Chronic Illness Across the Life Span: A Detailed Case Study Analysis

This report presents a detailed case study of a 76-year-old female patient presenting with shortness of breath, swollen legs, and difficulties with mobilization, ultimately diagnosed with chronic obstructive pulmonary disease (COPD) and right-sided heart failure. The analysis delves into the pathophysiology of the conditions, including the impact of COPD on pulmonary hypertension and subsequent right-sided heart failure. It explores relevant diagnostic procedures such as spirometry, chest X-rays, echocardiograms, and blood gas tests. Potential complications like respiratory infections and depression are also addressed. Furthermore, the report considers developmental, cultural, and health literacy factors, emphasizing the importance of Erikson's psychosocial development theory and appropriate patient education. Nursing management priorities are identified as addressing shortness of breath, managing swollen feet, and alleviating anxiety through interventions such as bronchodilators, compression stockings, and cognitive behavioral therapy. The report concludes by highlighting the significance of health literacy in improving patient outcomes.

Running head: CHRONIC ILLNESS ACROSS THE LIFE SPAN
Name of the student:
Name of the university:
Author note:

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Part a:
Introduction:
Heart failure along with chronic obstructive pulmonary disease has emerged as a global
epidemics, affecting more than 10 million patients each year worldwide. Both conditions
contributed to significant mortality rate and present major difficulties to healthcare providers. In
2016, a prevalence of 251 million cases of chronic obstructive pulmonary disease reported
globally. More than half a million Australian are estimated to experience moderate to severe
COPD, accounting for approximately 4.8% of the total Australian population aged 45 years
(Www.aihw.gov.au., 2020). The majority of the population with COPD usually experience right-
sided heart failure due to the typical feature of cardiac dysfunction. The common symptoms of
COPD and heart failure include nocturnal cough, shortness of breath and ankle edema. The case
study involves a 76 years old female, Gladys presented at GP clinical with increased shortness of
breath, swollen leg and difficulties with mobilization. This essay aims to provide chronic disease
and presenting condition, pathophysiology, relevant diagnosis, ongoing, potential complication
literacy consideration and major nursing priority for management in the following paragraphs.
Discussion:
Chronic disease and the presenting condition:
The case study highlighted that a 76 years old female, Gladys presented at GP clinical
with increased shortness of breath, swollen leg and difficulties with mobilization. In this context,
considering the clinical manifestations, the chronic condition is a chronic obstructive pulmonary
disease where hallmark sign is shortness of breath. Since the lungs of the patient affected due to
COPD, it has a direct impact on the right-sided heart failure. Tuttle et al. (2016), suggested that

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possible reason can be abnormally oxygen inside the vessels of lungs due to COPD induces
pulmonary hypertension followed by excessive stress on the right ventricle of heart which
resulted in clinical manifestations of the patient.
Pathophysiology:
Gautam and O'Toole (2016), highlighted that pathophysiology of COPD is associated
with adverse changes associated with the disease and it starts with damages to the airways and
air sacs in the lungs. Due to the presence of risk factors such as smoking cigarette, industrial
chemicals, cooking fumes or heavy air pollutants and genetic factors, the airways and lining of
lungs become damaged and inflamed (Wang, Ni & Liu, 2016). The inflamed airways become
narrowed down the passage for moving enough air and resulted in shortness of breath.
Inadequate oxygen inside the vessels of lungs due to COPD induces pulmonary hypertension as
the blood pressure rapidly increased in the arteries of the lungs. Pulmonary hypertension causes
excessive stress on the right ventricle of the heart as it works to pump blood through the lungs.
Consequently, heart muscles weaken which give rise to right-sided heart failure (Ko et al., 2016).
Wheezing exhibited by the patient due to obstructed air passages in the lungs covered with
excess mucus and it emerged as musical sounds. The swollen leg is a clinical manifestation of
COPD associated right heart failure where due to pulmonary hypertension, fluid blocked in the
veins throughout the body and leaks into sounding tissue. Due to the effects of gravity, fluid
starts to accumulate in the lower parts of the body and the patient experience swollen feet.
Diagnosis of the condition:
The relevant diagnosis for the COPD is to assess the lung functioning of the patient by
using spirometer which measures the deep breathing and how fast air can move into and out of
the lungs. Chest x-ray and computerized tomography (CT) are also relevant diagnoses for

