Patients with chronic Health Condition

Running head: NURSING
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1NURSING
Patients with chronic health condition present with many health related
complications during their life span. To promote optimal health and quality of life of such
patient, examining pathophysiology behind the condition and implementing proper
disease management strategy is important This essay will look into the case study of
Gladys, a 76 year old woman who is suffering from the chronic disease of Chronic
Obstructive Pulmonary Disease (COPD) and presenting health issue of right sided heart
failure. The essay will look into the pathophysiology, symptoms, anatomy and
physiology linked to the chronic health condition and the presenting health issue. The
essay will outline relevant diagnostic tests for the patient’s condition and identify two
potential problems linked to the disease. The essay will also discuss about
development, cultural and health literacy consideration for the care of Gladys and
discuss three priorities for the nursing management of the patient.
The case scenario is about Gladys, who attended the GP clinic with complaints
of increased breathlessness, wheeziness and swollen leg. Her symptoms are similar to
the symptoms of COPD. COPD is a severe lung disease associated with airflow
limitation and interference in normal breathing pattern of patient. Common symptoms
found in patient include chest tightness, shortness of breath, wheeziness and chronic
cough (State of Victoria, 2020). Some patient with COPD may have swelling in the
ankles or leg which occurs due to pulmonary hypertension. Swelling of the leg was one
of the symptoms for Gladys too. The main organ affected in this disease is the lungs
and it mainly affects the smaller airways in the lung such as the bronchi and alveolar
walls. Two important phenomenon involved in the pathophysiology of COPD includes
chronic bronchitis and emphysema. Emphysema is a condition that is associated with
permanent enlargement of the respiratory space and damage of the airway walls.
People with emphysema are found have damaged alveoli and bronchi. Accoridng to
Berg and Wright (2016), exposure to noxious particles and gases contribute to the
pathological changes of COPD. It results in inflammation of the lungs which is
associated with increase in number of neutrophils and eosinophils and progressive
airflow limitation. Other pathological change that takes place following lung inflammation
includes mucous hypersecretion, pulmonary hyperinflation, ciliary dysfunction and gas

2NURSING
exchange abnormalities (Kim, 2017; Berg & Wright, 2016). Hence, several mechanisms
appear to play a role in the pathogenesis of COPD.
Another presenting condition found for Gladys was right sided heart failure and
she was found to be worried about it. Right sided heart failure is a pulmonary heart
disease which occurs due to the failure of the right ventricle to pump blood properly.
Common symptoms found in patient include distended abdomen, weight gain and cold
and sweaty skins. Many conditions like diabetes, lung disease, congenital heart defects
and hypertension increase risk of congestive heart failure. In case of Gladys, her
presenting condition of right sided failure is due to COPD. According to de Miguel Díez,
Chancafe Morgan and Jiménez García (2013), COPD and congestive heart failure often
exists together because of shared risk factors such as cigarette smoking, advancing
age and systemic inflammation. The risk of heart disease increases for COPD patient
because of severe airflow obstruction and high concentration of circulating C-reactive
protein (CRP). CRP is an inflammatory marker of cardiac risk and the concentration of
CRP changes with changes in vascular structure function in COPD patients (Konstam et
al., 2018). Pulmonary hypertension (PH) is a cause behind right sided heart failure too.
It occurs when the oxygen level decreases and pulmonary hypertension occurs. PH
increases right ventricular load leading to right sided heart failure and inability to adapt
to peripheral demand during exercise. It is seen in 5-10% of patient with advanced
COPD. During exercise and movement, pulmonary hypertension worsens (Zangiabadi,
De Pasquale & Sajkov, 2014). For this reason, Gladys might be having difficulty during
mobilization.
Gladys was suffering from the chronic condition of COPD. Some of the
diagnostic test that helps to detect or diagnose COPD includes spirometry test,
pulmonary function test, FEV1/FVC ratio and vital capacity. Spirometry is a breathing
test that measures lung function of an individual. Spirometry test is important for those
patients who have symptoms of dyspnoea, chronic cough and sputum production (State
of Victoria, 2020). Other test includes chest x-ray and CT scan, which can help to detect
the extent of emphysema in the lungs. Medical history and physical examination of
patient is also done to diagnose COPD. Arterial blood gas analysis result can help to