or difficulty in breathing. The pathophysiology of dyspnoea mainly involves
a complex interplay of both peripheral and central receptor and cognition. Breathing is an
involuntary process that helps the central nervous system from getting flooded with irrelevant yet
constant sensory impulses. However, when the oxygen saturation in the body falls below the
normal level (95%) the process of breathing becomes voluntary as central nervous system make
conscious effort (gate-in) to conduct the breathing process with the help of the bi-lateral muscles
of the lungs (Rogers & Bush, 2015). This results in the generation of shortness of breath or
severe dyspnea. The oxygen saturation of Mrs. Brown is 85% and thus indicating the chances of
severe dyspnea. As the oxygen saturation (amount of dissolved in the hemoglobin) decreases
below the normal range, the heart increases the effort to pump more oxygen (oxygenated blood)
to peripheral regions of the body. This increases the systolic blood pressure (the upper blood
pressure). The systolic blood pressure is defined as the pressure executed by the arteries by

2HEALTHCARE
squeezing and pumping the blood. In case of Mrs. Brown, the blood pressure was 170/95 mm Hg
thus indicating she has higher systolic pressure (normal range: 120/80 mm Hg). The increase in
the systolic blood pressure further increases the pulse rate of Mrs Brown, 120 beats/ minute
(normal up to 100 beats per minute). The fall in the oxygen saturation and increased blood
pressure leads to lack of aeration during expiration. This leads to “popping open” of the small
airways. This popped open alveolus is filled by fluid resulting in collapsing of the alveoli and
formation of bi-basal crackles. The increase in the bi-basal crackles leads to poor inhalation of
oxygen from the atmosphere by the lungs and at the same time decreases the oxygen saturation
of the body further (Rogers & Bush, 2015). In order words, it can be said that, bi-basal crackles
or wheezes is known as adventitious lung sound. These are regarded as additional respiratory
sounds that are super-imposed over the normal breath sounds. Crackles to be specified is
discontinuous sound that is attributed to the passage of air through accumulated secretions. These
secretions block the opening and closing of the airways leading to blockage in the free
transportation of oxygen within the blood (Sarkar, Madabhavi, Niranjan &Dogra, 2015).Under
this condition, the overall cardiac output increases and hence Mrs. Brown’s systolic blood
pressure is high, it resulted in the formation of chronic systolic heart failure. Moreover, the ECG
report of Mrs. Brown had shown a valid evidence of atrial fibrillation. Atrial fibrillation is
defined as abnormal rhythm of the heart. It happens when the electrical impulses of the heart
triggers rom different places in the atria that is the top chambers of the heart. These atrial
fibrillations can be sited as another cause behind the clinical manifestations of the chronic
systolic heart failure (Kirchhof et al., 2016).