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assessing the lungs (Heuvelmans et al., 2019). On the other hand, echocardiogram and
Electrocardiogram can provide heart failure by the ability of the heart to pump the blood.
Moreover, Arterial blood gas test is used for the acidity and levels of the acidity, levels of
oxygen and carbon dioxide in the blood from the artery which will provide an idea of the ability
of the lungs to move oxygen into the blood and remove carbon dioxide. Pulmonary arterial
hypertension abnormality provides the idea of the narrowed lungs since the blood in the arteries
goes from heart to lungs (Yang et al., 2017). The laboratory tests for B-type natriuretic peptide
will provide an idea of the right-sided heart failure as B-type natriuretic peptide released when
heart unable to pump the blood (Tromp et al. 2018).
Potential complications associated with chronic disease:
The two potential complications associated with chronic obstructive pulmonary disease
include respiratory infection and depression. The patients with chronic obstructive pulmonary
disease usually catch a cold and flu along with pneumonia make it more difficult to breathe and
causes further damage to the lung tissues followed by difficulties in breathing. The patients
usually experience respiratory failure if left untreated (Numata et al., 2018). An annual flu
vaccination against pneumonia can prevent the infection. On the other hand, depression and
anxiety are common amongst patients with COPD as the inability to mobilize hinder daily
activity and resulted in social exclusion as observed in this case (Rasouli et al. 2016). The
patient lives alone and difficulties in mobilizing due to swelling feet and shortness of breathing
which resulted in anxiety.
Developmental, cultural and health literacy:
The case study highlighted that patient is suffering from COPD associated right-sided
heart failure and she was unaware of heart failure and how to cope it. In this context, the

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psychosocial factors that influence her health condition include hindrance of mobility due to
swelling feet, poor balance, sedentary lifestyle and social exclusion. She lives alone since his son
lives in interstate which contributed to the development of anxiety as she subjected to stress
(Numata et al., 2018). According to Erik Erikson’s psychosocial development theory, she is
suffering from Ego Integrity vs. Despair where individuals may feel disconnected and
uninvolved with their community due to slow productivity and serious illness. Therefore, this
developmental stage is required to consider while providing health literacy to the patient. In this
context, health literacy would be given to her by considering the developmental stage and
cultural aspect (Numata et al., 2018). Before providing health literacy Rapid Estimate of Adult
Literacy in Medicine tool (REALM) would be used for assessing the readability and cognitive
ability of her as poor reading skills impact the literacy associated with COPD (Vitko et al.,
2016). After the assessment, the health literacy would be provided to her where health
professional will explain the reason behind her anxiety in relation to her psychosocial
developmental stage, the reason behind COPD and right-sided heart failure (Numata et al.,
2018). Self-management skills associated with COPD and right-sided heart failure would be
provided such as medication adherence, proper nutrition and physical activity along with skills
for coping with anxiety (Numata et al., 2018). The pamphlet would be considered as a means of
providing patient education. The cultural consideration in this context would be the cultural
values and beliefs of the patient regarding the COPD and right-sided heart failure along with any
traditional medicinal practice that can improve the health condition of the patient. It will
empower the patient and improve adherence with the treatment.

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Three priorities of nursing management:
As the patient presented with shortness of breath, swollen leg and difficulties with
mobilization, three nursing priorities for management would be following:
1. Shortness of breath:
The shortness of breath in COPD indicate narrowed airway and limited functioning of the
lungs. In this context, bronchodilator such as salbutamol can be provided to her which will relax
and opens the airways in the lungs and treat lung conditions (Yon et al., 2017) .
2. Swollen feet:
As discussed by Hanif et al. (2018), swollen feet observed due to fluid build-up in the legs
due to dysfunctional lungs and heart. In this context, TOTAP assessment would be conducted for
the patient for assessing the severity of the injury. TOTAP stands for Touch, Observe, Talk,
Active, Movement, Passive Movement, and Skill Test. After the assessment, the patient can be
provided with physical activity of the legs so that mobility can be restored. The supporting
compression stocking can be provided for reducing the possibility of a blood clot in that area
(Welsh et al.,2019). The nutrition devoid of salts can be provided to control the blood pressure.
3. Anxiety:
Development of anxiety is common for the patient with lack of health literacy for
management. In this context, the Hamilton Anxiety Rating Scale can be used for assessing the
severity of anxiety for the patient (May & Pridmore, 2020). Cognitive behavioral therapy can be
provided to her for altering her negative thoughts with positive thought so that anxiety can be
reduced.

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Conclusion:
On a concluding note, it can be said that Heart failure along with chronic obstructive
pulmonary disease is leading cause mortality around the globe that impacted more than
thousands of every year. The case study focused on a patient of 76 years with COPD. In this
condition, the lungs of the patient affected due to COPD where airways and lining of lungs
become damaged and inflamed which resulted in inadequate oxygen supply. It increased
pulmonary hypertension increased pressure on heart followed by right side heart failure. The
common management priorities would be shortness of breath, swollen ankle and anxiety.
Bronchodilator can be provided to reduce shortness of breath and swollen ankle can be reduced
by using compression shocks. CBT can be provided to reduce anxiety. Additionally, health
literacy is the possible option for improving adherence and empowering

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